The Application Of Transrectal Three-dimensional Ultrasound And MRI Examination In The TN Staging For Middle And Low Rectal Cancer

Objective:To evaluate the application of three-dimensional Transrectal Uitrasound?3D-TRUS?and Pelvic Magnetic Resonance Image?MRI?in TN staging for middle and lower rectal cancer,and further to explore the value of3D-TRUS combined with MRI in preoperative TN staging of middle and low rectal cancer.Methods:A total of 67 patients who were hospitalized in the General Hospital of Western Theater Command from October 2016 to April 2018 and diagnosed with moderate to low rectal cancer by pathological biopsy under the colonoscopy were selected.All patients were underwent the examination of3D-TRUS and MRI by B-K color Doppler ultrasound system and Philips 1.5T magnetic resonance instrument within 2 weeks before operation,and TN staging was performed according to the depth of the intestine wall and the lymph nodes surrounding the lesion.T₁-T₂ stage includes tumor infiltration into the mucosa and submucosa of the rectal wall and infiltration into the muscularis of the rectal wall.T₃ stage is the lesion that penetrates the muscularis propria and reaches the tissues surrounding the rectum;T₄ stage that penetrates the infiltrating visceral peritoneum and/or adjacent to the tumor Organs and organs.N₀ stage is regional lymph nodes showed no metastasis;N₁ stage is 1-3 of regional lymph nodes had metastasis.N₂ stage is greater than or equal to 4regional lymph node metastases.When 3D-TRUS combined with MRI was used to evaluate TN staging of rectal cancer,T₁-T₂staging was dominated by3D-TRUS staging,and T₃,T₄,and N staging were dominated by 3D-TRUS or MRI staging,and either method could It is more clearly shown that tumor infiltration or lymph node metastasis can be considered positive?higher staging principle?.All the lesions were completely resected during the operation,and the postoperative gross pathological specimens were used as the gold standard.SPSS 17.0 statistical software was used for data analysis.The value of TN staging of rectal cancer was evaluated by using the two methods independently and combined.Results:1.The results of postoperative pathological examination showed that there were 67 cases of T stage,including 24 cases of T₁-T₂ stage,23 cases of T₃ stage,and 20 cases of T₄ stage.The postoperative pathological results showed that there were 67 cases of N stage,including 36 cases of N₀ stage.There were 22 cases of N₁ stage and 9 cases of N₂ stage.2.Preoperative3D-TRUS examination evaluated the accuracy of T₁-T₂,T₃,T₄ and T staging at83.3%,78.3%,70.0%and 77.6%,respectively;preoperative MRI examination evaluated T₁-T₂,T₃,T₄ and T The accuracy of staging was 50%,52.3%,75%,and 58.2%,respectively.The accuracy of T₁-T₂ staging and T staging was statistically significant?P<0.05?,but for T₃ and T₄ staging.There was no significant difference in the accuracy rate?P>0.05?.3.Preoperative 3D-TRUS examination evaluated the accuracy of N₀,N₁,N₂,and N stagings as 86.1%,50.0%,22.2%,and 65.7%,respectively.Preoperative MRI assessed the accuracy of N₀,N₁,N₂,and N staging.They were 88.9%,77.3%,66.7%,and 82.1%,respectively.There was no significant difference in the accuracy of N₀,N₁,and N₂ staging between the two methods?P>0.05?,but there were significant difference in the overall accuracy of N staging?P<0.05?.4.The accuracy of the combined examination for T₁-T₂,T₃,T₄ and T staging of rectal cancer was83.3%,73.9%,95.0%,and 95.0%,respectively.The accuracy of the combined examination for the assessment of N₀,N₁,N₂and N staging of rectal cancer was83.3%,90.9%,77.8%and 85.1%.The agreement between 3D-TRUS and preoperative T staging of rectal cancer was higher than that of MRI?Kappa0.662,p<0.05;Kappa 0.373,p<0.05?;MRI was consistent with the pathological results of preoperative N staging of rectal cancer.The sex was higher than3D-TRUS?Kappa 0.686,p<0.05;Kappa 0.364,p<0.05?.The combination of the two methods in the T-stage and N-stage of rectal cancer was highly consistent with the pathological results,and the agreement was higher than that of the single use?Kappa 0.754,p<0.05;Kappa 0.749,p<0.05??Conclusion:1.Because 3D-TRUS and MRI examinations can clearly show the fine layer structure of the intestinal wall and the abnormal lymph nodes around the lesion,both methods can be used to evaluate the preoperative TN stage of low and middle rectal cancer.2.3 D-TRUS is more accurate than MRI in preoperative T staging and T₁-T₂ staging of middle and low rectal cancer.The accuracy of MRI is higher than 3D-TRUS in N staging,and the difference is statistically significant,so 3D-TRUS examination has higher clinical value in the T stage of rectal cancer,especially T₁-T₂ stage,and MRI has more clinical application value in N stage.3.The complication of two methods has higher accuracy and consistency with pathological results than each method is used independently.