The Discussion Of The Combined Application Of Endoscopic Ultrasound, Contrast Enhanced CT And PET-CT In Preoperative Staging Of Esophageal Cancer

Objective:The clinical application value of endoscopic ultrasonography (Endoscopic Ultrasonography, EUS),contrast enhanced CT,PET-CT and combined application of the three methods above on esophageal carcinoma preoperative T, N staging was discussed. The purpose was in order to provide clinical basis for esophageal carcinoma preoperative staging by analysis of the advantages and disadvantages of various examination methods.Methods:The60cases (including48male cases, female12cases, aged39to78years, mean age53.14±6.27years) of esophageal cancer had already been treated by preoperative endoscopy pathology and postoperative pathologic diagnosis.All patients were confirmed by EUS, cervical, thoracic, abdominal enhanced CT and PET-CT examination before operation and preoperative T and N stage of the tumor was confirmed according to the result of the examination. And then a comprehensive analysis of three kinds of examination results on tumor were performed in preoperative T and N stage.The lymph node of the corresponding region of intraoperative dissection were sent for histopathological examination. The T, N staging of tumor in postoperative was confirmed according to tumor specimens and pathological findings postoperative and intraoperative exploration of esophageal tumor with tracheal, aorta, azygos vein, the thoracic duct and other organ.Taking the postoperative pathological T, N staging as a "gold standard",the coherence of T, N staging postoperation was compared with various preoperative examination method. We also analysed the sensitivity, specificity and accuracy of preoperative EUS, enhanced CT and PET-CT single and combined examination of esophageal carcinoma in T, N staging. The measured data was analysed by using the statistical software of SPSS13.Results:(1)The accuracy (consistency) between endoscopic ultrasonography (EUS) on esophageal carcinoma preoperative T staging and postoperative pathological T staging was71.7%and showed no significant difference (P>0.05)at the different stage, The sensitivity and specificity on the esophageal carcinoma preoperative N staging was67.3%and81.8%respectively, and the accuracy (consistency) postoperative pathological N staging was61.2%. The NO and N1staging’s accuracy was50.0%and76.2%respectively and the difference had statistics meaning(P<0.05).(2)The accuracy (consistency) between Enhanced CT on esophageal carcinoma preoperative T staging and postoperative pathological T staging was66.7%. The data of T3and T4were significantly higher than those of T1, T2. The difference had statistics meaning (P<0.05). The N staging’s sensitivity and specificity on the esophageal carcinoma preoperative was respectively63.3%,72.7%, which had a accuracy (consistency) of73.5%with postoperative pathological N staging. The NO and N1staging accuracy was67.9%,76.2%respectively and the difference doesn’t had statistics meaning (P>0.05). (3)The accuracy (consistency) of PET-CT for T staging between esophageal carcinoma preoperative T staging and postoperative pathological was80.0%. The data of T3, T4were significantly higher than those of T1, T2. The difference had statistics meaning (P<0.05). The N stage’s sensitivity and specificity on the esophageal carcinoma preoperative were73.5%,90.9%respectively and accuracy (consistency) with postoperative pathological N staging was81.6%, The NO and N1stage’s accuracy was75.0%,90.5%respectively and the difference had statistics meaning (P<0.05).(4) The accuracy (consistency) of EUS combined with enhanced CT between esophageal carcinoma preoperative T staging and postoperative pathological T staging was88.3%. The data of T3, T4were significantly higher than those of T14, T2. The difference had statistics meaning (P<0.05). The sensitivity, specificity on the esophageal were respectively85.7%,81.8%, and the accuracy (consistency) with postoperative pathological N staging was85.7%. The NO and N1stage’s accuracy was78.6%,95.2%respectively and the difference had statistics meaning (P<0.05).(5) The accuracy (consistency) of EUS combined with PET-CT on esophageal carcinoma between preoperative T staging and postoperative pathological T staging was91.7%. The data of T3, T4were significantly higher than those of T1, T2. The difference had no significant difference (P>0.05). The sensitivity, specificity on the esophageal carcinoma preoperative N staging were respectively91.8%,90.9%and accuracy (consistency) of postoperative pathological on N staging was91.8%. The NO and N1stage’s accuracy was89.3%,95.2%respectively and the difference had no significant difference (P>0.05).(6) The accuracy (consistency) of three joint on esophageal carcinoma preoperative T staging and postoperative pathological T staging was95.0%. There had no significant difference between different stage (P>0.05). The sensitivity and specificity on the esophageal carcinoma preoperative N staging was95.9%,90.9%respectively and postoperative pathological N staging accuracy (consistency) was95.9%. The NO and N1stage’s accuracy was96.4%,95.2%respectively, the difference didn’t have statistics meaning (P>0.05).(7) The accuracy (consistency) of EUS combined with enhanced CT and EUS combined with PET-CT on esophageal carcinoma preoperative T staging and postoperative pathological T staging was significantly higher than that of EUS, CT, PET-CT enhanced inspected individually. The difference had statistics meaning (P<0.05).(8) The accuracy (consistency) of three joint on esophageal carcinoma preoperative T staging and postoperative pathological T staging was significantly higher than that of EUS combined with enhanced CT. The difference had statistics meaning (P<0.05).(9) Lymph node metastases were found in49cases postoperation. The accuracy of diagnosis (consistency) of EUS-CT and EUS-PET-CT combined joint of esophageal carcinoma preoperative N staging was significantly higher than that of EUS, enhanced CT and PET-CT enhanced inspected individually. The difference had statistics meaning (P<0.05). The accuracy of diagnosis (consistency) of three joint of esophageal carcinoma preoperative N staging was significantly higher than that of EUS, enhanced CT and PET-CT enhanced inspected individually and the difference had statistics meaning (P<0.05).Conclusion:The combined application of EUS, enhanced CT, PET-CT enhanced three method can obviously improve the sensitivity, specificity of esophageal carcinoma preoperative T, N staging and improve the consistency of postoperative pathology T, N staging. There has important guiding significance on esophageal cancer patients with the clinical staging and treatment options.