Preoperative staging of rectal cancer
Preoperative staging of rectal cancer
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DOI：
10.1007/s003840050002
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发表时间：
2000-02-01
影响因子：
2.8
通讯作者：
Hill, GL
中科院分区：
文献类型：
--
作者：
Kwok, H;Bissett, IP;Hill, GL
随着直肠癌术前放射治疗的广泛应用和经肛门内镜显微手术治疗早期病变的发展，这些肿瘤的术前放射学分期越来越重要。本研究是一项系统性综述，旨在评价计算机断层扫描（CT）、直肠内超声（ES）和磁共振成像（MRI）作为直肠癌术前分期方法的价值。对1980年至1998年间使用CT、ES或MRI进行直肠癌术前分期的研究进行了基于Medline的检索。对引文清单进行了广泛的交叉核对，补充了论文清单。如果研究符合预定标准，则纳入研究。将已接受研究的数据输入汇总表，比较每种方式在确定肠壁穿透和淋巴结受累方面的放射学和病理学分期结果。确定了汇总结果的准确度、灵敏度、特异性、阳性预测值、阴性预测值、阳性似然比和阴性似然比。来自78篇论文的83项研究（包括4897例患者）符合纳入标准。在确定肿瘤壁穿透方面，CT、ES、MRI和直肠内线圈MRI的敏感性分别为78%、93%、86%和89%;特异性分别为63%、78%、77%和79%;准确性分别为73%、87%、82%和84%。CT、ES、MRI和直肠内线圈MRI诊断淋巴结转移的敏感性分别为52%、71%、65%和82%，特异性分别为78%、76%、80%和83%，准确性分别为66%、74%、74%和82%。直肠内线圈MRI是最准确预测直肠癌病理分期的单一检查。
With the widespread introduction of preoperative radiotherapy for rectal cancer and the development of transanal endoscopic microsurgery for selected early lesions, preoperative radiological staging of these tumours has taken on increasing importance. This study is a systematic review to evaluate computed tomography (CT), endorectal sonography (ES) and magnetic resonance imaging (MRI) as preoperative staging modalities in rectal cancer. A Medline-based search identifying studies using CT, ES, or MRI in preoperative staging of rectal cancer between 1980 and 1998 was undertaken. The list of papers was supplemented by extensive cross-checking of citation lists. Studies were included if they met predetermined criteria. Data from the accepted studies were entered into pooled tables comparing radiological and pathological staging results for each modality both in determining bowel wall penetration and involvement of lymph nodes. Accuracy, sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were determined for the pooled results. Eighty-three studies from 78 papers including 4897 patients met the inclusion criteria. In determining the wall penetration of the tumour the values for sensitivity for CT, ES, MRI and MRI with endorectal coil were 78%, 93%, 86% and 89%; for specificity 63%, 78%, 77% and 79%; and for accuracy 73%, 87%, 82% and 84%, respectively. In determining the nodal involvement by tumour the sensitivity values for CT, ES, MRI and MRI with endorectal coil 52%, 71%, 65% and 82%; for specificity 78%, 76%, 80% and 83%; and for accuracy 66%, 74%, 74% and 82%, respectively. MRI with an endorectal coil is the single investigation that most accurately predicts pathological stage in rectal cancer.