MRI与CT在鼻咽癌诊断中的应用价值及分期系统比较

目的 评价MRI与CT检查在鼻咽癌诊断中的应用价值,并对鼻咽癌2008年分期、1992年福州分期及2002年国际抗癌联盟(UICC)分期系统进行比较.方法 分析76例鼻咽癌初诊患者MRI和CT影像资料,依据2008年分期以MRI为标准,评价MRI与CT对鼻咽癌新分期的差异.并以MRI为标准,比较鼻咽癌不同分期系统间的差异.MRI与CT对肿瘤侵犯范围比较采用McNemar法检验.结果 MRI判断鼻咽癌翼内肌(22例)、翼外肌(15例)、颅底(35例)及颅内(11例)侵犯方面与CT(分别为24、11、32、6例)存在差异,但无统计学意义(P＞0.05);MRI在判断咽旁间隙侵犯(50例)、咽后组淋巴结转移(48例)、T1期(18例)、T2期(15例)、N0期(18例)、N1期(33例)上,与CT(分别为61、23、11、22、24、27例)不一致者分别为11例、25例、7例、7例、6例及6例,差异有统计学意义(P＜0.05).CT多显示的11例咽旁间隙侵犯,MRI证实5例为咽旁间隙受压,6例为咽后组淋巴结转移,而MRI较CT共多显示咽后组淋巴结转移25例,以上2点为引起T、N分期差异的主要原因.鼻咽癌2008年分期与1992年分期比较,T分期上升9例,下降1例,N分期上升16例,临床分期上升15例,下降1例;与2002年UICC分期比较,T分期上升7例,N分期上升10例,临床分期上升12例.结论 与鼻咽癌2008分期规定的MR检查比较,CT在显示病变咽旁间隙侵犯及咽后组淋巴结转移方面存在较大差异.相对于1992年分期及2002年UICC分期,鼻咽癌2008分期主要使肿瘤T、N分期上升、临床分期上升.     

鼻咽癌105例基于磁共振与CT的不同临床分期系统在T分期上的比较分析

目的研究分析105例鼻咽癌患者按基于磁共振（MR）的2008分期与基于CT的92分期两个不同临床分期系统在T分期上的差异。方法收集经病理确诊并在1周内同时行MR与CT检查的鼻咽癌患者资料105例，均按2008分期与92分期系统分别进行T分期评估，并对两者差异进行统计学分析。结果2008分期与92分期对比，35．2％（37／105）病例的T分期发生了改变，L、T。期病例增多，而T1、T2期病例减少，两者总体差异具有统计学意R（P=0．039），在R、L期差异具有统计学意义（P=0．011，P=0．033），而T—L期差异无统计学意义？结论基于MR为基础的2008分期比92分期更能真实反映鼻咽癌在T分期办而的病情，有利于治疗计划的制定，     

鼻咽癌的MRI表现(附78例分析)

目的：探讨初诊鼻咽癌的MRI表现及分期诊断要点，提高鼻咽癌MRI诊断水平。方法：回顾性分析78例初诊鼻咽癌患者MRI表现及分期。MRI扫描序列包括：轴位T1W／SE及T2W／TSE，冠状位SPIR，Gd-DTPA增强后三维扫描。结果：按1997年UICC和AJCC联合提出的鼻咽癌TNM分期，78例鼻咽癌患者分期为：0期1例，Ⅰ期6例，ⅡA期1例，ⅡB期24例，Ⅲ期23例，ⅣA21例，ⅣB2例；综合分期属早期(0～ⅡA期)的患者仅8例(10．3％)，而中晚期(ⅡB及以上)患者70例(89．7％)。结论：初次就诊鼻咽癌患者即大部分为中晚期，而MRI检查可清晰显示鼻咽癌侵犯范围及淋巴结转移，为鼻咽癌的分期、进一步治疗及其疗效观察提供客观依据。     

