MRI在胃癌术前分期中的应用研究

发布时间：2018-05-31 05:10

本文选题：胃癌 + MRI　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]探讨MRI在胃癌术前分期中的应用价值。[方法]收集昆明医科大学第一附属医院肿瘤科2015年6月至2016年12月手术治疗的胃癌患者28例,所有患者术前行腹盆腔MRI检查,根据MRI图像进行术前分期,并与术后病理结果进行对照。[结果]1、28例患者中,MRI对胃癌术前T分期判定结果如下:T1期为1例,T2期为7例,T3期为11例,T4期为9例。病理诊断下T分期判定结果如下:T1期为3例,T2期为3例,T3期为12例,T4期为10例。MRI与术后病理诊断相比:T1期的灵敏度为33.3%,特异度为100%,准确率为92.9%,T2期的灵敏度为66.7%,特异度为80%,准确率为78.6%,T3期的灵敏度为66.7%,特异度为81.2%,准确率为75%,T4期的灵敏度为80%,特异度为94.4%,准确率为89.3%。MRI对胃癌术前N分期判定结果如下:N0期为10例,N1期为5例,N2期为8例,N3期为5例。病理诊断下N分期判定结果如下:NO期为9例,N1期为4例,N2期为5例,N3期为10例。MRI与术后病理诊断相比:NO期的灵敏度为77.8%,特异度为84.2%,准确率为82.1%,N1期的灵敏度为25%,特异度为83.3%,准确率为75%,N2期的灵敏度为60%,特异度为78.3%,准确率为75%,N3期的灵敏度为50%,特异度为100%,准确率为82.1%。2、28例患者中肿瘤位于胃底1例,胃体9例,胃窦18例,胃体中T分期的准确率分别为 T1(100%)、T2(77.8%)、T3(77.8%)、T4(100%,P0.01),N 分期的准确率分别为 NO(77.8%)、N1(88.9%)、N2(66.7%)、N3(88.9%,P0.01);胃窦中T分期的准确率分别为T1(88.9%,P0.01)、T2(77.8%)、T3(77.8%,P0.01)、T4(88.9%,P0.01),N 分期的准确率分别为NO(83.3%,P0.01)、N1(66.7%)、N2(72.2%)、N3(77.8%)。3、28例患者中肿瘤位于胃小弯20例,胃大弯7例。胃小弯中T分期的准确率分别为 T1(90%,P0.01)、T2(85%,P0.01)、T3(85%,P0.01)、T4(90%,P0.01),N 分期的准确率分别为 NO(90%,P0.01)、N1(75%)、N2(75%)、N3(80%,P0.01),胃大弯中T分期的准确率分别为T1(100%)、T2(57.1%)、T3(57.1%)、T4(100%,P0.01),N 分期的准确率分别为NO(57.1%)、N1(71.4%)、N2(71.4%)、N3(85.7%,P0.01)。4、28 例患者中 Borrmann Ⅰ 型 0 例,Borrmann Ⅱ 型 11 例,Borrmann Ⅲ 型 8例,Borrmann Ⅳ型9例。Borrmann Ⅱ型中T分期的准确率分别为T1(90.9%)、T2(81.8%,P0.01)、T3(81.8%,P0.01)、T4(90.9%,P0.01),N 分期的准确率分别为 NO(81.8%)、N1(63.6%)、N2(54.5%)、N3(72.7%);Borrmann Ⅲ型中 T 分期的准确率分别为 T1(87.5%,P0.01)、T2(75%)、T3(75%,P0.01)、T4(87.5%,P0.01),N 分期的准确率分别为 NO(87.5%,P0.01)、N1(75%)、N2(100%)、N3(87.5%,P0.01);Borrmann Ⅳ型中 T 分期的准确率分别为 T1(100%)、T2(77.8%)、T3(66.7%)、T4(88.9%,P0.01),N 分期的准确率分别为 NO(77.8%,P0.01)、N1(88.9%,P0.01)、N2(77.8%)、N3(88.9%,P0.01)。5、28例患者中Lauren分型为肠型2例,混合型9例,弥漫型9例(有8例患者病检报告未诊断),Lauren分型为混合型的T分期的准确率分别为T1(88.9%)、T2(77.8%)、T3(77.8%,P0.01)、T4(88.9%,P0.01),N分期的准确率分别为NO(77.8%,P0.01)、N1(44.4%)、N2(66.7%)、N3(77.8%),Lauren分型为弥漫型的T分期的准确率分别为T1(100%)、T2(88.9%)、T3(77.8%,P0.01)、T4(88.9%,P0.01),N 分期的准确率分别为N0(88.9%,P0.01)、N1(100%,P0.01)、N2(77.8%)、N3(88.9%,P0.01)。[结论]1、MRI对胃癌术前分期有较高的准确率,特别在T3、T4和N3分期上更具有明显优势;2、MRI对胃小弯肿瘤在T及N分期中有较高的准确率,与术后病检一致性较高。3、在不同的Borrmann分型中,T分期中T4有较高的准确率,N分期中N3准确率较高,且随分型而增高,与术后病检一致性较高。4、Lauren分型为弥漫型肿瘤有较高的T、N分期,特别在N分期上有优势。
[Abstract]:[Objective] to investigate the value of MRI in the preoperative staging of gastric cancer. [Methods] 28 cases of gastric cancer were collected from the oncology department of the First Affiliated Hospital of Kunming Medical University from June 2015 to December 2016. All patients underwent abdominal pelvic MRI examination before operation, and the preoperative staging was carried out according to MRI images and compared with the postoperative pathological results. [results]1,28 In the patients with MRI, the results were as follows: the T1 stage was 1, T2 was 7, T3 was 11, and T4 was 9. The pathological diagnosis of T staging was as follows: T1 phase was 3, T2 was 3, T3 was 12,.MRI was 33.3%, specificity was 100%, and the accuracy was 92.9%. The sensitivity was 66.7%, the specificity was 80%, the accuracy was 78.6%, the sensitivity of the