| Objective:To explore the value of thin-layer spiral enhanced CT to lymph node metastasis of thoracic esophageal cancer by evaluating the CT imaging of203thoracic esophageal cancer.Materials and methods:Select203patients of our hospital who underwent thin-layer enhanced CT scan within a week before surgery, observe the location, size, density, edge and enhancement pattern of every lymph node seen within view by two or more radiologists, record the information after consensus obtained, and compare the information with pathological data seriously, and then:1. Calculate the sensitivity, specificity and Youden Index of short-axis diameter, long-axis diameter, ratio of short-to-long axis diameter, the maximum cross-sectional area, the degree of enhancement,"if the edge is fuzzy","if there is a central low density area " to lymph node metastasis. Numerical variables were calculated by ROC curve, categorical variables were calculated by fourfold table method, and the comparison of rate was calculated by Chi-square test.2. Select the best standard of the standards mentioned above, and calculate the diagnostic significance of this method to the lymph node metastasis of different partitions.3. Calculate the best short-axis diameter(by ROC curve) to diagnose lymph node metastasis in tracheoesophageal groove and the district next to cardia and the left gastric area which have the highest lymph metastasis degrees(which was calculated in part Ⅱ).Results:1. The sensitivity of short-axis diameter, long-axis diameter, ratio of short-to-long axis diameter, the maximum cross-sectional area, the degree of enhancement,"if the edge is fuzzy","if there is a central low density area" to lymph node metastasis is72.9%,80.3%,70.8%,67.7%,58.9%,32.3%,19.7%and13.8%respectively, and the specificity is72.3%,50.8%,57.4%,74.2%,41.2%,96.4%,99.4%and99.7%respectively, the Youden Index is0.452,0.311,0.282,0.419,0.001.0.287,0.191and0.135respectively. The value of short-axis diameter is the highest, and the best threshold of short-axis diameter to diagnose lymph node metastasis is6.7mm.2. The highest Youden Index of thin-layer spiral enhanced CT to lymph node metastasis of thoracic esophageal cancer is from hilar, the district next to cardia and the left gastric area, and the area next to inferior pulmonary ligament, respectively0.713,0.566,0.533.3. The best threshold of short-axis diameter to diagnose lymph node metastasis in tracheoesophageal groove and the district next to cardia and the left gastric area is7.2mm.Conclusion:The best method for diagnosis of lymph node metastasis is short-axis diameter method, and the best threshold of short-axis diameter is6.7mm. The highest Youden Index of thin-layer spiral enhanced CT to lymph node metastasis of thoracic esophageal cancer is from hilar, the district next to cardia and the left gastric area, and the area next to inferior pulmonary ligament. The best threshold of short-axis diameter to diagnose lymph node metastasis in tracheoesophageal groove and the district next to cardia and the left gastric area is7.2mm. Objective:To explore the law and influencing factors of lymph node metastasis of thoracic esophageal cancer.Materials and methods:Through retrospective analysis of surgical and pathological data of203patients with thoracic esophageal cancer who underwent radical esophageal cancer surgery and chest-abdomen two fields lymph node dissection, analyze the lymph node metastasis rates and lymph node metastasis degrees of thoracic esophageal cancer of different primary sites, and their relationship with the lesion depth of invasion, pathologic morphology, lesion length and the degree of tumor differentiation.Results:1. There were120cases with lymph node metastasis of203cases, and lymph node metastasis rate was59.1%(120/203). Total harvested lymph nodes were2618. of which413lymph node metastasis, and lymph node metastasis degree was15.8%(413/2618).2. For upper thoracic esophageal cancer, the highest lymph node degrees is from tracheoesophageal groove, para-esophageal area, and lower paratracheal area, respectively28.1%,11.0%and8.0%. For middle and lower thoracic esophageal cancer, the highest lymph node degrees is from tracheoesophageal groove, the district next to cardia and the left gastric area, and para-esophageal area, respectively32.5%and74.7%,22.3%and33.9%,20.9%and22.1%. For all patients with esophageal cancer, the highest lymph node degrees is from tracheoesophageal groove, the district next to cardia and the left gastric area, and para-esophageal area, respectively34.9%,25.4%and18.1%.3. The lymph node metastasis rates and degrees of early and advanced esophageal cancer were respectively6.8%and29.2%,17.8%and63.1%, both having significant difference(P<0.05), while lymph node metastasis rates and degrees between different T stages of advanced esophageal cancer(T2, T3, T4) has no significant differences.4. The lymph node metastasis rates and degrees of the pathological morphology in medullary, mushroom, ulcerative, stenotic and cavity types were18.0%,14.7%,19.8%,13.5%,12.5%and61.4%,60.7%,64.0%,33.3%,100%, and there were no significant differences(P>0.05).5. Grouping203patients into3groups according the lesion length is≤3cm,3～5cm or>5cm, the lymph node metastasis rates and degrees were47.0%,64.4%,62.%and9.1%,18.2%,18.6%. There were significant differences between the first two groups (P=0.041,0.001), and there were no significant differences between the latter two groups (P=0.666,0.832).6. The lymph node metastasis rates and degrees of well, medium and poorly differentiated squamous cell esophageal cancer were respectively55.6%,52.0%,68.6%and13.8%,14.7%,19.2%. There were no significant difference between the high and medium differentiated squamous cell esophageal cancer (P=0.784,0.629), and there were significant differences between medium and poorly differentiated squamous cell esophageal cancer (P=0.032,0.004).Conclusion:The lymph node metastasis of thoracic esophageal cancer has bidirectional and jumping characteristics and it can occur in early esophageal cancers. The depth of lesion invasion, lesion length and degrees of differentiation has a certain influence with lymph node metastasis of thoracic esophageal cancer. Different pathologic types have no influence with lymph node metastasis of thoracic esophageal cancer. |
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