64层螺旋CT在肝内胆管细胞癌术前分期中的应用

目的 探讨64层螺旋CT在肝内胆管细胞癌(ICC)术前分期中的应用价值.资料与方法 回顾性分析42例经术后病理或穿刺活检证实的肝内胆管细胞癌临床、病理及CT资料.应用一致性检验分析肝内胆管细胞癌64层螺旋CT分期与临床病理分期吻合程度.结果 42例中,CT分期Ⅰ期8例,Ⅱ期7例,Ⅳa期10例,Ⅳb期17例;临床病理分期Ⅰ期12例,Ⅱ期6例,Ⅳa期11例,Ⅳb期13例.CT对T、N、M分期及对血管侵犯的阳性预测值、正确率分别为T (T1 89％、T2 75％、T3 100％、T4 100％)、86％ (36/42),N 81％、88％ (37/42),M 76％、90％ (38/42),血管85％、95％ (40/42).对比肝内胆管细胞癌临床病理分期,CT对T、N、M分期及对血管侵犯判断的Kappa值分别为0.780、0.759、0.795、0.884.结论 肝内胆管细胞癌64层螺旋CT分期与临床病理分期具有很好的一致性,术前CT分期有利于肝内胆管细胞癌的诊断.     

早期鼻咽癌放疗失败模式分析

目的 分析早期鼻咽癌患者放疗失败模式及其与临床因素的相关性,探讨提高早期鼻咽癌治疗效果的方法.方法 回顾性分析行单纯根治性放射治疗的早期(T1-2N0-1M0)鼻咽癌患者350例,计算其5年生存率、无局部区域复发生存率、无远处转移生存率、局部区域控制率及远处转移率;计算局部区域复发和转移的发生率,总结其放疗失败模式;分析与放疗失败相关的临床因素;将患者按T、N期分层,计算其5年无局部区域复发生存率及无远处转移生存率.结果 本组患者的5年总生存率、无局部区域复发生存率及无远处转移生存率分别为82.8%、89.1%、86.7%,5年局部区域控制率及远处转移率分别为82.6%、13.1%.T1N0、T2 N0、T1N1及T2N1期患者的5年生存率分别为95.3%、88.0%、81.3%及72.9%(P<0.05).所有患者中96例(27.4%)治疗失败:其中局部区域复发61例,远处转移46例,局部区域复发+远处转移11例.鼻腔受累、N分期及临床分期对局部区域复发率有显著影响(P<0.05),N分期和临床分期对远处转移率有显著影响(P<0.05).不同T、N分期患者的无局部区域复发生存率及无远处转移生存率具有显著性差异.结论 局部区域复发和远处转移是早期鼻咽癌治疗失败的主要模式;T1-2N1患者预后差,应采取综合治疗措施以提高疗效.     

鼻咽癌MRI三维径线和体积测量及与临床分期的相关性

【摘要】目的：探讨鼻咽癌MRI三维径线和体积（PTV）测量及与临床分期的相关性。方法：回顾性分析经病理证实的118例鼻咽癌患者的临床及影像学资料。基于横轴面、冠状面和矢状面脂肪抑制T2WI,分别测量鼻咽癌病灶的左右径（MLD）、上下径（CCD）和前后径（APD）,并采用面积求和法计算PTV。结果：进展期肿瘤（T3+T4期）组的PTV、APD、MLD和CCD均明显高于非进展期肿瘤（T1+T2期）组（P<0.05）。PTV、APD、MLD和CCD在N0期和非N0期（N1+N2+N3）组间的差异均无统计学意义（P>0.05）。受试者工作特性（ROC）曲线分析结果显示,APD和CCD鉴别进展性和非进展期肿瘤的诊断效能与PTV相似（P>0.05）,而MLD明显低于PTV（P<0.05）。结论：鼻咽癌MRI三维径线和体积测量值与其T分期密切相关。     

