多层螺旋CT对术前非小细胞肺癌分期的诊断价值

Diagnostic Value of Multi-slice Spiral CT in Non-small Cell Lung Cancer Preoperative TNM Staging

目的比较非小细胞肺癌患者术前多层螺旋CT(MSCT)诊断的临床TNM分期和术后病理TNM分期的一致性,评价MSCT对肺癌TNM分期的诊断价值。资料与方法收集行外科手术治疗、经病理证实为非小细胞肺癌的92例患者,比较MSCT对非小细胞肺癌TNM分期结果与手术病理TNM分期结果,评价MSCT诊断各组淋巴结转移的敏感度、特异度和准确度。结果 CT-T分期结果与病理T分期结果一致性比较满意(Kappa=0.727,P<0.05),总符合率为83.7%;CT-N分期结果与病理N分期结果一致性比较满意(Kappa=0.635,P<0.05),总符合率为79.3%;CT-TNM分期结果与病理TNM分期结果一致性比较满意(Kappa=0.680,P<0.05),总符合率为75.0%。CT诊断淋巴结转移的敏感度、特异度、阳性预测值、阴性预测值、准确度分别为71.1%、85.2%、77.1%、80.7%、79.3%。CT诊断4组、5组、6组、10组淋巴结转移的准确率较低,其中4组淋巴结转移的假阳性率最高,10组淋巴结转移假阴性率最高。结论 MSCT用于诊断术前非小细胞肺癌TNM分期有重要的临床价值,可作为评估患者能否手术、选择最佳治疗方案及预测预后的主要依据,MSCT诊断淋巴结转移的重要特征是提高肺癌CT-TNM分期准确性的关键。

Purpose To evaluate the diagnostic value of multi-slice spiral CT（MSCT） in preoperative TNM staging in non-small cell lung cancer（NSCLC） by comparing with corresponding postoperative pathology. Materials and Methods Ninety-two cases of surgically resected lung cancer were included. Clinical and pathological staging were made and compared,and to evaluate the sensitivity,specificity and accuracy of the MSCT in diagnosing lymph node metastasis. Results MSCT made correct T staging in 83.7% of the cases with excellent agreement（Kappa=0.727,P〈0.05）. Accurate N staging was in 79.3% of the patients with acceptable agreement（Kappa=0.635,P〈0.05）. The TNM staging was 75.0% accurate with moderate agreement（Kappa=0.680,P〈0.05）. The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of CT in diagnosis of lymph node metastasis were 71.1%,85.2%,77.1%,80.7% and 79.3%,respectively. CT accuracy in the diagnosis of groups 4,5,6,10 lymph nodes metastasis was relatively low,in which group 4 had highest false positive,and group 10 had the highest false negative. Conclusion The TNM staging of NSCLC based on MSCT scan is valuable. It can be used as the main basis to evaluate the patient＇s ability to choose the best treatment plan and predict the prognosis.