T3 stage was 66.7%, the specificity was 81.2%, the accuracy was 75%, the sensitivity of the T4 stage was 80%, the specificity was 94.4%, and the accuracy was 89.3%.MRI for the preoperative N staging of gastric cancer as follows: the N0 stage was 10, the N1 period was 5, the N2 phase was 8, the N3 phase was 5. The pathological diagnosis of N staging. The results were as follows: phase NO was 9, stage N1 was 4, N2 phase was 5, N3 period was 10 cases of.MRI compared with postoperative pathological diagnosis: the sensitivity of NO stage was 77.8%, specificity was 84.2%, accuracy was 82.1%, sensitivity of N1 phase was 25%, specificity was 83.3%, accuracy was 75%, N2 sensitivity was 60%, specificity was 78.3%, accuracy rate was 75%, N3 period sensitivity. For 50%, the specificity was 100%, the accuracy rate was 1 cases in the fundus of the stomach in 82.1%.2,28 cases, 9 cases in the stomach body, 18 cases in the gastric antrum, and the accuracy rate of T staging in the stomach body was T1 (100%), T2 (77.8%), T3 (77.8%), T4 (100%, P0.01), the accuracy rate of N staging was respectively NO (77.8%), N1 (88.9%), N2 (66.7%), N3 (88.9%,), respectively. The accuracy rate in the gastric antrum was respectively the rate of the staging of the gastric antrum. T1 (88.9%, P0.01), T2 (77.8%), T3 (77.8%, P0.01), T4 (88.9%, P0.01). The accuracy of N staging is NO (83.3%, P0.01), N1 (66.7%), N2 (72.2%), 77.8%) in 20 cases of gastric small bend and 7 cases in stomach bend. The accuracy rate was NO (90%, P0.01), N1 (75%), N2 (75%), N3 (80%, P0.01), the accuracy rate of T staging in the big stomach curve was T1 (100%), T2 (57.1%), T3 (57.1%), T4 (100%, P0.01), respectively (57.1%), 71.4%, 71.4%, 85.7%. The accuracy rate of T staging in type Borrmann IV type 9 cases (type Borrmann IV) was T1 (90.9%), T2 (81.8%, P0.01), T3 (81.8%, P0.01), T4 (90.9%, P0.01), T4 (81.8%), 63.6%, 72.7%, 72.7%, 72.7%, 87.5%, 72.7%, respectively. P0.01), the accuracy of N staging was NO (87.5%, P0.01), N1 (75%), N2 (100%), N3 (87.5%, P0.01). The accuracy of T staging in Borrmann IV was T1 (100%), T2 (66.7%), 88.9%, 77.8%, 88.9%, respectively. 2 cases of intestinal type, 9 cases of mixed type and 9 cases of diffuse type (8 cases undiagnosed by disease examination), the accuracy rate of Lauren classification as mixed type T staging is T1 (88.9%), T2 (77.8%), T3 (77.8%, P0.01), T4 (88.9%, P0.01), N staging, respectively, NO (77.8%, 44.4%), N1 (66.7%), 77.8%). The accuracy rates were T1 (100%), T2 (88.9%), T3 (77.8%, P0.01), T4 (88.9%, P0.01), and the accuracy of N staging was N0 (88.9%, P0.01), N1 (100%, P0.01), N2 (77.8%), and 88.9%. There was a high accuracy rate and high consistency with postoperative disease detection. In the different Borrmann typing, T4 had higher accuracy in T staging. The accuracy rate of N3 in N staging was higher, and with the classification, the consistency was higher in.4, Lauren typing for diffuse tumors had higher T, N staging, especially in N stage.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.2

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