凋亡刺激蛋白抑制因子表达对鼻咽癌预后预测的研究

目的 探讨凋亡刺激蛋白抑制因子（iASPP）的表达水平与鼻咽癌预后的关系。方法 随访2012年1月至12月广西医科大学第一附属医院放疗科治疗的初诊鼻咽癌患者130例。临床分期依据2009 AJCC/UICC分期标准。所有患者均接受调强放射治疗,Ⅲ~Ⅳ_B期患者行铂类为基础的同步放化疗。采用免疫组织化学法检测iASPP在130例鼻咽癌组织中的表达情况,比较iASPP表达与临床病理因素的关系,并分析其表达对鼻咽癌患者疗效和生存的影响。结果 130例患者中iASPP阳性表达者86例（66.2%）,阴性表达者44例（33.8%）。不同N分期和临床分期患者的iASPP阳性表达率比较,差异有统计学意义（χ²=7.565、4.947,P<0.05）。治疗后3个月,iASPP阳性表达者与阴性表达者的近期疗效差异无统计学意义（P>0.05）。单因素分析显示,iASPP阳性表达者3年无远处转移生存（DMFS）和无进展生存（PFS）均低于iASPP阴性表达者（82.6% vs. 95.4%,χ²=4.335,P=0.037和74.4% vs. 93.1%,χ²=6.640,P=0.01）。N_2~3患者3年DMFS、PFS和总生存（OS）均低于N_0~1患者（χ²=8.058、9.554、6.987,P<0.01）。多因素分析显示,iASPP表达水平及N分期是影响PFS的独立预后因素（χ²=4.336、5.228,P<0.05）。结论 鼻咽癌患者iASPP阳性表达水平升高是影响预后的不利因素。     

胃癌CT体积测量在预测其术后病理分期中的应用

【摘要】目的：探讨胃癌患者CT肿瘤体积与术后病理分期的相关性及临床应用价值。方法：搜集2015年4月-2016年1月确诊的胃癌患者105例（男69例,女36例,年龄34～84岁,平均60.96±9.95岁）。术前1周内行CT增强扫描,通过人工测量门脉期每一层面的肿瘤面积乘以层厚叠加获得肿瘤体积,与术后病理分期进行关联性分析,将T分期分为T1-2组和T3-4组,N分期分为N0组和≥N1组后进行U-检验及ROC分析。结果：CT肿瘤体积与术后病理T分期及N分期的相关性分别为r=0.80（P<0.001）和r=0.66（P<0.001）,呈显著相关,不同T或N分期的CT肿瘤体积中位数值随着T或N分期的增加呈增长趋势,各组间差异均具有统计学意义（P<0.001）。T3-4组或≥N1组的CT肿瘤体积分别明显>T1-2组或N0组（P<0.001）。CT肿瘤体积预测T1-2期的ROC曲线下面积AUC=0.96（95%CI 0.90~0.99）,95%置信区间的相伴概率P<0.001,如果将CT肿瘤体积≤24.5mL作为预测T1-2期的阈值时,其敏感度为92.9%,特异度为90.5%,准确度为91.4%。CT肿瘤体积预测N0期的ROC曲线下面积为0.84（95%CI 0.76~0.90）,95%置信区间的相伴概率P<0.001。如果将CT肿瘤体积≤23.4mL作为预测N0期的阈值时,其敏感度为75.6%,特异度为85.0%,准确度为81.0%。CT肿瘤体积预测T1-2N0期的ROC曲线下面积为0.80（95%CI 0.65~0.91）,95%置信区间的相伴概率P<0.001。如果将CT肿瘤体积≤10.8mL作为预测T1-2N0期的阈值时,其敏感度为71.9%,特异度为80.0%,准确度为73.8%。结论：CT肿瘤体积与术后病理T、N分期均具有显著相关性,通过选取恰当的阈值,可为胃癌的术前临床分期提供良好的参考价值。     

16层螺旋CT胃癌术前TNM分期

目的 :评价 16层螺旋CT双期增强扫描在胃癌TNM分期中的诊断价值。方法 :2 9例胃癌患者 ,术前采用 16层螺旋CT平扫和动脉期、静脉期双期增强扫描 ,随后薄层重建 ,采用容积再现法 (VR)、多平面容积重建法 (MPVR)、表面遮盖显示 (SSD)和仿真内镜 (CTVG)技术重建 ,结合原始图像TNM分期 ,与术后病理对照 ,评价CT在胃癌TNM分期中的诊断价值。结果 :2 9例胃癌患者T分期 :T1期敏感度为 5 0 % ,特异度 5 0 % ;T2 期敏感度 87.5 % ,特异度 70 % ;T3 期敏感度 85 .7% ,特异度 80 % ;T4期敏感度 10 0 % ,特异度 83 .3 %。N分期 :N0 期敏感度为 71.4% ,特异度 71.4% ;N1期敏感度 80 % ,特异度 66.7% ;N2 ～N3 期敏感度为 83 .3 % ,特异度 66.7%。M1期敏感度和特异度均为 10 0 %。结论 :16层螺旋CT双期增强扫描结合重建技术能够较好地进行TNM分期 ,有效地指导手术方案的选择。     

