胃癌淋巴结大小与转移的探讨

Assessing Reliablity of Lymph Node Size in Judging Metastases of Gastric Cancer

目的 本文通过胃癌淋巴结病理与CT对照 ,讨论根据淋巴结大小 (以 >10mm为标准 )判断淋巴结转移的可靠性。方法 2 4例胃癌切除和D1或D2 淋巴结清除以及术前CT检查 ,分别记录淋巴结直径大小、数量和转移阳性率。结果 2 4例胃癌手术摘取淋巴结 3 95个 ,病理证实 12 3个 (3 1% )淋巴结转移阳性。10mm以下的淋巴结占 76% ,其中 5 6%的淋巴结转移阳性 ,1～ 5mm和 6～ 9mm淋巴结转移率分别为 8%和 46% ;10mm或以上淋巴结转移阳性率分别为 5 4%和 68%。CT检出淋巴结 174个 ,病理证实 71个 (4 1% )淋巴结转移阳性。小于 10mm淋巴结占 3 8% ,1～ 5mm和 6～ 9mm淋巴结转移率分别为 17%和 3 1% ;10mm以上淋巴结转移阳性 5 0 %～ 76%。结论 胃癌小淋巴结转移率也较高 ,CT影像单纯依据淋巴结大小判断淋巴结转移是不可靠的。

Objective To assess reliability of lymph node size (>10mm in diameter) in judging metastases of gastric cancer on CT images.Methods The regional lymph nodes were removed with D 1 or D 2 in the 24 patients of primary gastric cancer.These lymph nodes were counted and divided into four groups according to its size,each node size was measured in diameter and analyzed for metastases with histology. Spiral CT scans were performed in the 24 patients. CT images of each group nodes were analyzed and compared with histologic findings in the 24 patients.Results A total 395 of lymph nodes were counted in the 24 patients.Of these 395 nodes, 123 (31%) were contained metastases and 76% nodes size was less than 10mm,in which 56% nodes contained metastases.Lymphatic metastatic rate of size 1-5mm group, of size 6-9mm group and size 10mm group as well as size more than 10mm group were 8%, 46%, and 54%, 68% respectively. Of 174 nodes were detected on CT images in the 24 patients, 71 (41%) nodes were contained metastases and 38% nodes size was less than 10mm. Lymphatic metastatic rate of size 1-5mm, 6-9mm, and more than 10mm group were 17%, 31% and 50%-76% respectively.Conclusion The assessment of lymphatic metastases of primary gastric cancer according to lymph node size on CT images is not reliable, due to high lymphatic metastatic rate in small lymph nodes of primary gastric cancer.