The Study Of EUS And CT In The Diagnosis Of Preoperative Esophageal Cancer T Staging And The Study Of Lymph Node Metastasis In T1 Esophageal Carcinoma

PartⅠ:The diagnostic value of EUS and CT in T staging of preoperative esophageal carcinomaBackground and objective:Whether for early esophageal cancer or advanced esophageal cancer,the accurate assessment of T staging before treatment plays a very important role in the choice of treatment modality.The purpose of this study was to evaluate the value of EUS and CT in the diagnosis of esophageal cancer T staging.Methods:Collected in the first affiliated hospital of xiamen university from september 2015 to october 2017 treated 76 cases of EUS and CT examination at the same time of patients with esophageal cancer,contrast the postoperative pathologic results,analysis of EUS and CT for esophageal cancer preoperative T staging diagnosis,in order to evaluate the different diagnosis value.Results:The Kappa value of esophageal carcinoma was diagnosed by EUS at T1 T2,T3-4a and T4b were 0.759,0.294,0.759,and 0.661,respectively.It is suggested that EUS showed a better consistency between the diagnosis of esophageal cancer in T1 and T3 and the postoperative pathology.EUS has a poor consistent between the diagnosis of esophageal cancer in T2 and the postoperative pathology.EUS showed a general consistency between the diagnosis of esophageal cancer in T4b and the postoperative pathology.The Kappa value of esophageal carcinoma was diagnosed by CT at T1-2,T3-T4a and T4b were 0.224,0.234,and 0.490,respectively.It is suggested that CT has a poor or general consistency between the diagnosis of esophageal cancer in T1-2.T3－4a and T4b and the postoperative pathology.EUS for diagnosing Tla stage of esophageal cancer with postoperative pathological has high consistency(Kappa value was 0.797)and eus for diagnosing Tla-EP/LPM,T1a a MM,T1b stage of esophageal cancer with postoperative pathological has generally consistency(Kappa value was 0.537,0.542,0.645,respectively).Conclusions:The accuracy and accuracy of ultrasonic endoscopy in the diagnosis of esophageal cancer T staging were better than that of CT.The accuracy and precision of T staging are better than that of CT.EUS has high accuracy in the diagnosis of T1 and T3 esophageal cancer,while the accuracy of diagnosis of T2 tumor is poor.EUS was highly accurate in the diagnosis of Tla esophageal cancer,and the accuracy of the diagnosis of Tla-EP/LPM,T1a-MM and T1b was low.Part Ⅱ:The study of lymph node metastasis in T1 esophageal carcinomaBackground and objective:For early esophageal cancer,the choice of endoscopic treatment or surgical treatment is dependent on lymph node metastsis.The purpose of this study was to evaluate the regularity of lymph node metastasis in T1 esophageal carcinoma.Methods:This study conducted a retrospective analysis of 86 patients with T1 stage esophageal squamous carcinoma treated in the first affilia,ted hospital of xiamen university from January 2014 to October 2017.The pathologic T stage,degree of differentiation and maximum diameter of tumor were reviewed.In order to find out the probability of lymph node metastasis at each infiltration level of esophageal squamous cell carcinoma in T1,and the characteristics of lymph node metastasis,it was compared with postoperative pathological N staging.Results:Statistically,there was no difference in the incidence of lymph node metastasis in T1a-MM and T1b esophageal squamous cell carcinoma.But may be due to sample size too small to embody the differences.There was no difference in the incidence of lymph node metastasis in patients with high-middle differentiation,middle-differentiated esophageal squamous cell carcinoma and middle-and low-differentiated esophageal squamous cell carcinoma.The maximal diameter of tumor in the lymph node metastasis group in T1 was larger than that in the no lymph node metastasis group.The maximal diameter of tumor in the lymph node metastasis group in T1b was larger than that in the no lymph node metastasis group.The characteristics of the lymph node jump metastasis of T1 esophageal squamous carcinoma were confirmed.Conclusions:In T1 esophageal cancer,the infiltration depth reaches the submucosal layer,the differentiation degree is poor,the tumor maximal diameter is larger,lymph node metastasisis more likely to occur and lymph node jump metastasis can occur.