Value of Multidetector Row Helical CT in Diagnosing Lymph Node Metastasis for Adenocarcinoma of Esophagog-astric Junction_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Chenglong ,  ZHAI Zhaohua , ZHOU Haiying , GOU Zonglin , HUANG Xiaohua , ZHANG Yawen

Department of Radiology， The Affiliated Hospital of North Sichuan Medical College， Nanchong 637000， Sichuan Province， China;

Corresponding author：

ZHAI Zhaohua, Email: zhaizhaohuada@163.com

Keywords：

Adenocarcinoma of esophagogastric junction; Multidetector row helical CT; Neoplasm; Lymph node metastasis

Video：

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Objective 　To explore the value of multidetector row helical CT （MDCT） in the diagnosis of lymph node metastasis in adenocarcinoma of esophaogastric junction （AEG）， and to study the pattern of lymph node metastasis of it.
Methods 　The MDCT images of 60 patients with AEG who underwent operation in our hospital from Jan. 2011
to Oct. 2012 were collected， in order to explore the value of MDCT in the diagnosis of lymph node metastasis in AEG， and to study the pattern of lymph node metastasis of it. Results　With diameter upper 8 mm and the difference of the mean value of enhanced degree upper 70 Hu as the standard of lymph node metastasis， the Kappa value （0.819 and 0.718），
sensitivity （83.1% and 91.8%）， and specificity （78.9% and 83.5%） were all optimal. The lymph node metastasis rate was significantly higher in serosa invasion group than those of non-invasion group （P＜0.05）. The metastatic area of lymph
nodes mainly concentrated around cardia （No. 7， 8， and 9 group）， lesser curvature of the stomach， celiac axis， and hepato-gastric ligament （No. 10， 11， 12， and 14 group） with the metastasis rate of 83.8% and 82.3%， respectively.
Conclusion　 MDCT is useful to confirm the features， location， and rules of lymph node metastasis in patients with AEG， which is helpful in accurately cleaning the lymph nodes.

Citation： WANG Chenglong,ZHAI Zhaohua,ZHOU Haiying,GOU Zonglin,HUANG Xiaohua,ZHANG Yawen. Value of Multidetector Row Helical CT in Diagnosing Lymph Node Metastasis for Adenocarcinoma of Esophagog-astric Junction. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(6): 674-679. doi: Copy

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2.	张祥宏，王其彰. 对食管胃交界腺癌的认识和争议[J]. 中华肿瘤杂志， 2008， 12(30)：947-949.
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16.	林家威，黄顺荣，吴东波，等. 64排螺旋CT三期增强扫描在胃癌淋巴结清扫术前评估中的价值[J]. 世界华人消化杂志， 2012， 20(7)：596-600.
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18.	Fukuya T， Honda H， Hayashi T， et al. Lymph-node metastases：efficacy for detection with helical CT in patients with gastric cancer[J]. Radiology， 1995， 197(3)：705-711.
19.	姜波健，吴巨钢，俞继卫，等. 胃癌淋巴管生成、淋巴管浸润及淋巴结微转移的临床意义[J]. 中国普外基础与临床杂志， 2008， 15(12)：903-909.
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22.	Paramo JC， Gomez G. Dynamic CT in the preoperative evaluation of patients with gastric cancer：correlation with surgical findings and pathology[J]. Ann Surg Oncol， 1999， 6(4)：379-384.
23.	Siewert JR， Stein HJ， Feith M. Adenocarcinoma of the esophago-gastric junction[J]. Scand J Surg， 2006， 95(4)：260-269.
24.	Shin SH， Jung H， Choi SH， et al. Clinical significance of splenic hilar lymph node metastasis in proximal gastric cancer[J]. Ann Surg Oncol， 2009， 16(5)：1304-1309.
25.	Mönig SP， Collet PH， Baldus SE， et al. Splenectomy in proximal gastric cancer：frequency of lymph node metastasis to the splenic hilus[J]. J Surg Oncol， 2001， 76(2)：89-92.

