超声内镜和磁共振成像技术对直肠癌术前分期和环周切缘诊断的临床价值研究

The Study on Clinical Value in Endoscopic Ultrasonography and Magnetic Resonance Imaging in the Diagnosis Staging of Rectal Cancer

目的:探讨超声内镜(EUS)和磁共振成像(MRI)技术对直肠癌患者T分期和环周切缘(CRM)诊断的临床价值。方法:收集2013年1月—2016年12月在我院首次诊断为直肠癌的102例患者作为研究对象。观察指标:(1)手术前分别用EUS和MRI评估直肠癌T分期,用术后病理证实两种方法对直肠癌T分期的诊断符合率;(2)术前分别用EUS和MRI测量直肠癌CRM,用术后病理证实两种方法的诊断符合率。结果:(1)在高位直肠癌T分期中,两种方法与术后病理结果比较,EUS Kappa值为0.928,MRI Kappa值为0.898,有统计学意义(P<0.01);(2)在低位直肠癌T分期中,两种方法与术后病理结果比较,EUS Kappa值为1,MRI Kappa值为0.969,有统计学意义(P<0.01);(3)在T3期直肠癌中,两种方法测量CRM与术后病理结果比较,EUS Kappa值为0.746,MRI Kappa值为0.485,有统计学意义(P<0.05)。结论:(1)在高位直肠癌术前T分期诊断中,EUS和MRI均具有较好的诊断符合率,在低位直肠癌术前T分期诊断中,EUS比MRI更具有诊断优势;(2)在T3期直肠癌CRM诊断中,EUS比MRI更具有诊断优势。

Objective：This study is to evaluate the clinical value of endoscopic ultrasonography（EUS）and magnetic resonance imaging（MRI）in the diagnosis of T stage and circumferential resection margin（CRM）in patients with rectal cancer.Methods：A total of 102 patients who were first diagnosed with rectal cancer in the Affiliated Hospital of QingHai University from January 2013 to December 2016 were involved in the study.Observation indexes are followings：（1）The T stage of rectal cancer is evaluated by respectively using EUS and MRI before surgery,then the postoperative pathological is used to confirm the two methods for T stage of rectal cancer the diagnostic coincidence rate;（2）The circumferential resection margin of rectal cancer is measured by respectively using EUS and MRI before surgery,the postoperative pathological is used to confirm the diagnostic coincidence rate of these two methods.Results：（1）In the T-stage of high rectal cancer,two methods were compared with the postoperative pathological results,in which the Kappa value of EUS was 0.928,and MRI was 0.898 with statistical significance（P〈0.01）;（2）In the Tstage of low rectal cancer,two methods were compared with the postoperative pathological results,in which the Kappa value of EUS was 1,and MRI was 0.969,with statistical significance（P〈0.01）;（3）In the T3 stage of rectal cancer,two methods were used to measure the CRM comparison with postoperative pathological results,in which the Kappa value of EUS was 0.746,and the MRI was 0.485 with statistical significance（P〈0.05）.Conclusion：（1）In the preoperative T-stage diagnosis of high rectal cancer,both EUS and MRI had better diagnostic accordance rate,while in the preoperative T-stage diagnosis of low rectal cancer,EUS shows more diagnostic advantage than MRI;（2）In the CRM diagnosis of the T3 stage of rectal cancer,EUS has a diagnostic advantage compared with MRI.