Value of abdominal computed tomography in evaluating extramural vascular invasion of gastric cancer
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摘要:目的 探讨腹部电子计算机断层扫描(CT)在胃癌壁外血管侵犯评估中的应用价值。方法 选取原发性胃癌患者98例，均行腹部CT检查。以手术病理检查结果为金标准，分析腹部CT诊断胃癌壁外血管侵犯的价值。比较壁外血管侵犯和未侵犯者TNM分期及肿瘤大小和生长方式。结果 腹部CT诊断胃癌壁外血管侵犯结果与手术病理结果的一致性较高(Kappa=0.953, P=0.001); 腹部CT诊断胃癌壁外血管侵犯的准确性为97.96%(96/98), 敏感性为100.00%(30/30), 阳性预测值为93.75%(30/32), 特异性为97.06%(66/68), 阴性预测值为100.00%(66/66)。胃癌壁外血管侵犯及未侵犯者N分期及M分期比较，差异无统计学意义(P>0.05); 与未发生壁外血管侵犯者比较，壁外血管侵犯者T分期中T4分期所占比例较高，差异有统计学意义(P < 0.05)。与壁外血管未侵犯者比较，壁外血管侵犯者肿瘤>5 cm及近端结节型加弥漫型所占比例较高，差异有统计学意义(P < 0.05)。结论 腹部CT可提高胃癌壁外血管侵犯的术前评估效果，准确判断胃癌壁外血管侵犯疾病。Abstract:Objective To explore the value of abdominal computed tomography (CT) in evaluating extramural vascular invasion of gastric cancer.Methods Totally 98 patients with primary gastric cancer were selected and conducted with abdominal CT examination. The value of abdominal CT in the diagnosing extramural vascular invasion of gastric cancer was analyzed based on the results of surgical pathology as the gold standard. TNM staging, tumor size and growth pattern were compared between extramural vascular invaders and non-invaders.Results Abdominal CT for diagnosis of extramural vascular invasion of gastric cancer was highly consistent with surgical and pathological results (Kappa=0.953, P=0.001). The accuracy of abdominal CT for diagnosis of extramural vascular invasion of gastric cancer was 97.96% (96/98), the sensitivity was 100.00% (30/30), the positive predictive value was 93.75% (30/32), the specificity was 97.06% (66/68), and the negative predictive value was 100.00% (66/66). There were no significant differences in stage N and stage M between extramural vascular invaders and non-invaders (P>0.05). Compared with non-extramural vascular invaders, the proportion of T4 stage was significantly higher in extramural vascular invaders (P < 0.05). Compared with non-extramural vascular invaders, the proportions of patients with tumors size over 5 cm and nodular and diffuse type was significantly higher in extramural vascular invaders (P < 0.05).Conclusion Abdominal CT can improve the preoperative evaluating effect of extramural vascular invasion of gastric cancer, and can accurately judge the disease of extramural vascular invasion of gastric cancer.
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Keywords:
- gastric cancer /
- extramural vascular invasion /
- abdomen /
- computed tomography /
- accuracy /
- sensitivity
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表 2 胃癌壁外血管侵犯及未侵犯者TNM分期比较[n(%)]
指标 壁外血管侵犯(n=30) 壁外血管未侵犯(n=68) T分期 T1 2(6.67) 8(11.76) T2 0 12(17.65) T3 0 10(14.71) T4 28(93.33) 38(55.88)* N分期 N0 10(33.33) 14(20.59) N1 6(20.00) 14(20.59) N2 8(26.67) 30(44.12) N3 6(20.00) 10(14.70) M分期 M0 19(63.33) 48(70.59) M1 11(36.67) 20(29.41) 与壁外血管侵犯比较, *P < 0.05。 
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表 3 胃癌壁外血管侵犯及未侵犯者肿瘤大小及生长方式对比[n(%)]
类型 肿瘤>5 cm 肿瘤≤5 cm 近端结节型加弥漫型 远端结节型 壁外血管侵犯(n=30) 28(93.33) 2(6.67) 16(53.33) 14(46.67) 壁外血管未侵犯(n=68) 36(52.94)* 32(47.06)* 22(32.35)* 46(67.65)* 与壁外血管侵犯比较, *P < 0.05。
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