| Objective: To investigate the consistency of preoperative CT scan showing and postoperative pathological diagnosis of lymph node metastasis of esophageal carcinoma, and to judge the value in diagnose lymph node metastasis of esophageal carcinoma by preoperative CT scanning. At the same time, to evaluate prognosis effect of different number of metastatic lymph nodes and metastatic regions in preoperative CT scanning and postoperative pathological results. At last, to analysis the prognosis factors on survival of esophageal carcinoma.Methods: This study was a retrospective analysis. In this study we collected 618 patients with esophageal carcinoma after radical resection at the Fourth Hospital of Hebei Medical University from May 2002 to June 2006, all patients did not receive preoperative chemoradiotherapy and complete information of postoperative pathological reports. All patients had the CT scanning examination at our hospital ahead the surgery one week. According to esophageal conventional CT scan, the slice thickness and the layer distance were 3-6mm, the CT scanning followed layer by layer from the lower neck to superior abdomen level, and some cases used of enhanced scanning. The CT scanning image could be transmitted to the Philips TPS Pinnacle 7.6c American three-dimensional treatment planning system by the network at digital format and be reconstructed, in this system we observed, measured and recorded every index, including the tumor location of esophageal carcinoma, the diameter of largest dimension of tumor, the greatest depth of invasion, the region and the number of lymph node metastasis. Intrathoracic lymph node regions were divided by accordance with American Thoracic Society standards of intrathoracic lymph node distribution, including the lower neck, chest and upper abdominal lymph nodes region and combined with lymph node dissection habits of clinical operations of my hospital. Then we compared with postoperative pathological results. All database was set up by Statistical Package of SPSS11.5, calculated the survival rate using Kaplan-Meier method and the significance test by Logrank method, to multivariate analysied using Cox regression model to assess the independent prognostic factors. The comparison of groups rate usedχ2 test, and the relationship between variables with the Spearman correlation analysis.Results: 30 cases were out of contact among these 618 cases, so the follow-up rate was 95.15%. The 1-, 3-, 5-years survival rate were 83.32%, 53.33%, 36.02% respectively since the surgical resection date. The average survival time and median survival time were 42.26 months and 38.33 months respectively.In all patients, the consistent rate of 0, 2,≥3 lymph node metastasis by preoperative CT scanning found with postoperative pathological diagnosis was higher than 1 lymph node metastasis in CT scan. In the five regions method, the consistency was the best about diagnosis of lymph node metastasis in lower mediastinum by CT scanning with postoperative pathological results, and the concordance rate was up to 95.10%. In the three regions method, the consistency was the worst about diagnosis of lymph node metastasis in entire mediastinum region by CT scanning with postoperative pathological results, and the concordance rate was only 70.10%. The concordance rate of CT scan showing no lymph node metastasis comparing with postoperative pathological results was higher than having 1 lymph node on CT image of upper-thoracic cases. The concordance rate of CT scan showed 0, 2,≥3 lymph node metastasis comparing with postoperative pathological results was also higher than having 1 lymph node metastasis on CT scan of middle-thoracic cases. The concordance rate of CT scan showed different number of lymph node metastasis comparing with postoperative pathological results were no found the statistical significance in compared each other of lower-thoracic cases.Upper-thoracic cases in the five regions method, diagnosis of lymph node metastasis by preoperative CT scan and postoperative pathologic results on middle-mediastinum, lower-mediastinum and superior abdomen of the concordance rates were up to 93.60%,97.60%,90.40% respectively, and all were better than lower neck. Preoperative CT scan diagnosis on middle-mediastinum and lower-mediastinum the concordance rate all were higher than 80.80% of upper-mediastinal concordance rate. Middle-thoracic cases in the five regions method, diagnosis of lymph node metastasis by preoperative CT scan comparing with postoperative pathologic results on lower-mediastinum the concordance rate was highest up to 94.90%. Lower-thoracic cases in the five regions method, diagnosis of lymph node metastasis by preoperative CT scan comparing with postoperative pathologic results on lower neck, upper-mediastinum and lower-mediastinum the concordance rate all were higher than midlle-mediastinum and