1. Hasegawa S， Yoshikawa T. Adenocarcinoma of the esophagogastric junction：incidence， characteristics， and treatment strategies[J]. Gastric Cancer， 2010， 13(2)：63-73.
2. 张祥宏，王其彰. 对食管胃交界腺癌的认识和争议[J]. 中华肿瘤杂志， 2008， 12(30)：947-949.
3. Tsiouris A， Hammoud Z， Velanovich V. Barrett’s esophagus afterresection of the gastroesophageal junction：effects of concomitant fundoplication[J]. World J Surg， 2011， 35(8)：1867-1872.
4. Inomata Y， Koike T， Ohara S， et al. Preservation of gastric acid secretion may be important for the development of gastroesophagealjunction adenocarcinoma in Japanese people， irrespective of the H. pylori infection status[J]. Am J Gastroenterol， 2006， 101(5)：926-933.
5. Dent J. Pathogenesis and classification of cancer around the gastro-esophageal junction—not so different in Japan[J]. Am J Gastr-oenterol， 2006， 101(5)：934-936.
6. 杨琳，朱玥璐，王斌，等. 进展期食管胃交界腺癌临床病理分析319例[J]. 世界华人消化杂志， 2012， 20(9)：784-789.
7. 王龙，刘巍，吕雅蕾，等. 食管胃结合部腺癌及胃癌Cox模型预后影响因素分析[J]. 中国肿瘤临床， 2012， 39(19)：1420-1425.
8. Griffiths EA， Pritchard SA， Mapstone NP， et al. Emerging aspectsof oesophageal and gastroesophageal junction cancer histopa-thology—an update for the surgical oncologist[J]. World J Surg Oncol， 2006， 4(4)：82-98.
9. Koppert LB， Wijnhoven BP， Tilanus HW， et al. Neuroendocrine in barrett’s mucosa and adenocarcinomas of the gastroesophageal junction[J]. Int J Surg Pathol， 2004， 12(2)：117-125.
10. Chandrasoma P， Wickramasinghe K， Ma Y， et al. Is intestinal metaplasia a necessary precursor lesion for adenocarcinomas ofthe distal esophagus， gastroesophageal junction and gastric cardia?[J]. Dis Esophagus， 2007， 20(1)：36-41.
11. Chak A， Ochs-Balcom H， Falk G， et al. Familiality in barrett’s esophagus， adenocarcinoma of the esophagus， and adenocarcinoma of the gastroesophageal junction[J]. Cancer Epidemiol Biomarkers Prev， 2006， 15(9)：1668-1673.
12. Gee DW， Rattner DW. Management of gastroesophageal tumors[J]. Oncologist， 2007， 12(2)：175-185.
13. Lehrbach DM， Cecconello I， Ribeiro Jr U， et al. Adenocarcinoma of the esophagogastric junction：relationship between clinicopathological data and p53， cyclin D1 and Bcl-2 immunoexpressions[J]. Arq Gastroenterol， 2009， 46(4)：315-320.
14. Gertler R， Stein HJ， Loos M， et al. How to classify adenocarcinomas of the esophagogastric junction：as esophageal or gastric cancer?[J]. Am J Surg Pathol， 2011， 35(10)：1512-1522.
15. de Manzoni G， Zanoni A， Giacopuzzi S. Treatment of esophago-gastric junction adenocarcinoma[J]. Ann Ital Chir， 2012， 83(3)：208-214.
16. 林家威，黄顺荣，吴东波，等. 64排螺旋CT三期增强扫描在胃癌淋巴结清扫术前评估中的价值[J]. 世界华人消化杂志， 2012， 20(7)：596-600.
17. Mönig SP， Baldus SE， Zirbes TK， et al. Lymph node size and metastatic infiltration in colon cancer[J]. Ann Surg Oncol， 1999， 6(6)：579-581.
18. Fukuya T， Honda H， Hayashi T， et al. Lymph-node metastases：efficacy for detection with helical CT in patients with gastric cancer[J]. Radiology， 1995， 197(3)：705-711.
19. 姜波健，吴巨钢，俞继卫，等. 胃癌淋巴管生成、淋巴管浸润及淋巴结微转移的临床意义[J]. 中国普外基础与临床杂志， 2008， 15(12)：903-909.
20. 莫景雄，黄力营. 胃癌淋巴结转移CT分析[J]. 现代医用影像学， 2012， 21(3)：169-171.
21. 王成龙，郑兴菊，孙家瑜，等. MDCT对胃食管交界区癌术前TN分期及分型的诊断价值[J]. 中国普外基础与临床杂志， 2012， 19(4)：446-451.
22. Paramo JC， Gomez G. Dynamic CT in the preoperative evaluation of patients with gastric cancer：correlation with surgical findings and pathology[J]. Ann Surg Oncol， 1999， 6(4)：379-384.
23. Siewert JR， Stein HJ， Feith M. Adenocarcinoma of the esophago-gastric junction[J]. Scand J Surg， 2006， 95(4)：260-269.
24. Shin SH， Jung H， Choi SH， et al. Clinical significance of splenic hilar lymph node metastasis in proximal gastric cancer[J]. Ann Surg Oncol， 2009， 16(5)：1304-1309.
25. Mönig SP， Collet PH， Baldus SE， et al. Splenectomy in proximal gastric cancer：frequency of lymph node metastasis to the splenic hilus[J]. J Surg Oncol， 2001， 76(2)：89-92.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Value of Multidetector Row Helical CT in Diagnosing Lymph Node Metastasis for Adenocarcinoma of Esophagog-astric Junction

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