| Backgrounds:Esophageal cancer is one of the world common digestive system maligmant tumors, and it's also one of our country common cancers. Our country has the highest adjusted mortality rate in the world. In the past, it was too late when patients with esophageal cancer were found, cure rates and survival rates weren't satisfactory. The commom symptoms such as dysphagia.substernal discomfort, were often neglected in the early, and the inspection methods were unsatisfactory. Surgery was the preferred program when esophageal cancer was diagnosed, preoperative/postoperative chemotherapy and radiotheraphy could be combined. The 5-year survival rate could reach 90 percent after surgical resection of early esophageal cancer, but only 6-15 percent in patients with advanced. It's necessary to determine staging as early as possible when the disease was diagnosed, which could improve the quality of life significance and prognosis. Common inspection methods included exfoliative cytologic examination, esophageal barium meal, esophageal CT, PET, endoscopy, ultrasound endoscopy, et al. Since eighties of last century, endoscopic ultrasound (EUS) was used in clinical, and had been reported repeatedly in the TNM staging of esophageal cancer, especially in T staging was significant. In N staging, EUS had a high accuracy to find the mediastinal lymph nodes, while intra-abdominal lymph nodes were in the lower range of diagnosis, and limitations due to check the range of M staging could not be more clear. CT, PET and other imaging compared to EUS, the clinical application had a longer time, and the research about diagnosis, staging area was more. There were many reports about comparison of EUS and CT/PET in the diagnosis of esophageal cancer, but the reports about whether the two could further increase the accuray and sensitivity were less, the difference of EUS T1-T4 each period in the accuracy and sensitivity in their reports were rare.Objective:In this study of 51 patients with esophageal cancer in the preoperative staging, EUS and CT findings with pathological diagnosis were retrospectively analyzed, to explore the clinical value of two checks each and combined and whether it can improve the accuracy, sensitivity, and EUS in the T1-T4, N0-N1 staging of their accuracy and sensitivity were compared.Methods:Fifty-one patients with esophageal cancer in our hospital from July 2007 to June 2010 were enrolled in this study. According to UICC(1997) TNM clinical stage, after the TN results of esophageal cancer by EUS and CT examination of above 51 cases were compared with the postoperative pathological TN stage, the EUS, CT, EUS+CT staging results were pairwise comparison. Statistical methods chose the statistical software SPSS 11.5, and paired count data selected x 2 test, P< 0.05 suggested significant differences in results. Results:1) The sensitivity of T stage by EUS and CT were76.47%,47.06%, in which, the sensitivity of T1 were 50%,0, the sensitivity of T2 were 50%,50%, the sensitivity of T3 were 83.33%,38.89%, the sensitivity of T4 were 85.71%,61.90%;2) The sensitivity of N stage by EUS and CT were 68.63%,54.9%, in which, the sensitivity of NO stage were 80.95%,66.67%, the sensitivity of N1 stage were 60%,54.9%;3) The accuracy rates of T and N stage by EUS were 76.47%(39/51) and 68.63% (35/51) respectively, the accuracy rates of T and N stage by CT were 47.06% (24/51) and 52.94%(27/51) respectively, the accuracy rates of T and N stage by combination of EUS and CT were64.71%(33/51) and 70.58%(36/51) respectively;4) The difference between the groups results:EUS and CT comparison: PT=0.006((x2=7.26), PN=0.263 (χ2=1.25); EUS and EUS+CT comparison:PT =0.092 (χ2=2.77), PN=1 (χ2=0); CT and EUS+CT comparison:PT= 0.057 (χ2=3.5),PN=0.021(χ2=4.9).Conclusions:In the preoperative T-staging of esophageal cancer, EUS has the incomparable superiority of CT, and it may help clinicians select appropriate treatment programs to reduce the suffering of patients. For T2N0M0, T2N1M0, different treatment options, and in T2 stage patients, N stage has high accuracy, thereby it is imminent to increase the accuracy and sensitivity of T2 stage. In the future, we can try to switch to high-frequency probe to improve its accuracy. In N staging, the accuracy of EUS is higher than CT, but hasn't significant difference. And in T3, T4 stage patients with esophageal cancer, EUS Nl has a high rate of missed diagnosis, which should joint to chest and abdominal CT diagnosis. As a result, combining EUS and CT examination can improve the TN staging of esophageal cancer. |
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