直肠癌术前MRI-T分期的误差分析

Error Analysis of MRI in the Preoperative T-Stage of Rectal Cancer

摘要: 目的：分析MRI各成像序列对直肠癌术前T分期与术后病理分期之间的误差，从而提高MRI直肠癌术前T分期的准确性及其对临床诊断的应用价值。资料与方法：对南昌大学第一附属医院2017年1月~2018年5月间首诊为直肠癌的49例患者进行前瞻性研究。49例患者均行术前MRI检查并做术后病理分期，由两位高年资诊断医师进行T分期及征象评估，最终结果与术后病理分期对照研究，分析误差。结果：直肠癌的术前MRI分期与术后病理学分期的一致性较好(Kappa = 0.409, P < 0.001)。MRI术前分期总不符合率：38.8%，其中3例PT1 (病理分期为T1)被过度分期为T2，9例PT2被过度分期为T3，2例PT3过低分期为T2，4例PT4过低分期为T3，1例PT2过度分期为T4。结论：正确评估直肠癌MRI术前分期的误差，有利于准确分期，从而提高临床利用价值。

Abstract: Objective: Errors between preoperative MRI-T-staging and postoperative pathological staging of rectal cancer were analyzed to improve the accuracy of MRI in preoperative T-staging of rectal cancer and value of clinical diagnosis. Materials and methods: A prospective study was conducted on 49 patients with rectal cancer who were first diagnosed in the First Affiliated Hospital of Nan-chang University from January 2017 to May 2018. All the 49 patients were treated by surgical and pathological staging after MRI. T-stages and signs were evaluated by two senior diagnostic physi-cians. The final results were compared with postoperative pathological stages to analyze the mis-judgment. Results: The consistency of preoperative staging by MRI and postoperative pathological staging of rectal cancer was fine (Kappa =0.409, p < 0.001). MRI inconsistent rate was 38.8% in the preoperative staging of rectal cancer. According to our criteria, 3 cases pT1 (pathological stage T1) were over-staged as T2, 9 cases PT2 were over-staged as T3, 2 cases PT3 were under-staged as T2, 4 cases PT4 were under-staged as T3, 1 case PT2 were over-staged as T4. Conclusion: The correct evaluation of preoperative staging errors of rectal cancer is beneficial to accurate staging and to improve the clinical utilization value of MRI.