超声内镜与CT检查对食管癌临床TN分期的比较

Comparison of endoscopic ultrasonography and CT scan for patients with esophageal carcinoma

目的比较超声内镜(EUS)与CT检查在食管癌术前临床分期中的准确率。方法对临床诊断为食管癌的68例患者按照随机数字表的方法随机分为EUS检查组和CT检查组,每组各34例,于术前行EUS或CT检查,并按照TNM(2003)分期标准作出诊断,与术后病理分期结果比较。结果以食管癌术后病理分期作为标准,术前EUS检查T、N分期的诊断准确率分别为Tis期0(0/2),T1期75.0%(3/4),T2期75.0%(6/8),T3期86.7%(13/15),T4期80.0%(4/5),T期总准确率为76.5%(26/34);N0期71.4%(5/7),N1期75.0%(9/12),N2期0(0/11),N3期0(0/4),N期总准确率为41.2%(14/34)。术前CT检查T、N分期的诊断准确率分别为Tis期0(0/1),T1期33.3%(2/6),T2期28.6%(2/7),T3期78.6%(11/14),T4期83.3%(5/6),T期总准确率为58.8%(20/34),与EUS检查组T期总准确率相比差异有统计学意义(P<0.05);N0期77.8%(7/9),N1期76.9%(10/13),N2期66.7%(4/6),N3期50.0%(3/6),N期总准确率为70.6%(24/34),与EUS检查组N期总准确率相比差异有统计学意义(P<0.05)。结论 EUS检查对食管癌的临床T期诊断准确率较高,而CT检查对食管癌的N期诊断准确率较高,术前采用EUS联合CT检查可能对指导术前制订治疗方案、评估预后有重要意义。

Objective To evaluate the guidance value of endoscopic ultrasonography（EUS） and CT scan in preoperative clinical staging for diagnosis and treatment of esophageal cancer. Methods 68 patients with esophageal cancer were randomly divided into EUS group and CT group using a random numbers table（34 cases in each group）. Patients in EUS group were examined by EUS, patients in CT group were examined by CT scan,and staged according to the TNM（2003） staging system,and were compared with surgical pathologic findings. Results The accuracy rates of T staging by EUS were 0（0/2） for Tis,75.0%（3/4） for T1,75.0% （6/ 8） for T2,86.7%（13/15） for T3,80.0%（4/5） for T4,and the totle accuracy rate was 76.5%（26/34） for T;those of N staging were 71.4%（5/7） for N0,75.0%（9/12） for N1,0（0/11） for N2,0（0/4） for N3,and the totle accuracy rate was 41.2%（14/34） for N. The accuracy rate of T staging by CT scan were 0（0/1） for Tis,33.3%（2/6） for T1,28.6%（2/7） for T2,78.6%（11/14） for T3,83.3% （5/6） for T4 and the totle accuracy rate was 58.8 % （20/34） for T, the difference was statistically significant com- pared with the EUS group（P〈0.05） ;those of N staging were 77.8%（7/9） for N0,76.9%（10/13） for N1,66.7%（4/6） for N2, 50.0 % （3/6） for N3 and the totle accuracy rate was 70.6 % （24/34） for N, the difference was statistically significant compared with the EUS group （P〈0.05）. Conclusion The accuracy rate of EUS are higher for diagnosis in esophageal cancer and preoperative T staging. The accuracy rate of CT scan are higher for the preoperative N staging. EUS combined with CT scan has great significance for choosing ideal therapy plan for esophageal cancer, and for estimating prognosis of esophageal cancer.