MRI在喉癌及下咽癌术前T分期中的价值

MRI-based T staging of laryngeal and hypopharyngeal cancers

目的探讨MRI在喉癌及下咽癌术前T分期中的价值。方法回顾性分析40例经手术病理证实的喉癌、下咽癌患者MRI图像,根据MRI表现对肿瘤进行T分期,并将MRI分期结果与手术病理检查结果相对照。结果喉癌及下咽癌MRI表现为声带/咽壁增厚或软组织肿块形成。MRI诊断其侵犯周围结构的敏感性为95.4%(83/87),阳性预测值为89.2%(83/93),假阴性率为4.6%(4/87)。MRI对各期喉癌及下咽癌术前T分期的准确率分别是T1期100%(1/1),T2期80%(12/15),T3期83.3%(5/6),T4期100%(18/18),总准确率为90%(36/40),MRI术前T分期与病理分级的一致性具有统计学意义(K=0.843,P<0.05)。结论 MRI能准确地显示喉癌及下咽癌的部位、形态及侵犯范围,其术前T分期与病理分级一致性好,具有重要的诊断价值。

Objective To assess the value of MRI for preoperative T staging of laryngeal and hypopharyngeal cancers. Methods The laryngeal or hypopharyngeal cancer of 40 patients with pathology-confirmed diagnoses were retrospectively analyzed and staged based on magnetic resonance images. MRI-based staging was compared with pathology-based staging. Results MRI of laryngeal and hypopharyngeal cancers showed vocal cord/pharyngeal wall thickening or the presence of a soft tissue mass. Sensitivity of MRI for assessing invasion was 95.4%（83/87）and positive predictive value was 89.2%（83/93）,while the technique failed to detect 4.6%cases of invasion （4/87）. The diagnostic accuracy of MRI for each preoperative T stage was 100%（1/1）for T1,80%（12/15）for T2：, 83.3%（5/6）for T3,and 100%（18/18）for T4. Overall accuracy was 90%（36/40）. Paired test results showed Kappa=0.843（P＜0.05）, indicating good consistency between preoperative MRI staging and pathological staging. Conclusion MRI can reveal the location, shape and extension of laryngeal and hypopharyngeal tumors,suggesting usefulness in preoperative T staging.