| Objective:To study the diagnostic value of multi-slice CT(MSCT)in the restaging of locally advanced esophageal squamous cell carcinoma after neoadjuvant chemotherapy,and to provide reference for clinical diagnosis and treatment.Methods:In this study,65 patients with esophageal squamous cell carcinoma who underwent surgical resection after neoadjuvant chemotherapy in the Affiliated Hospital of North Sichuan Medical College from October 2016 to August 2020 were included,and 65 patients with esophageal squamous cell carcinoma who underwent surgical resection alone were used as the control groups.Two experienced radiologists in our hospital performed preoperative T and N staging according to the CT image data of the patients,and if the staging was inconsistent,they jointly discussed to achieve agreement.Two radiologists were completely blinded to the tumor location,size,clinical and surgical results.Referring to the 8th edition of esophageal cancer staging criteria,with pathological staging as the gold standard,the sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of preoperative MSCT in the diagnosis of esophageal squamous cell carcinoma T and N staging were calculated and compared between the two groups.The Cohen Kappa values of T and N staging diagnosed by preoperative MSCT were used to determine the consistency between preoperative T and N staging and pathological staging in the surgery alone and neoadjuvant chemotherapy groups,respectively.Results:The results of the neoadjuvant chemotherapy group were as follows:the overall accuracy of preoperative MSCT for the diagnosis of T staging after neoadjuvant chemotherapy was 66%(43/65)The sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of preoperative MSCT after neoadjuvant chemotherapy in the diagnosis of T0 stage were 20%,98%,50%,94%,and 92%,respectively;the sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of T1-2 stage were 74%,67%,48%,86%,and 69%,respectively;the sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of T3 stage were 68%,81%,84%,61%,and 74%,respectively;and the sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of T4a stage were 100%,98%,50%,100%,and 99%,respectively.The sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of stage T4b were 50%,100%,100%,98%,and 99%,respectively.The Kappa of preoperative MSCT in the diagnosis of T stage after neoadjuvant chemotherapy was 0.424(p<0.05),which was generally consistent with the pathological T stage.The overall accuracy of preoperative MSCT in diagnosing N stage after neoadjuvant chemotherapy was 62%(39/63).The sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of preoperative MSCT in the diagnosis of N+after neoadjuvant chemotherapy were 41%,79%,63%,61%,and 62%,respectively.The Kappa of preoperative MSCT diagnosis of N stage after neoadjuvant chemotherapy was 0.213(P>0.05),without statistical significance.The results of the surgery-only group were as follows:the overall accuracy of preoperative MSCT in diagnosing T stage was 83%(54/65)The specificity of preoperative MSCT in the diagnosis of T0 stage was 95%;the sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of T1-2 stage were 75%,90%,82%,86%,and 85%,respectively;the sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of T3 stage were 90%,84%,90%,84%,and 88%,respectively;and the sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of T4a stage were 0,100%,0,99%,and 99%.Preoperative MSCT diagnosis of T stage Kappa 0.659(P<0.05),and pathological T stage agreement is good.The overall accuracy of preoperative MSCT for the diagnosis of N staging was 77%(50/65)The sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of preoperative MSCT for the diagnosis of N+were 33%,98%,88%,75%,and 77%,respectively.The Kappa of preoperative MSCT in the diagnosis of N stage was 0.371(P<0.05),which was in poor agreement with pathological stage.Comparison of diagnostic results between the two groups:The overall accuracy of preoperative MSCT in the diagnosis of T staging in the neoadjuvant chemotherapy group was 66%(95%CI 54%-7 7%)and 83%(95%CI 72%-90%),respectively(P<0.05).Among them,the clinical T1-2 stage accuracy was 69%(95%CI 57%-79%),85%(95%CI 74%-92%),respectively(P<0.05).Clinical T3 stage accuracy was 74%(95%CI 62%83%),88%(95%CI 77%-94%),respectively(P<0.05).The specificity of preoperative MSCT in the diagnosis of T1-2 stage in the neoadjuvant chemotherapy alone group was 67%(95%CI 52%-80%)and 90%(95%CI 76%-100%),respectively(P<0.05).The sensitivity at stage T3 was 68%(95%CI 51%-82%),and 90%(95%CI 75%-100%),respectively(P<0.05).The accuracy of preoperative MSCT in the diagnosis of N staging in the neoadjuvant chemotherapy alone group was 62%(95%CI 50%-73%)and 77%(95%CI 65%-86%),respectively(P>0.05),with no statistically significant difference.The specificity of preoperative MSCT in the diagnosis of N stage in the neoadjuvant chemotherapy alone group was 79%(95%CI 62%-91%)and 98%(95%CI 86%-100%),respectively(P<0.05).There was no statistically significant difference between the two groups in terms of gender,age,tumor location,and tumor thickness.Conclusion:1)the overall accuracy of preoperative MSCT in the diagnosis of esophageal squamous cell carcinoma treated with surgery alone was high.Relatively speaking,after neoadjuvant chemotherapy for locally advanced esophageal squamous cell carcinoma,the overall accuracy of preoperative MSCT restaging is low,in which the specificity of T1-2 stage and the sensitivity of T3 stage are low,which tends to underestimate the T stage;the specificity of N+is low,and it is not easy to distinguish and exclude metastatic lymph nodes.2)Preoperative diagnosis of MSCT after neoadjuvant chemotherapy has advantages in ruling out advanced tumors of esophageal cancer. |
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