- 期刊
直腸癌術前TNM分期於磁振造影之臨床應用
The Value of MRI in Preoperative TNM Staging Diagnosis of Rectal Cancer
摘要
近年來隨著工商業的繁忙，造成國人飲食習慣西化及三餐不正常的緣故，腸胃方面的疾病日益增加，其中直腸癌目前已躍升為台灣十大癌症死亡原因的第三位。雖然直腸癌診斷與治療方法日趨進步，但在已開發國家中每年仍有超過百萬人罹患此疾病，據統計每年約33%死於直腸癌，可見這是健康照護上重要的課題。臨床病理分期是影響直腸癌預後最重要的因素，故本研究於2014年9月至2016年4月間，經外科手術及病理檢體均證實為直腸癌，共收錄30位病患，將所有病患手術治療前進行之磁振造影檢查影像，以TNM(Tumor-Node-Metastasis)分類法進行分期的結果與術後病理檢體結果進行比較，結果顯示利用TNM分期對直腸癌的診斷準確率為86.7%，其中T1及T2期診斷準確率80% (4/5)，T3、T4期診斷準確率分別為95.2%(20/21)、100%(4/4)，其中有3例分期被高估。磁振造影術前TNM分期與病理分期結果，經統計分析顯示為極顯著高度相關性(r=0.923，p＜0.001)，可見利用磁振造影檢查TNM方式進行直腸癌的分期，其準確性是可信賴的，希望藉由此一分期診斷方式可以提供臨床醫師正確及詳實之癌症期別，而直腸癌病患亦可得到更優質之醫療服務及品質，進而提昇國人之健康及醫療環境。
並列摘要
Rectal cancer is now the third leading cause of death in Taiwan. Despite advances in diagnosis and treatment, there are still around one million deaths every year in developed countries from rectal cancer, and its mortality rate is approximately 33%. This figure is of concern to health professionals. Clinic pathological stage at the time of diagnosis remains the most important prognostic indicator in rectal cancer. This present study involved 30 patients with surgically and pathologically proven rectal cancer, and was performed between September 2014 and April 2016. The results of staging based on a preoperative MRI scan were compared to staging from the pathological specimen itself removed at surgery. Results indicated that the overall diagnostic accuracy of MRI scans for T staging of rectal cancer was 86.7% - the accuracy in the T1-T2 stage was 80% (4/5); in the T3 stage was 95.2% (20/21); and for the T4 stage was 100% (4/4). However, three cases of rectal cancer were overestimated in their stage by MRI scans. Statistical analysis still indicates that the results of MRI staging as compared to pathologic staging are in good agreement (r = 0.696, p＜0.001). The overall results suggest that the detailed cross-sectional images provided by MRI scans can assist in both diagnosis and staging of rectal cancer, particularly when correlated with pathological findings.
延伸閱讀
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