X线透视下食管癌活动度检查和胸部CT在评估胸上段食管癌可切除率中的价值

The value of esophageal activity examination under X-ray fluoroscopy and chest CT in assessing the resectability of upper thoracic esophageal cancer

目的探讨X线透视下食管癌活动度检查和胸部CT在评估胸上段食管癌可切除率中的价值。方法选取2009~2015年在我科行食管癌根治术的221例胸上段食管癌患者,其中男141例、女80例,中位年龄59(47~79)岁。术前患者均常规行X线透视下食管癌活动度检查及胸部增强CT扫描,判断肿瘤是否发生外侵,分析两种术前判断方法与术中实际结果的符合情况。结果食管癌活动度评分1~6分的患者数分别为70例、85例、32例、29例、2例和3例。食管癌活动度检查预测食管癌外侵的受试者工作特征(ROC)曲线下面积(AUC)为0.897(95%CI 0.85~0.93,P<0.001),最大约登指数处所对应的截断点值为>3。根据ROC曲线活动度评分,将4~6分认为是外侵,1~3分认为是无外侵。与胸部增强CT扫描比较,X线透视下食管癌活动度检查的灵敏度75.0%,特异度89.3%,准确度88.2%,误诊率10.7%。胸部增强CT检查判断外侵的灵敏度75.0%,特异度66.8%,准确度67.4%,误诊率33.2%。两种方法比较,前者的检查特异度更高,误诊率更低。实际侵犯气管与活动度检查符合率86.7%,实际侵犯其它部位患者与活动度检查符合率85.7%。结论X线透视下食管癌活动度检查可提高判断胸上段食管癌可切除率的准确性,是胸部CT检查的有益补充,尤其是在判断病变与气管关系方面有更大优势。

Objective To investigate the value of esophageal activity examination under X-ray fluoroscopy and chest CT in evaluating the resectability of upper thoracic esophageal cancer.Methods A total of 221 upper thoracic esophageal carcinoma patients underwent radical operation between 2009 and 2015 in our hospital were enrolled,including 141 males and 80 females with a median age of 59(47-79)years.Preoperative routine esophageal activity examination under X-ray fluoroscopy and chest enhanced CT were performed to determine whether the tumor had external invasion.The results of the two methods were compared with that observed during the operation.Results The number of patients with esophageal activity score 1-6 was 70,85,32,29,2 and 3,respectively.The area under the receiver operating characteristic(ROC)curve(AUC)of esophageal activity examination was 0.897(95%CI 0.85-0.93,P<0.001),and the cut off value was>3.According to the ROC curve activity score,4-6 points were considered as invasion,and 1-3 points were non-invasion.The sensitivity,specificity,accuracy and misdiagnosis rate of esophageal activity examination was 75.0%,89.3%,88.2%,10.7%,respectively,and those of CT scan were 75.0%,66.8%,67.4%,33.2%,respectively.Compared with CT scan,the specificity of esophageal activity examination was higher and the misdiagnosis rate was lower.Compared with the detection during the operation,86.7%of patients with actual invasion of trachea and 85.7%of patients with actual invasion of other parts were in accordance with the esophageal activity examination results.Conclusion Esophageal activity examination under X-ray fluoroscopy can accurately predict the resectability of upper thoracic esophageal cancer,which is a useful supplement to chest CT examination,especially in the aspect of judging the relationship between lesions and the trachea.