术前及术中超声、CT及术中触诊诊断肝肿瘤的一致性评价

Evaluation of the agreement of preoperative ultrasonography, CT, intraoperative ultrasonugraphy and intraoperative palpation in the diagnosis of liver tumors

目的评价术前超声、CT及术中超声、术中触诊诊断肝肿瘤良恶性的一致性。方法分析70例肝肿瘤患者的术前超声、术前CT检查、术中超声以及术中触诊结果，对四种检查结果与病理及随访结果诊断肝肿瘤良恶性的一致性进行评价。结果术前超声与病理及随访结果诊断肝肿瘤良恶性的一致性为中等（Kappa值0．63），术中触诊与病理及随访结果的诊断一致性较低（Kappa值0．38），CT以及术中超声检查与病理及随访结果诊断一致性较高（Kappa值分别为0．71及0．89），而术中超声与CT检查之间诊断一致性也较高（Kappa值为0．53）。而术前超声与术中超声以及术前超声与术中触诊之间诊断一致性均较低（Kappa值均为0．23）。结论在肝肿瘤诊断评价中，CT与术中超声具有较高的诊断一致性，虽然术前超声与术中触诊诊断结果一致性较低，但在临床工作中依然不可或缺，而若能将四者结合应用，将有助于肝肿瘤的诊断与治疗。

Objective To assess the agreement of preoperative uhrasonography （US）, CT, intraoperative uhrasonography（IOUS） and intraoperative palpation in the diagnosis of liver tumors. Methods The results of preoperative US,CT, IOUS and intraoperative palpation in the diagnosis of liver tumors in 70 patients were reviewed,and the agreement of them were evaluated. Results There was a moderate level of agreement between US and the pathology and follow-up in the diagnosis of liver tumors （Kappa = 0.63）. There was a high level of agreement among CT,IOUS and the pathology and follow-up（CT vs the pathology and follow-up, Kappa = 0.72 ; IOUS vs pathology and follow up, Kappa = 0.89 ; CT vs IOUS, Kappa = 0.53）, whereas the level of agreement between intraoperative palpation and the pathology and follow-up （Kappa = 0.38） ,US and intraoperative palpation （Kappa = 0.23） ,US and IOUS （Kappa = 0.23） was low. Conelusions In the assessment of liver tumors,CT and IOUS have a high agreement. Although the agreement of US and intraoperative palpation were low, they were still indispensable. Four methods were integrated, will contribute to the diagnosis and treatment of liver tumors.