超声内镜和多层螺旋CT在SiewertⅡ和Ⅲ型食管胃结合部腺癌术前TN分期中的临床应用价值

Clinical value of endoscopicultrsaonography and multi-slice spiral CT in Siewert Ⅱand Ⅲ type adenocarcinoma of esophagogastric junction

目的探讨超声内镜（EUS）和多层螺旋计算机断层扫描（MSCT）检查对SiewertⅡ和Ⅲ型食管胃结合部腺癌（AEG）术前T、N分期准确性的影响，并评价其临床应用价值。方法回顾性分析术前未行放化疗的145例经术后病理证实且临床资料完整的SiewertⅡ和Ⅲ型AEG患者，均于术前进行EUS和MSCT检查，结合术后病理分期进行对比分析。结果EUS诊断SiewertⅡ和Ⅲ型AEG各T分期的敏感度、特异度、准确率均高于MSCT；其中EUS诊断T分期总的准确率为90.3%，明显高于MSCT（63.5%; χ2＝29.52，P〈0.01）；EUS诊断T1、T2、T3期SiewertⅡ和Ⅲ型AEG的敏感度分别为89.5%、91.1%和85.2%，均明显高于MSCT（分别为42.1%、66.7%和29.6%，均P〈0.01）。EUS和MSCT诊断SiewertⅡ和Ⅲ型AEG N分期总的准确率分别为75.9%和64.8%，差异有统计学意义（P＝0.04）。EUS诊断N1期SiewertⅡ和Ⅲ型AEG的敏感度为82.1%，明显高于MSCT（53.6%，P＝0.02）；EUS诊断N2期SiewertⅡ和Ⅲ型AEG的敏感度为79.3%，明显高于MSCT（60.4%，P＝0.03）。但在N0和N3期敏感度的比较中，EUS和MSCT的诊断差异无统计学意义（P〉0.05）。结论EUS诊断T1、T2、T3期SiewertⅡ和Ⅲ型AEG的优势明显大于MSCT；EUS较MSCT对N1、N2期转移淋巴结的判断效果更好。

ObjectiveTo investigate the clinical value of endoscopic ultrasonography （EUS） and Multi-slice Spiral CT （MSCT） in the preoperativestaging of tumor（T） and lymph node （N） metastasis in patients with SiewertⅡand Ⅲ typeadenocarcinoma of esophagogastric junction（AEG）.MethodsClinical data of 145 Siewert Ⅱ and Ⅲ type AEG patientswithout preoperative chemoradiotherapy were retrospectively reviewed. Theyall received preoperative EUS and MSCT examination and underwent surgical resection, and the results of EUS and MSCT were compared with their postoperative pathologic staging.ResultsThe sensitivity, specificity, and accuracy of EUS for T stage in Siewert Ⅱ and Ⅲ type AEG were higher than those of MSCT. The total accuracy of EUS and MSCT were 90.3% and 63.5%, respectively, and the difference was statistically significant （χ2=29.52, P〈0.01）. The sensitivity of EUS for T1, T2 and T3 were 89.5%, 91.1% and 85.2%, respectively, which were significantly higher than 42.1%, 66.7% and 29.6% of MSCT （χ2=9.47, P〈0.01 for T1; χ2=8.07, P〈0.01 for T2; χ2=17.40, P〈0.01 for T3）. In addition, the total accuracy of EUS and MSCT for lymph node metastasis status of Siewert Ⅱ and Ⅲ type AEG were 75.9% and 64.8%, respectively, showing a statistically significant difference（χ2=4.23, P=0.04）. The sensitivity of EUS for N1 and N2 were 82.1% and 79.2%, respectively, which were significantly higher than 53.6% and 60.4% of MSCT （χ2=5.24, P=0.02; χ2=4.48, P=0.03）. There was no statistical significance for sensitivity of EUS and MSCT in N0 and N3 （P〉0.05）.ConclusionEUS diagnosis of T and N staging in Siewert Ⅱ/Ⅲ type AEG showed significantly greater performance than MSCT.