Analysis Of Clinical Application Of Multi-slice Spiral CT In Judgment Of N Stage After Conversion Treatment Of Advanced Gastric Cancer

Objective:To explore the value of multi-slice spiral CT(MSCT)in the N stage metastasis of patients with advanced gastric cancer who underwent surgery after transformation therapy.Methods:Clinical data of 27 patients with advanced gastric cancer who underwent surgery after transformation therapy,form July 2017 to July 1919 in Yantai Yuhuangding Hospital of Qingdao University were analyzed retrospectively,and all of patients underwent SOX regimen transformation therapy with three or four.The MSCT enhanced scan was performed before operation,and the postoperative pathology was used as the gold standard.The preoperative N stage and lymph node metastasis groups were evaluated by MSCT enhanced scan and compared with the pathological results.Results:1.Comparative analysis of lymph node metastasis and pathological results judged by MSCT: Using postoperative pathology as the gold standard,the accuracy rates of MSCT in assessing lymph node metastasis in groups 1,2,3,4,5,6,7,8,9,10,12 and 16 were 77.78%(21/27)、92.59(25/27)、92.59%(25/27)、96.30(26/27)、85.19%(23/27)、88.89%(24/27)、85.19%(23/27)、74.07%(20/27)、96.30%(26/27)、81.48%(22/27)、85.19%(23/27)and96.30%(26/27)。The sensitivity was 69.23%,75.00%,80.00%,66.67%,70.00%,33.33%,40.00%,54.55%,100%,0.00%,66.67%,100%,respectively.The specificity was 85.71%,95.65%,83.33%,95.83%,94.12%,95.83%,95.45%,87.50%,96.00%,95.65%,87.50% and 96.00%,respectively.2.Comparison of preoperative N stage and pathological N stage: The overall accuracy of MSCT in assessing N-stages after transformation of advanced gastric cancer was 62.96%(17/27).The accuracy of N1,N2 and N3 were 81.48%,66.67% and 77.78%,respectively.The sensitivity of N1,N2 and N3 were 90.00%,55.54% and 33.33%,respectively.The specificity of N1,N2 and N3 were 76.47%,75.00% and 90.48%,respectively.3.The consistency of MSCT for N stage diagnosis of advanced gastric cancer after transformation therapy and postoperative pathological N stage is moderate(κ=0.419,P=0.003).Conclusion:1.MSCT has high accuracy and consistency for the N stage of advanced gastric cancer after transformation therapy.2.Besides,MSCT has a certain diagnostic rate for lymph node metastasis in patients with advanced gastric cancer in lymph node groups of No.1,No.2,No.3,No.4,No.5,No.6,No.7,No.8,No.9,No.10,No,12 and No.16.3.MSCT can more accurately assess the N stage after advanced gastric cancer transformation treatment,and guide the clinical whether radical surgery can be performed.In addition,it also has a good predictive effect on lymph node metastasis in advanced gastric cancer regions,and it is of great significance for the individualized treatment of gastric cancer.4.Due to its non-invasive,rapid and economic advantages,MSCT has a good consistency in the N staging of advanced gastric cancer after transformation therapy,so MSCT is recommended as the preferred imaging method for the n-staging assessment after transformation therapy.