CT评估黏液胃癌及非黏液胃癌淋巴结转移

Evaluation of Lymph Nodes Metastasis of the Gastric Mucinous Carcinoma and the Nonmucinous Gastric Carcinoma by CT

目的:探讨黏液胃癌(MGC)及非黏液胃癌(NGC)淋巴结大小与转移的关系及CT征象。方法:分析我院及浙江省肿瘤医院38例经手术病理证实的黏液胃癌病人的CT资料,同时将从520例非黏液胃癌中按年龄、性别配对的38例作为对照组,重点分析两组病例淋巴结大小及阳性转移率的异同,采用x^2进行统计学处理,P<0.05差异有统计学意义。复习文献并讨论MGC的术前CT诊断价值。结果:MGC组淋巴结检出数量及阳性率均较NGC组高,分别是53%、38%,P<0.01,差异有统计学意义。1～5mm、6～9mm大小淋巴结的阳性转移率:MGC与NGC两组分别为29%、57%与11%、32%.P<0.01,两组差异有统计学意义。≥10mm淋巴结检出率及阳性转移率MGC亦较NGC组略高,但差异无统计学意义。两组平均肿瘤体积MGC较NGC大;CT增强MGC以内层明显强化,中外层以低密度为主,NGC以均匀强化为主,结论:<10mm的淋巴结MGC较NGC更易发生阳性转移,对术前趋向于MGC的淋巴结观察要十分仔细,不能忽略≤10mm的淋巴结阳性转移率。肿瘤大小、大体病理类型、强化方式等CT征象有助于MGC的术前诊断。

Purpose： To investigate the CT characteristics of the lymph nodes in gastric mucinous car- cinoma and the nonmucinous gastric carcinoma, and to study the relationship between the size of lymph nodes and the metastasis in mucinous gastric carcinoma and nonmucinous gastric carcinoma.Methods： The CT images of 38 mucinous carcinoma cases proved by pathology were analyzed retrospectively. And other 38 age and gender matched nonmucinous gastric carcinoma cases which were selected from 520 cases were also studied as the control. The lymph nodes were counted and divided into four groups according to their size. The size of every nodes was measured in diameter and analyzed for metastases with histology ,P value of χ^2 test less than 0.05 was considered to indicate a statistically significant difference. The CT signs which were used to assist the differentiation between mucinous and nonmucinous gastric carcinomas were also observed. Results： The rates of lymph node metastasis is higher in mucinous gas- tric carcinomas group than in nonmucinous gastric carcinomas group. The rate of these two groups in the cases with diameter between 1 - 5mm and between 6- 9mm were 29%, 57% and 11%, 32%, P 〈 0.01. In the cases with diameter〉 10mm, the metastatic rate of mucinous gastric carcinomas group was a bit higher than the nonmucinous gastric carcinomas group, but there was no significant statistical difference between them. The mucinous carcinomas were found with larger tumor size （5.6cm） vs（4.7cm） . The most common contrast enhancement patterns were inner layer enhancement in mucinous carcinomas and homogeneous enhancement in nonmucinous carcinomas. Conclusion： The lymph nodes with diameter less than 10mm are more easily to metastasis in mucinous cancinoma than in nonmucinous carcinomas. Helical CT can be used to distinguish the mucinous and nonmucinous gastric carcinoma.