经直肠超声和MRI检查对中低位直肠癌术前环周切缘的诊断价值

The value of transrectal ultrasonography and MRI in preoperative diagnosis of peripherally incised margin of middle and low rectal cancer

目的探讨经直肠超声(ERUS)和磁共振成像(MRI)检查对中低位直肠癌术前环周切缘(CRM)的诊断价值。方法回顾性分析2015年1月至2023年1月内蒙古自治区人民医院收治的89例直肠癌患者的临床资料。分析中低位直肠癌的临床病理因素与CRM是否受累的关系;以术后病理为金标准,分析ERUS和MRI术前评估中低位直肠癌CRM的准确率及诊断效能。结果89例患者术后病理结果均为直肠癌,其中77例病理结果为CRM阴性,12例CRM阳性,阳性率为13.48%(12/89)。病理TN分期、直肠癌壁外血管侵犯(EMVI)与中低位直肠癌CRM是否受累有关,具有统计学意义(均P<0.05)。与病理结果对比,ERUS术前评估直肠癌CRM受累情况的准确率为88.76%(Kappa=0.578,P<0.001),灵敏度75.00%,特异度90.91%,阴性预测值95.89%,阳性预测值56.25%AUC为0.788;MRI术前评估CRM受累情况的准确率为88.76%(Kappa=0.602,P<0.001),灵敏度83.33%,特异度89.61%,阴性预测值97.18%,阳性预测值55.56%,AUC为0.830,二者AUC比较差异无统计学意义(Z=0.420,P=0.674)。结论ERUS和MRI检查术前评估中低位直肠癌CRM状态具有较高准确率,ERUS可作为MRI的补充用于术前评估中低位直肠癌患者的CRM。

ObjectiveeTo evaluate the value of transrectal ultrasound(ERUS)and magnetic resonance imaging(MRI)in the preoperative diagnosis of peripheral margin(CRM)for middle and low rectal cancer.Methods The clinical data of 89 patients with rectal cancer treated in the Inner Mongolia Autonomous Region People's Hospital from January 2015 to January 2023 were retrospectively analyzed.The relationship between clinicopathological factors and CRM involvement in middle and low rectal cancer was analyzed.Using postoperative pathology as the gold standard,the accuracy and diagnostic efficacy of CRM in preoperative assessment of low and middle rectal cancer by ERUS and MRI were analyzed.Results All the 89 patients had postoperative pathological results of rectal cancer,of which 77 were CRM-negative and 12 were CRM-positive,the positive rate was 13.48%(12/89).Pathological TN stage and extramural vascular invasion(EMVI)of rectal cancer were associated with CRM involvement in middle and low rectal cancer,with statistical significance(all P<0.05).Compared with the pathological results,the accuracy of ERUS preoperative assessment of CRM involvement was 88.76%(Kappa=0.578,P<0.001),the sensitivity was 75.00%,the specificity was 90.91%,the negative predictive value was 95.89%,the positive predictive value was 56.25%,and area under the curve(AUC)was 0.788.The accuracy rate of CRM involvement before MRI was 88.76%(Kappa=0.602,P<0.001),sensitivity was 83.33%,specificity was 89.61%,negative predictive value was 97.18%,positive predictive value was 55.56%,and AUC was 0.830.There was no significant difference in AUC between the two groups(Z=0.420,P=0.674).Conclusions ERUS and MRI have high accuracy in preoperative assessment of CRM status in patients with middle and low rectal cancer.ERUS can be used as a supplement to MRI for preoperative assessment of CRM in patients with middle and low rectal cancer.