局部残存和复发鼻咽癌立体定向放疗后诱发鼻咽出血

立体定向放射治疗 (SRT)提高了局部残存和复发鼻咽癌的治疗效果 ,然而合并较高的鼻咽出血。一、材料和方法自 1996年 10月至 2 0 0 1年 1月SRT治疗鼻咽癌局部残存和复发患者各 8例。男性 12例 ,女性 4例 ,中位年龄 4 9 5(30～ 74 )岁。病理均为低分化鳞癌 ,无远处转移。TNM分期采用UICC1997分期标准。残存组Ⅰ期 1例 ,Ⅲ期 3例 ,Ⅳ期4例。复发组Ⅰ期 3例 ,Ⅱ期 1例 ,Ⅳ期 4例。残存组常规外照射 6 8～ 70Gy。复发组中 2例为外院首程治疗 ,1例常规外照射 70Gy ,1例常规外照射 6 7Gy后放射外科 (SRS)加量 12Gy;余 6例在我院治疗 ,常规…     

A clinical statistical study of lung cancer patients in Japan with special reference to the staging system of TNM classification: a report from the Japan Joint Committee of Lung Cancer associated with the TNM System of Clinical Classification (UICC)

In 1978, after having conducted clinical field trials, the TNM Committee of Union Internationale Contre le Cancer (UICC) decided on an uniform system for the classification of lung cancer. The Japan Joint Committee of Lung Cancer (JCC) has continued to conduct field studies recommended by UICC, and since then has completed its third series carried out at 149 participating institutions. In this third series, the case records of 4,931 lung cancer patients were submitted for analysis. A clinical staging system of these findings was then set up, arranged in the TNM classification. As a result of this work, some improvements were made in the staging system. And JCC will now propose these changes, given as follows, to UICC for consideration: Occult Cancer: TX N0 M0 Stage I: T1 N0 M0, T2 N0 M0 Stage II: T0 N1 M0, T1 N1 M0, T2 N1 M0 Stage III: T3 N0 M0, T3 N1 M0, Any T N2 M0 Stage IV: Any T, Any N M1 The factors influencing the prognosis of patients with lung cancer (Yoshimura et al., 1982 (b)) (which include age, sex, histological type, modality of treatment and type of clinical staging used) were then re-evaluated. The results of this evaluation suggest an improved 5-year survival rate when using multi-modality treatment.     

Preoperative staging of renal cell carcinoma using triphasic helical computed tomography

Objective

To determine if staging of renal cell carcinoma (RCC) can be predicted from preoperative triphasic helical computed tomography (CT) findings.

Patients and methods

We reviewed the triphasic helical CT scans of 48 consecutive patients with pathologic diagnosis RCCs. All tumors were staged according to the 2002 version of TNM staging system. The preoperative radiologic staging was compared with postoperative pathologic staging. Agreement between the two staging systems was determined using the kappa test.

Results

Comparison between triphasic helical CT staging and pathologic staging showed harmony in all lesions in stage T1a, and T1b. Triphasic helical CT over diagnosed two cases of stage T1b regarded as stage T3a while agreement was noted in all cases of stage T2. Harmony was noted between triphasic helical CT and pathologic staging in two lesions stage T3a, four lesions in stage T3b, and two lesions stage T4. The agreement between triphasic helical CT and pathologic T stages was perfect (K = 0.941). Forty-two cases were staged N0, one case was N1, and five cases were staged N2 by triphasic CT. Three cases were over staged, and six cases were under staged while, 39 were correctly N staged. The agreement between triphasic helical CT and pathologic N staging was poor (K = 0.33).

Conclusion

The agreement between the preoperative triphasic helical CT staging and postoperative pathologic T staging is perfect, while agreement in N stages is poor. So T staging of RCC can be predicted from triphasic helical CT findings while N staging cannot be predicted preoperatively.     

