| Objective1. To analysis the imaging findings of enhanced (MSCT) to lymph nodemetastasis of thoracic esophageal cancer by evaluating the MSCT imaging of190thoracic esophageal cancer.2. To explore the regularity and influencing factors of thoracic esophageal canerlymph node metastasis.Materials and MethodsRandom Selection190patients of our hospital who proposed surgical treatmentand underwent multi-slice spiral CT scan within a week before surgery. Preoperativeesophagoscopy or gastroscopy brush cytology or biopsy confirmed or suspicioussquamous cell carcinoma. Patients before surgery without any anti-cancer therapy andhave a complete, accurate clinical and pathological data.190patients underwent CT scaning within a week before surgery, usedPhilips128slice spiral CT. Scanning parameters:120KV200mAs; slice thickness5mm, matrix512×512, pitch1.375:1. Before the examination of patients fasted formore than6h scan before taking positive contrast agents500ml, filling the stomach,easy to observe abdominal lymph node. Patient supine on the scanning bed,Shuangshoubaotou, scan range from the the hyoid level of the liver the lower edge ofthe median cubital vein bolus injection of contrast agent90ml, injection speed of2.5ml/s, respectively delay30s,75s scan, rebuild the original data layer thickness of1.5mm, layer spacing0.75mm, coronal and sagittal reconstruction necessary. Application Philips digital diagnostic imaging workstation, the use of the imagereading function observed lymph node size, shape, and density. Drainage area isolatedsoft tissue density nodules to exclude the diagnosis of lymph node vascular crosssection and partial volume effects. Diameter measurement lymph short, short axismeasurement standards to take axial largest level. Independently by two physiciansand reading the results objection discuss consensus as the final result.MSCT diagnostic criteria: lymph node groups, and the metastatic lymph nodesin esophageal cancer surgery extensive lymph node dissection, lymph node groupingand numbering in accordance with the standards developed by the Japan Society ofesophageal disease, lymph nodes after surgery cleaning grouping censorship record ofeach patient lymph node metastasis number. Cervical lymph nodes including101,102,103, and104lymph nodes, upper mediastinal lymph nodes, including105,106TL106TR,106L,106R,106F,113and114of the lymph nodes in the mediastinal lymphnodes, including the lymph nodes107,108,109and112, under the mediastinal lymphnodes110and111lymph nodes, abdomen, including the stomach1to16lymphnodes.The MSCT enhance scanned images on a comprehensive evaluation of lymphnodes in accordance with the following criteria:①The of101,102,103,104,105,106recR,106recL lymph nodes short diameter≥6mm,108L,109L≥7mm106tbL,106tbR106pre,113,114, abdomen≥8mm,108R,109R≥10mm,107≥12mm asabnormal; abnormal lymph node morphology, the ratio of the length of diameter≤1.6②lymph nodes regardless of the size of the center of fat density or centralcalcification is benign; necrosis area or the eccentric calcification, compared withmalignant;③lymph enhanced homogeneously enhanced or heterogeneousenhancement of the edge of thick, compared with benign; enhanced heterogeneousenhancement, ring enhancement, consistent with the primary tumor enhancementcompared with malignant;④more than three lymph nodes, lymph node metastasisfrom violations of the lack of boundaries with the surrounding fat gap.SPSS17.0software for data processing. Measurement data to indicate that thediagnostic performance of MSCT lymph nodes using χ2test, P <0.05for thedifference was statistically significant. Various clinicopathological factors and lymphnode metastasis using χ2test, P <0.05for the difference was statistically significant.Results1. Clinical data and pathological findings:141cases were male and49females; aged45to76years, with a median age of60years old. Sub-standard,27cases ofupper thoracic, middle thoracic108cases,55cases of the lower thoracic Internationalesophageal AJCC-UICC TNM staging system (2009). The group of190patients,87patients had lymph node metastasis, metastasis rate was45.8%; totallymphadenectomy2582, the average per patient cleaning13.1(5to32),303metastasis, lymph node metastasis11.7%; in this group there were18cases ofrecurrent laryngeal nerve chain only other parts of lymph node metastasis withoutlymph node metastasis. On the chest, under paragraph lymph node metastasis ratewere40.7%(11/27),46.3%(50/108) and47.3%(26/55).2. MSCT performance of lymph node metastasis of thoracic esophageal cancer:in accordance with the established MSCT diagnosis of lymph node metastasis andpreoperative diagnosis of metastatic lymph nodes967, pathologically confirmedlymph node metastasis303. The sensitivity, specificity, positive