Résumé
Objective To study the consistency in the diagnosis of preoperative TNM rectal cancer staging using high resolution magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) combined with carcinoembryonic antigen (CEA) and postoperative pathological TNM.Methods 156 cases pathologically proven were retrospectively analyzed and divided into 4 groups including preoperative MRI group (39 cases),TRUS group (39 cases),MRI and TRUS group (39 cases),MRI and TRUS combined with CEA group (39 cases).The differences between preoperative T,N staging and postoperative pathologic T,N staging were analyzed.Results There were statistically significant differences in the diagnosis of preoperative T and postoperative pathological T in 4 groups (T: Kappa =0.685,P =0.000; N: Kappa =0.544,P =0.000),but there were no significant differences in preoperative N and postoperative pathological N staging in preoperative MRI group,TRUS group,MRI and TRUS group (Kappa =0.142,P =0.329; Kappa =0.154,P =0.645; Kappa =0.154,P=0.229),and significant difference was observed in MRI and TRUS combined with CEA group (Kappa =0.544,P =0.000).There were no significant differences in the accuracy of T staging among the 4 groups (x2 =0.326,P =0.574; x2 =0.562,P =0.719; x2 =0.287,P =0.986),but significant difference in the accuracy of N staging were showed among the 4 groups (x2 =4.643,P =0.026; x2 =6.643,P =0.026; x2 =5.243,P =0.019).Conclusion Preoperative evaluation by the MRI add TRUS combined with CEA can improve the accuracy of preoperative staging,which can provide more reliable basis for decision-making and improve the coincidence rate of operative procedures in line with the estimate.It also provides the basis fur the accurate preoperative diagnosis and individualized treatment.
Résumé
Objective To study the consistency of preoperative staging by transrectal ultrasonography (TRUS) combined with serum carcinoembryonic antigen (CEA) and the postoperative pathological TNM staging (PTNM).Methods 118 rectal cancer patients pathologically proven were divided into preoperative TRUS combined with CEA group (59 cases) and along TRUS group (59 cases).The consistency of preoperative stag in 2 groups and postoperative pathological stage was analyzed retrospectively.Results In TRUS combined with CEA group,the accuracy of T stage was 79.7 ％ (47/59),and the accuracy of N stage was 77.8 ％ (42/59),compared with the postoperative pTNM.While in along TRUS group,the accuracy of T stage was 86.4 ％ (51/59),and the accuracy of N stage was 57.7 ％ (30/59).The consistencies of T and N stage in TRUS combined with CEA group and postoperative pTNM were better (κ =0.685,P =0.000; κ =0.544,P =0.000).While the consistency of T stage in along TRUS and postoperative pTNM was better (κ =0.755,P =0.000),but that of N stage was poor (κ =0.154,P =0.229).Conclusion Preoperative evaluation by the TRUS combined with CEA can increase the accuracy of preoperative stage which can provide more reliable basis for decision-making and improve the rate of coincidence of operative procedures in line with forecasts.At the same time,it can provide the basis for the accurate preoperative diagnosis and individualized treatment.