食管癌临床分期对三维适形放射治疗预后的影响

目的 分析食管癌三维适形放射治疗的预后影响因素,评价食管癌临床分期对判断预后的价值。方法回顾性分析资料完整的81例接受三维适形放疗的食管癌患者,对可能影响预后的因素进行多因素分析,并比较肿瘤局部T分期、N分期和临床分期与预后的关系。结果全组患者1、2、3、4年总生存率分别为67.9%、45.7%、40.5%和30.9%,1、2、3、4年局部控制率分别为83.0%、76.1%、73.9%和69.8%。放疗前X射线病变长度、病变局部T分期、临床分期、食管GTVD₉₅为影响患者总生存率的独立预后因素。T₁+T₂期与T₃、T₄期比较,临床Ⅰ+Ⅱ与临床Ⅲ、Ⅳ期比较,总生存率、局部控制率、无远处转移生存率及无瘤进展生存率的差异均有统计学意义。N₀期与N₁、N₂期比较,除局部控制率外,总生存率、无远处转移生存率及无瘤进展生存率差异均有统计学意义。临床Ⅲ期与Ⅳ期之间除局部控制率差异无统计学意义外(χ²=2.03,P=0.155),总生存率、无远处转移生存率及无瘤进展生存率比较差异均有统计学意义(χ²值分别为5.38、4.26、3.96,P值分别为0.020、0.039、0.045 )。结论食管癌临床分期的四分类法是非手术治疗食管癌比较理想的分期方法,能较好地预示放射治疗的预后。     

^18F-FDGPET／CT在滤泡性淋巴瘤分期及疗效评价中的临床价值

目的探讨^18F—FDGPET／CT在滤泡性淋巴瘤（FL）的分期、疗效评价、复发监测及预后判断方面的临床价值。方法回顾性分析2005年12月至2013年1月行PET／CT检查的经病理确诊为FL的28例患者[男12例,女16例,平均年龄57（36～82）岁]资料。对患者均进行AnnArbor临床分期,统计行PET／CT检查后临床分期改变情况。比较不同临床分期组间、病理高级别（3a＋3b级）组和低级别（1＋2级）组间SUVmax差异。28例中有17例行化疗后PET／CT检查和电话随访（10-88个月）监测疗效,比较疗效佳（CR＋PR）和不佳（SD＋PD）者生存差异。统计分析采用Mann—Whitneyu秩和检验、Wilcoxon符号秩检验和Kaplan—Meier生存分析。结果（1）28例治疗前行^18F—FDGPET／CT的患者中,10．7％（3／28）分期上调,3．6％（1／28）分期下调。Ⅰ＋Ⅱ期组SUVmax为10．1±3．2,Ⅲ＋Ⅳ期组SUVmax为11．5±4．9,差异无统计学意义（z=-0．619,P〉0．05）。病理低级别组（15例）和高级别组（13例）SUVmax分别为6．9±3．6和12．4±5．6（Z=-3．706,P〈0．01）。（2）17例治疗前后均行^18F-FDGPET／CT检查的患者中,疗效佳组（11例）治疗前SUV～10．8±5．1,治疗后SUVmax3．4±2．3（Z=-2．312,P〈0．05）;疗效不佳组（6例）治疗前SUVmax11．2±6．9,治疗后SUVmax7．8±3．3,差异无统计学意义（Z=-1．153,P〉0．05）。疗效佳与疗效不佳组的中位无进展生存期（PFS）分别为48和26个月（x^2=4．207,P〈0．05）。结论^18F-FDGPET／CT有助于明确FL分期、评价疗效、监测复发及提示预后。     

Comparative impact of standard approach, FDG PET and FDG dual-head coincidence gamma camera imaging in preoperative staging of patients with non-small-cell lung cancer

