食管胃结合部腺癌膈肌旁及下纵隔淋巴结转移的CT与病理对照研究

Diagnosis of Regional Lymph Node Metastasis Around Diaphragm and Lower Mediastinum for Patients with Adenocarcinoma of Esophago-Gastric Junction: the Correlation between Computed Tomography Andpathology

目的探讨多排螺旋CT对食管胃结合部腺癌(AEG)膈肌旁及下纵隔区域淋巴结转移的诊断价值。方法回顾性搜集AEG患者的临床病理资料。患者均行根治性手术,术前2周内接受胸部及腹部多排螺旋CT检查。手术均清扫膈肌附近区域淋巴结(包括第19组膈下淋巴结,第20组食管裂孔淋巴结,第111组膈肌上淋巴结)和下纵隔区域淋巴结(第110组胸下部食管旁淋巴结,第112组后纵隔淋巴结),并按淋巴结分组记录手术病理情况。由两名影像医师共同阅读患者CT图像,按淋巴结分组观察检出以上各组淋巴结并达成一致,在轴位图像测量淋巴结长径、短径及门静脉期CT值,与术后病理淋巴结分组对照。统计以上各组淋巴结转移阳性组与阴性组的测量数据,评价CT诊断淋巴结转移的诊断效能。结果66例手术患者病理共检出75枚淋巴结,其中有8枚淋巴结转移阳性。影像医师阅读CT图像后,达到和病理对应的共37例患者,在这5组区域共检出49枚淋巴结,其中第19组膈下淋巴结11枚,第20组食管裂孔淋巴结9枚,第111组膈肌上淋巴结6枚,第110组胸下部食管旁淋巴结22枚,第112组后纵隔淋巴结1枚。与病理淋巴结按组对照后,发现第19组2枚淋巴结转移,第20组1枚淋巴结转移,其余淋巴结无转移。这5组淋巴结中转移阳性淋巴结与阴性淋巴结的平均长径分别为(6.00±2.83)mm和(5.44±1.23)mm,平均短径分别为(3.56±0.88)mm和(4.50±2.12)mm,平均CT值分别为(19.00±21.21)HU和(28.86±24.88)HU。转移阳性与阴性淋巴结的长径、短径及CT值差异均无统计学意义(P>0.05)。结论CT可以检出AEG膈肌旁及下纵隔的淋巴结并达到与病理的按组对应,为AEG患者手术清扫淋巴结前确定重点关注清扫范围提供参考,但CT无法根据淋巴结的长径、短径和CT值对这5组淋巴结转移做出准确诊断。

Objective To investigate the usefulness of multi-detector computed tomography(MDCT)in the diagnosis of adenocarcinoma of esophago-gastric junction(AEG)with lymph node metastasis around diaphragm and lower mediastinal regions.Methods This retrospective studycollected the clinical and pathological data of patients with AEG in our hospital from March 2013 to July 2019.All patients underwent radical surgery and received enhanced MDCT examinations within 2 weeks before surgery.Regional lymph nodesaround diaphragm(No.19 subdiaphragmatic group,No.20 hiatal group,No.111 supradiaphragmatic group)and lower mediastinal lymph nodes(No.110 paraesophageal group and No.112 posterior mediastinal group)were all dissected by surgery.Pathologist diagnosed metastatic nodes and recorded them by groups.Two radiologists detected lymph nodes of the above groups on axial CT images and reached a consensus for the nodes grouping.The long diameters,short diameters and CT values in portal phase of lymph nodes were measured in the axial image.We correlated the lymph nodes between CT and pathological results by group-to-group.Statistical analysis was performed for measurement data of lymph nodes in these groups.Results Radiologists detected 49 lymph nodes on CT images for these 37 patients,including 11 nodes of No.19 subdiaphragmatic group,9 nodes of No.20 hiatal group,6 nodes of No.111 supradiaphragmatic group,22 nodes of No.110 paraesophageal group and 1 node of No.112 posterior mediastinal group.After correlation with pathological lymph node groups,2 metastatic lymph node was found in the 19 th group,1 lymph node metastasis in the 20 th group,and no metastasis was found in other lymph nodes.The mean long diameter,short diameter and CT value of metastasis-positive and metastasis-negative lymph nodes in the five groups were(6.00±2.83)mm and(5.44±1.23)mm,(3.56±0.88)mm and(4.50±2.12)mm,(19.00±21.21)HU and(28.86±24.88)HU,respectively.There were no significant differences in the long diameter,short diameter and CT values between metastasis-positive and metastasis-negative lymph nodes(P>0.05).Conclusion CT can detect the lymph nodes around diaphragm and the lower mediastinum of AEG,providing a reference for the surgical dissection of the lymph nodes.CT is unable to accurately diagnose lymph node metastasis according to long diameter,short diameter and CT value.