predictive value,negative predictive value, accuracy rate and index Younden MSCT thoracicesophageal lymph node metastases diagnosis were49.2%,64.1%,15.4%,90.4%,62.4%,0.133. The preoperative MSCT diagnosis of mediastinal lymph nodemetastasis sensitivity, specificity, positive predictive value, negative predictive valuewere69.4%,85.8%,35.6%,96.1%, are the highest; Youden index also maximum for0.552The highest diagnostic efficacy. Followed by the upper mediastinal area, theYouden index of0.317. Diagnostic performance of the lowest for the abdominal area,the Youden index only0.268.3. MSCT manifestations of thoracic esophageal carcinoma metastatic lymphnodes: MSCT、pathological jointly confirmed63cases with lymph node metastasis inpatients with esophageal cancer,149common metastatic lymph nodes, in each caseincidence of lymph node metastasis Digital1to6, an average of2.36/cases; averageshort diameter of lymph node metastases maximum axial plane (1.2±0.3) cm;33(22.15%) of the lymph nodes in the subcarinal and maximum short axial planediameter were>1.0cm.78(52.35%) of metastatic lymph nodes performance for edgeblur metastatic lymph nodes of47(31.54%) fusion-like performance; majority (85.8%)of the length of metastatic lymph nodes diameter ratio≤1.6, the transfer of part(52.6%) lymph nodes appeared ring enhancement center to see low-density areas ofnecrosis and ring enhancement appeared in the second phase of the enhanced scan.This group, there are32(16.84%) cases with only recurrent laryngeal nerve chainDistrict lymph nodes (101,106recL and106recR) transfer, without other parts of lymph node metastasis.4. Thoracic esophageal distribution characteristics of metastatic lymph nodes:Transfer rate is higher in the mediastinal lymph nodes and abdominal area,31.1%(59/190) and27.4%(52/190). Upper thoracic esophageal cancer lymph nodemetastasis, to most the upper mediastinum groups the most common (33.3%), Middlethoracic esophageal cancer in the mediastinal most common (37.9%), Lower thoracicesophageal cancer over the abdominal area is the most common (41.8%). Upperthoracic esophageal cancer the most common sites of metastases105,101,106groupof middle thoracic esophageal cancer is the most common sites of metastases108,7,107group, the most common sites of metastases in the lower thoracicesophageal110,7,107group.5. Thoracic lymph node metastasis rate with clinical pathological factors: Upperthoracic, middle thoracic, lower thoracic esophageal cancer lymph node metastasisrates were40.7%,46.3%,47.3%, χ2test among the difference was not statisticallysignificant (P>0.05). Lesion length≤5cm lymph node metastasis (42.6%) less thanthe lesions>5cm lymph node metastasis rate was not statistically significant (P>0.05),but the difference between the two. Different T staging of esophageal cancer lymphnode metastasis rates were16.7%,20.0%,54.4%,82.6%, and the difference wasstatistically significant (P <0.05), lymph node metastasis ratio between different Tstageing. High, medium and poorly differentiated squamous cell carcinoma lymphnode metastasis were33.3%,46.8%,51.5%, and the transfer rate between thedifferent degree of differentiation of squamous cell carcinoma of the existence ofsignificant differences (P <0.05). Different pathologic type of esophageal cancerlymph node metastasis rate were ulcerated53.6%, the fungating28.6%,39.4%of themedullary, chi-square test prompted among groups (P>0.05), that is, the differenttypes of pathologic thoracic esophageal lymph node metastasis see no significantdifference.Conclusion1. The preoperative the MSCT enhanced scan assessment of thoracic lymph nodemetastasis have a higher value, to accurately reflect the distribution of lymph nodemetastasis, the highest diagnostic value of mediastinal lymph node metastasis.2. The imaging features of metastatic lymph nodes: lymph node metastasesnearly spherical shape or round lymph long/short axis ratio≤1.6; edge blur, and maybe associated with increased gap density of surrounding fat; plain was mostly or low-density, enhanced scan showed heterogeneous enhancement, part of thering-shaped strengthening.3. The site of upper thoracic esophageal cancer is the most prone to lymph nodemetastasis group105,101,106; middle thoracic esophageal cancer is the most prone tothe site of lymph node metastasis108,7,107group; most prone to the lower thoracicesophageal sites of lymph node metastasis the110,7,107group; esophageal lymphnode metastasis has a two-way, jumping characteristics.4. For thoracic esophageal tumor depth of invasion, degree of differentiation isthe important factor to affect the lymph node metastasis rate; lesion, lesion length, thepathologic type no significant correlation. |
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