We prospectively compared the impact of the standard approach, of fluorodeoxyglucose positron emission tomography (FDG PET) and of FDG dual-head coincidence gamma camera imaging (DHC) in preoperative staging of patients with non-small-cell lung cancer (NSCLC). In addition to traditional staging, 42 patients were studied with a PET system and a DHC system. The number of lesions detected on DHC and on PET were compared independently of the proof of a tumoural invasion. Then, for the sub-group of lesions with the proof of a tumoural invasion, the sensitivity of the different imaging modalities was compared. Finally, stagings were compared with final staging established by histopathological findings (n=28), additional imaging modalities (n=4), clinical and traditional imaging follow-up over at least 4 months. DHC detected 105 of the 145 lesions considered as pathological on PET (73%, P=0.01), with a concurrence of 89% (NS) in lesions larger than 1.5 cm, and only 17% (P=0.03) in those smaller or equal to 1 cm. Traditional staging detected 87 of the 114 verified tumoural lesions (76%), PET 110/114 (96%, P=0.01 vs traditional staging), DHC 88/114 (77%, NS vs traditional staging, P=0.01 vs PET). PET correctly predicted the N stage in 39/42 (93%) patients, DHC in 38/42 (90%), and computed tomography in 32/42 (76%). PET correctly predicted the M stage in 42/42 (100%) patients, DHC in 41/42 (98%), and traditional staging in 38/42 (90%). Identical NM staging was obtained with DHC and PET in 38/42 (90%) patients. Compared to traditional NM staging, PET correctly up-staged 9/42 (21%) patients and down-staged 3/42 (7%), with one additional false N up-staging. DHC correctly up-staged 7/42 (17%) patients and down-staged 3/42 (7%), with one additional false N down-staging. PET correctly reclassified 4/42 (9.5%) patients from resectable to unresectable and incorrectly reclassified one. DHC correctly reclassified 3/42 (7%) patients without false therapeutic reclassification. Although DHC detected fewer lesions than PET, DHC is a possible alternative to PET since the impact on staging was high as compared with traditional staging and was very similar to that of PET.     

Preoperative staging of gastric carcinoma with multidetector spiral CT

PURPOSE: To assess the accuracy of Multidetector computed tomography (MDCT) in the preoperative staging of gastric cancer. MATERIALS AND METHODS: Between March 2002 and October 2002, 27 patents with histologically proven gastric adenocarcinoma underwent MDCT. Unenhanced and contrast-enhanced CT scans were obtained after the oral administration of 400-600 ml of water for gastric wall distension. Biphasic enhanced scans were performed after the automatic injection of 2ml/kg of contrast agent at a flow rate of 3.5 ml/sec with a scan delay of 35 and 70 sec. The images were evaluated for: lesion morphology, degree of wall infiltration, presence of locoregional lymphadenopathies and distant metastases. Based on the findings, a TCMD staging system was established according to the criteria reported in the literature. All the patients underwent surgery, and the preoperative MDCT staging was evaluated against the pathology findings. RESULTS: MDCT staging was correct in 17/27 patients (62.9%). The T parameter was correctly assessed in 24/27 cases (88.9%), whereas it was understaged in 1 case (3.7%) (T1 stage at CT vs T2 at surgery) and overstaged in 2 cases (7.4%) (T3 vs T2). The N parameter was correctly evaluated in 19/27 patients (70.4%), understaged in 6/27 (22.2%) and overstaged in 2/27 (7.4%). CONCLUSIONS: MDCT may be proposed for the staging of gastric carcinomas and, although accuracy in N staging remains low in comparison to single-detector spiral CT, it provides a larger amount of diagnostic information.     

Natural history of cancer of the breast. Probability of developing bone metastases

The incidence of bone metastases in 448 patients with breast cancer was evaluated. 374 out of 448 cases showed negative bone scan at initial clinical staging and were followed up during a period of at least 5 years with serial bone scans. The results of bone scans were compared on the basis of clinical stage (according to the International UICC classification), of lymph node involvement (groups N0, N + ) and of complementary therapy after surgery (radiotherapy v/s hormone-chemotherapy). Cumulative probability of bone metastases in breast cancer showed a linear trend with annual mean rate of 5% (1st yr 2%; 2nd yr 8%; 3rd yr 15%; 4th yr 22%; 5th yr 29%; 10th yr 59%). Statistical analysis in different clinical stages showed mild difference not statistically significant, neither in lymph node involvement (NO v/s N + ) nor in complementary therapy (radiotherapy v/s hormone-chemotherapy).