内镜超声在胃部疾病性质诊断中的应用

doi:10.7517/issn.1674-0475.220109

摘要/Abstract

摘要： 本研究探讨内镜超声（EUS）在鉴别诊断胃部疾病良恶性及术前判断胃癌TNM分期中的价值。本研究采用病例对照研究方式，选取确诊的胃癌患者94例（胃癌组）、胃部良性疾病患者98例（良性组），所有患者均接受了EUS检查。EUS鉴别诊断胃部肿瘤良恶性的灵敏度为92.55%、特异度为92.86%，AUC值为0.927；EUS正确诊断T1分期23例、正确诊断T2分期21例、正确诊断T3分期11例、正确诊断T4分期8例，EUS诊断T分期与术后病理学的Spearman相关性=0.818，Kappa=0.616（P均<0.05）；EUS正确诊断N0分期35例、正确诊断N1分期21例、正确诊断N2分期6例，EUS诊断N分期与术后病理学的Spearman相关性=0.584，Kappa=0.523（P均<0.05）；EUS正确诊断M0分期64例、正确诊断M1分期15例，EUS诊断M分期与术后病理学的Spearman相关性=0.733，Kappa=0.731（P均<0.05）。EUS在鉴别诊断胃部肿瘤良恶性方面具有较高的灵敏度和特异度，同时作为一种术前TNM分期评估手段，与手术结果的病理学具有较高的一致性，因此临床上可以作为胃癌患者诊断及病理学判断的方式。

关键词: 内镜超声, 鉴别诊断, 良恶性, 胃癌, TNM分期

Abstract: This study investigated the value of endoscopic ultrasonography (EUS) in differential diagnosis of benign and malignant gastric diseases and preoperative TNM staging of gastric cancer. The case control study was used in this paper, 94 patients with gastric cancer (gastric cancer group) and 98 patients with benign gastric diseases (benign group) confirmed by pathological examination were selected. All patients underwent EUS examination. The sensitivity of EUS in the differential diagnosis of benign and malignant gastric tumors was 92.55% and the specificity was 92.86%, the AUC value was 0.927. EUS correctly diagnosed 23 cases of T1 stage, 21 cases of T2 stage, 11 cases of T3 stage, and 8 cases of T4 stage. The Spearman correlation between EUS-diagnosed T stage and postoperative pathology was 0.818, Kappa=0.616 (all P<0.05). EUS correctly diagnosed 35 cases of N0 stage, 21 cases of N1 stage and 6 cases of N2 stage. Spearman correlation between N stage and postoperative pathology by EUS was 0.584, Kappa=0.523 (all P<0.05). EUS correctly diagnosed 64 cases of M0 stage and 15 cases of M1 stage. Spearman correlation between M stage and postoperative pathology by EUS was 0.733, Kappa=0.731 (all P<0.05). EUS has high sensitivity and specificity in the differential diagnosis of benign and malignant gastric tumors. At the same time, as a preoperative TNM staging evaluation method, it has a high consistency with the pathology of surgical results, so it could be used clinically as a gastric cancer patient methods of diagnosis and pathological judgment.

Key words: endoscopic ultrasonography, differential diagnosis, benign and malignant, gastric cancer, TNM staging

穆雷霞, 王磊, 孙珺珺, 高娅萍. 内镜超声在胃部疾病性质诊断中的应用[J]. 影像科学与光化学, 2022, 40(4): 730-734.

MU Leixia, WANG Lei, SUN Junjun, GAO Yaping. Application of Endoscopic Ultrasonography in the Diagnosis of the Nature of Gastric Diseases[J]. IMAGING SCIENCE AND PHOTOCHEMISTRY, 2022, 40(4): 730-734.

参考文献

[1] 何文琪, 伍兵. 胃癌术前cTN分期的影像研究进展[J]. 国际医学放射学杂志, 2019,42(1):76-80.
[2] Jones C M, Lyles A, Foley K. A national cross-sectional survey investigating the use of endoscopic ultrasound in the diagnosis and treatment of oesophageal cancer in the UK[J]. Clinical Radiology, 2021,76(6):458-464.
[3] 李小溪, 石宛灵, 康利克, 等. 双重超声造影联合超声内镜在胃癌患者术前TNM分期的应用价值[J]. 中国超声医学杂志, 2021,37(11):1249-1252.
[4] 陈孝平, 汪建平. 外科学[M]. 8版. 北京:人民卫生出版社, 2013.
[5] 白日兰, 杜娜雯, 崔久嵬. 免疫治疗联合化疗在胃癌治疗中的研究进展[J]. 中国肿瘤生物治疗杂志, 2019,26(6):700-704.
[6] 杨兴益, 李朝军, 郭浩. 超声内镜及多层螺旋CT在诊断胃癌术前TNM分期中的可行性研究[J]. 中国CT和MRI杂志, 2019,17(8):134-136.
[7] 顾鹏飞, 邓靖宇, 梁寒. 胃癌术前分期研究进展[J]. 中国肿瘤临床, 2019,46(1):6-11.
[8] 陈晓波, 张敏红, 黄祖东, 等. 胃癌采用320排容积CT进行术前分型及TNM分期价值[J]. 医学影像学杂志, 2021, 31(6):1031-1034.
[9] Moutinho-Ribeiro P, Costa-Moreira P, Morais R, et al. 14 endoscopic ultrasound in the diagnosis and staging of pancreatic cancer:a comparison with computer tomography imaging[J]. American Journal of Gastroenterology, 2019,114(1):S8.
[10] 夏晨梅, 陈霞, 李倩倩, 等. 超声内镜对胃癌术前T、N分期准确率的评估及其影响因素分析[J]. 浙江医学, 2018,40(3):255-257, 265.
[11] Lu J, Dai Y, Xie J W, et al. Combination of lymphovascular invasion and the AJCC TNM staging system improves prediction of prognosis in N0 stage gastric cancer:Results from a high-volume institution[J]. BMC Cancer, 2019,19(1):216.
[12] 吴琼, 施敏, 惠萍萍, 等. 超声内镜联合螺旋CT检查对胃癌治疗前TNM分期的临床价值[J]. 临床消化病杂志, 2016,28(1):1-4.
[13] 于珊, 吕敏之, 罗荣奎, 等. 胃癌伴神经内分泌分化患者临床病理特征及根治术后生存分析[J]. 中华胃肠外科杂志, 2021,24(5):426-432.
[14] 李怡宁. 超声内镜与多层螺旋CT对胃癌术前TNM分期诊断的对比研究[D]. 苏州:苏州大学, 2018.
[15] 曾强. 影像解剖形态学及功能成像在胃癌术前分期及预后的临床应用[D]. 厦门:厦门大学, 2019.