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中华结直肠疾病电子杂志

中华结直肠疾病电子杂志 ›› 2023, Vol. 12 ›› Issue (06) : 512 -518. doi: 10.3877/cma.j.issn.2095-3224.2023.06.013

综述

直肠癌淋巴结转移诊断研究进展
杨红杰, 张智春, 孙轶†()   
  1. 300121　天津市人民医院肛肠病诊疗中心
  • 收稿日期:2022-07-04 出版日期:2023-12-25
  • 通信作者: 孙轶
  • 基金资助:
    天津市卫生健康科研项目(No. ZC20081); 天津市医学重点学科（专科）建设项目资助(No. TJYXZDXK-044A); 天津市人民医院院级科研基金资助课题(No. 2022GCXK001)

Study progress in the diagnosis of lymph node metastasis of rectal cancer

Hongjie Yang, Zhichun Zhang, Yi Sun†()   

  1. Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin 300121, China
  • Received:2022-07-04 Published:2023-12-25
  • Corresponding author: Yi Sun
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引用本文：

杨红杰, 张智春, 孙轶. 直肠癌淋巴结转移诊断研究进展[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 512-518.

Hongjie Yang, Zhichun Zhang, Yi Sun. Study progress in the diagnosis of lymph node metastasis of rectal cancer[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2023, 12(06): 512-518.

直肠癌淋巴结转移的诊断策略一直是外科领域研究的热点，目前，在手术前临床上通常以淋巴结的大小及形态学改变来判断淋巴结是否存在转移，但这种方法的准确性仍有待提高。近期研究提出临床危险因素构建淋巴结转移预测模型、影像组学模型、卷积神经网络模型等可更充分地利用患者临床检验及检查指标，提高直肠癌淋巴结转移的诊断效能，有助于直肠癌的个体化治疗。本文主要对直肠癌淋巴结转移的诊断方法进展进行综述，以期探讨高效能的直肠癌淋巴结转移诊断模型的可行性。

关键词: 直肠肿瘤, 淋巴道转移, 诊断

The diagnosis strategy of lymph node metastasis of rectal cancer has always been a hot topic in the field of surgery. At present, the size and morphological changes of lymph nodes are usually used to judge whether lymph nodes have metastasis, but this method is not accurate. Recent studies have proposed that clinical risk factors such as lymph node metastasis prediction model, imaging omics model and convolutional neural network model can make better use of a variety of clinical tests and examination indicators of patients, improve the diagnostic efficiency of lymph node metastasis from rectal cancer, and contribute to the individualized treatment of rectal cancer. In this paper, the progress of diagnostic methods for lymph node metastasis of rectal cancer is reviewed, in order to explore the feasibility of a high-performance diagnostic model for lymph node metastasis of rectal cancer.

Key words: Rectal neoplasms, Lymphatic metastasis, Diagnosis
表1 MRI、ERUS、CT在直肠淋巴结转移中的平均诊断效能（95%CI）
文献 MRI ERUS CT
敏感度 特异度 敏感度 特异度 敏感度 特异度
Bipat S，2004[21] 0.66（0.54~0.76） 0.76（0.59~0.87） 0.67（0.60~0.73） 0.78（0.71~0.84） 0.55（0.63~0.67） 0.74（0.67~0.80）
Li XT，2015[22] 0.76（0.70~0.81） 0.77（0.72~0.81） 0.63（0.58~0.68） 0.80（0.77~0.83） 0.70（0.59~0.79） 0.75（0.67~0.81）
表2 临床危险因素预测模型诊断直肠癌淋巴结转移的敏感度、特异度及AUC值
文献 例数 危险因素数量 危险因素 敏感度 特异度 AUC
Toiyama Y，2015[36] 157 6 性别、肿瘤直径、肿瘤形态、组织类型、血清、ANGPTL2 0.72 0.75 0.80
Xu H，2021[37] 341 8 T分期、N分期、CEA、CA19-9、ADC均值、EMVI、直肠癌环周切缘、组织学分级 0.68、0.68、0.73 0.87、0.78、0.80 0.79、0.77、0.76
Ogawa S，2015[38] 176 4 T分期、N分期、年龄、BMI 0.72 0.77 0.79
Liu Y，2016[39] 411 5 T分期、淋巴结短径、肿瘤分化程度、CEA、直肠癌环周切缘 0.85 0.56 0.76
表3 影像组学预测模型诊断直肠癌淋巴结转移的敏感度、特异度及AUC值
文献 例数 图像类型 ROI区域 临床危险因素 敏感度 特异度 AUC C指数
Huang YQ，2016[41] 326 CT - CEA、淋巴结状态 - - - 0.78
He J，2021[45] 199 PET-CT SUV>2.5 淋巴结短径、簇状淋巴结 0.72 0.73 0.73 -
Xian MF，2019[49] 87 SWE - - 0.88 0.79 0.88 -
Yang YS，2021[42] 139 MRI 原发病灶 CEA、淋巴结状态 0.85 0.82 0.90 -
Meng X，2019[43] 345 MRI 原发病灶 淋巴结状态 0.73 0.57 0.70 -
Zhou X，2020[44] 391 MRI 原发病灶 T分期，M分期 0.83 0.73 0.81 -
Eresen A，2020[46] 390 CT 淋巴结 - 0.74 0.85 0.83 -
Chen LD2018[50] 115 ERUS 原发病灶          
CT 原发病灶 CEA - - - 0.86
SWE 圆形区域          
Zhu H，2019[47] 215 MRI 淋巴结 - 0.95 0.60 0.81 -
原发病灶 - 0.32 0.81 0.52 -
Li M，2020[48] 766 CT 淋巴结 - 0.43 0.79 0.64 -
原发病灶 - 0.60 0.56 0.60 -
原发病灶+淋巴结 CA19-9、CEA等 0.65 0.78 0.76 -
Nakanishi R，2020[51] 247 CT 侧方淋巴结 - - - 0.91 -
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