superior abdomen regions. Upper thoracic cases in the three regions method, diagnosis of lymph node metastasis by preoperative CT scan comparing with postoperative pathologic results in inferior neck and lower-mediastinum the concordance rates were bad than superior abdominal region(P<0.0125). Middle-thoracic cases in the three regions method, diagnosis of lymph node metastasis by preoperative CT scan comparing with postoperative pathologic results to inferior neck and superior abdomen the concordance rates were better than 68.10% of all mediastinum. Lower-thoracic cases in the three regions method, diagnosis of lymph node metastasis by preoperative CT scan comparing with postoperative pathologic results to inferior neck the concordance rate was higher to 91.80%, and better than mediastinum and superior abdomen.All cases be to GTV1 volume≤21.00cm3, GTV2 volume>21.00cm3 relatively divided into two groups. Diagnosis of lymph node metastasis by preoperative CT scan comparing with postoperative pathologic results the concordance rate was 65.30% of group GTV1, it was higher than 54.70% of group GTV2. Diagnosis of lymph node metastasis by preoperative CT scan comparing with postoperative pathologic results of middle-mediastinum, lower-mediastinum, superior abdomen and all mediastinum the concordance rates in group GTV1 all were higher than group GTV2's(P<0.05). In all patients, the sensitivity, specificity, positive predictive value, negative predictive value, Younden index and accuracy rates of diagnosis of lymph node metastasis with preoperative CT scan were 58.30%, 70.70%, 56.20%, 72.50%, 29.00%,65.90% respectively. The accuracy rate of diagnosis lymph node metastasis by preoperative CT scan in upper-thoracic case up to 73.60%, followed the middle-thoracic case, and the lowest accuracy rate was in lower-thoracic case. While in the five regions method, the highest accuracy rate of diagnosis lymph node metastasis by CT scan were on lower-mediastinum region by CT scan, then the upper-mediastinum region, inferior neck followed by turns. While in the three regions method, the accuracy rate of diagnosis lymph node metastasis on inferior neck and upper-mediastinum by operative CT scan showing all were higher than mediastinum. According to the style of lymph node metastasis, the accuracy rate of diagnosis downward lymph node metastasis was highest, the positive predictive value diagnosis of local and downward lymph node metastasis were higher than upward and leaping lymph node metastasis obviously.Univariate analysis revealed that preoperative diet, the tumor length in CT scanning and in esophagoscopy, CT showed the largest diameter of tumor, GTV volume in CT image, CT showed the number of lymph node metastasis and the number of metastatic regions, preoperative clinical staging, operative incision type, the length of tumor in the resection, the status tumor invasion with nearby organs in resection, degree of tumor sticking together with nearby organs in resection, postoperative pathological types and histologic grade of differentiation, vascular tumor embolus, the total number of lymph node removed, the number of lymph node metastasis and the number of metastatic regions of postoperative pathologic results, metastatic lymph node ratio, postoperative pathological TNM staging were statistically significance on postoperative survival rate of esophageal carcinoma. Cox regression analysis revealed only the GTV volume in CT image,operative incision types, tumor invasion with nearby organs in resection, postoperative pathological type, metastatic lymph node ratio, postoperative pathological T staging, and the number of postoperative pathologic lymph node metastasis regions were independent prognostic factors for all esophageal carcinoma patients.Conclusions:(1)Preoperative CT scan showed the sensitivity, specificity, and accuracy in diagnosis of lymph node metastasis of esophageal carcinoma were 58.30%, 70.70%, 65.90% respectively, may be provide guidance on clinical. (2) Diagnosis of 0,≥3 lymph node metastasis by preoperative CT scan showed with postoperative pathological results of the concordance rates were highest, while having 1 lymph node metastasis in CT scanning image with postoperative pathological results of the concordance rates was the lowest. (3)The concordance rate was the highest up to 95.10% in diagnosis of lower mediastinal lymph node metastasis in preoperative CT scan comparing with postoperative pathologic results. (4)The GTV volume in CT image, the operative incision types, tumor invasion with nearby organs in resection, postoperative pathological types, metastatic lymph node ratio, postoperative pathological T staging, and the number of postoperative pathologic lymph node metastasis regions were independent prognostic factors to survival rate of esophageal carcinoma.
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