目的：探讨CT诊断早期宫颈癌患者淋巴结转移的价值。方法：回顾性分析78例宫颈癌患者的术前CT资料，分别从淋巴结大小、形态、强化、分布4方面判断淋巴结转移，并与术后病理结果进行对比。结果：78例患者中22例出现淋巴结转移。①淋巴结在长径、短长径比值、形态、边缘、强化表现几方面，各组之间差异均有统计学意义（P＜0.05），强化密度差值各组之间比较，差异无统计学意义（P=0.715）。有统计学意义的各组表现综合分析结果显示，≥3项CT表现的灵敏度为77.27%，特异度为82.14%。②依据盆腔淋巴结的引流途径将淋巴结分为三站，其中以第二站的转移率最高（分别为11.54%、24.36%、7.69%）。结论：当淋巴结长径≥10 mm、短长径比值≥0.7、形态呈圆形或近似圆形及不规则形、边缘模糊或与周围组织有粘连、不均匀性强化或环形强化时，对淋巴结转移诊断价值较高。≥3项以上特征，淋巴结的转移可能性较大。早期宫颈癌淋巴结转移的分布有一定规律。
Abstract
Objective: To explore the value of CT evaluation of lymph node metastasis in early-stage cervical carcinoma. Methods: Seventy-eight patients with cervical carcinoma detected by CT were enrolled in this study. The potential lymph node metastasis were evaluated by detecting factors, including the size, morphology, enhancement pattern and distribution. The results were compared with postoperative pathological finding. Results: There were 22 patients with lymph node metastasis in 78 patients. ①There were significant differences among long-to-short diameter ratio, morphology, margin, enhancement pattern(P＜0.05). There was no significant difference between extant of enhancement(P=0.715). Among the statistic results, the sensitivity and specificity of them that were using above or equal to the three CT factors was 77.27%, 82.14% respectively. ②According to the pelvic lymph nodes draining path, the lymph nodes were divided into three stages, stage two was the highest(The rate of lymph node metastasis were 11.54%, 24.36%, 7.69% respectively). Conclusion: Lymph node metastasis could be significantly diagnosed by long diameter with equal to or more than 10 mm, short-to-long ratio diameter with equal to or more than 0.7, circular or substantially circular or irregular shape, blurred edges or surrounding tissue adhesion, heterogeneous enhancement or ring enhancement. Lymph node metastasis may character as one lymph node with three features or more. Distribution of lymph nodes may partly be valuable for diagnosing lymph node metastasis.
关键词
宫颈肿瘤 /
体层摄影术 /
螺旋计算机
Key words
Cervix neoplasms /
Tomography, spiral computed
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1]Kamangar F, Dores GM, Anderson WF. Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world[J]. J Clin Oncol, 2006, 24(14): 2137-2150.
[2]Arbyn M, Antoine J, Valerianova Z, et al. Trends in cervical cancer incidence and mortality in Bulgaria, Estonia, Latvia, Lithuania and Romania[J]. Tumori, 2010, 96(4): 517-523.
[3]Tsili AC, Tsangou V, Koliopoulos G, et al. Early-stage cervical carcinoma: the role of multidetector CT in correlation with histopathological findings[J]. J Obstet Gynaecol, 2013, 33(8): 882-887.
[4]Hosaka M, Watari H, Mitamura T, et al. Survival and prognosticators of node-positive cervical cancer patients treated with radical hysterectomy and systematic lymphadenectomy[J]. Int J Clin Oncol, 2011, 16(1): 33-38.
[5]岳晓静，牛子儒，侯彩英，等. 宫颈癌盆腔淋巴结转移相关因素的分析[J]. 科学技术与工程，2013，13（8）：2045-2047.
[6]王景宇，冬冬，戴春来，等. 多层螺旋CT对胃癌淋巴结转移的诊断价值[J]. 中国医学科学院学报，2010，32（6）：659-662.
[7]赵红利，龚钿，徐曦，等. 宫颈癌转移性淋巴结的CT影像学特点[J]. 中国医药导报，2013，10（24）：111-113.
[8]王之龙，高云，唐磊，等. 人工神经网络模型基于胃癌生物学行为的MSCT影像信息判断淋巴结转移[J]. 中国医学影像技术，2011，27（6）：1218-1222.
[9]李相生，周纯武，戴景蕊，等. 多层螺旋CT诊断宫颈癌淋巴结转移的价值[J]. 中国医学影像学杂志，2008，16（1）：61-63.
[10]Torabi M, Aquino SL, Harisinghani MG. Current concepts in lymph node imaging[J]. J Nucl Med, 2004, 45(9): 1509-1518.
[11]周晓辉. 多层螺旋CT诊断宫颈癌淋巴结转移的价值[J]. 中国医药指南，2013，11（15）：635-636.
[12]吕冰，郭鲁展. 161排螺旋CT多期增强扫描及三维重建诊断宫颈癌的价值[J]. 临床误诊误治，2011，24（4）：77-78.
[13]杨志浩，高剑波，陈奎生，等. 螺旋CT诊断胃癌淋巴结转移的价值[J]. 郑州大学：医学报，2009，44（6）：1248-1250.
[14]Yang WT, Lam WW, Yu MY, et al. Comparison of dynamic helical CT and dynamic MR imaging in the evaluation of pelvic lymph nodes in cervical carcinoma[J]. AJR, 2000, 175(3): 759-766.
[15]曹彭刚，胡文军，黄亦梅. 多层螺旋CT检查在宫颈癌淋巴结转移诊断中的应用价值分析[J]. 齐齐哈尔医学院学报，2014，35（9）：1291-1292.
[16]张海燕，盛修贵，钟燕，等. 早期宫颈癌盆腔淋巴结转移的分布[J]. 中华肿瘤杂志，2008，30（6）：452-455.
[17]刘爽，韩娜娜，刘开江，等. 宫颈癌盆腔淋巴结转移相关因素分析[J]. 中国妇产科临床杂志，2013，14（3）：236-238.
[18]楼寒梅，朱滔，邵峰，等. 早期宫颈癌前哨淋巴结及非前哨淋巴结微转移的检测及其临床意义[J]. 中华肿瘤杂志，2013，35（6）：434-438.
[19]Sakuragi N. Up-to-date management of lymph node metastasis and the role of tailored lymphadenectomy in cervical cancer[J]. Int J Clin Oncol, 2007, 12(3): 165-175.
[20]尹月菊，盛修贵，李兴兰，等. 早期宫颈癌髂外末端淋巴结转移规律和影响因素[J]. 中华肿瘤杂志，2014，36（6）：457-460.
