高频超声内镜在早期胃癌可疑黏膜下浸润的诊断价值

目的探讨高频超声胃镜(HFUS)在判断早期胃癌可疑黏膜下浸润的诊断价值。方法回顾性分析2015年12月至2020年8月江苏省中医院术前行HFUS检查的126例早期胃癌患者的临床资料,将HFUS检查结果与术后病理结果做对比分析。结果将溃疡型病变剔除,HFUS评估早期胃癌病变浸润深度的准确性86.3%,其主要影响因素有分化类型、病灶大小、病灶形态等。针对白光内镜下怀疑有黏膜下浸润的病灶,HFUS评估早期胃癌病变浸润深度准确性提高至94.3%,胃角部位及残胃病灶可能会被白光内镜及HFUS过度判断。针对食管胃交界早癌siewertⅡ/Ⅲ型黏膜下浸润判断,准确性达到90.2%。结论HFUS作为判断早期胃癌浸润深度的诊断方法之一,具有一定的临床价值,对非溃疡型病灶白光内镜怀疑有黏膜下浸润时可行HFUS进一步明确。HFUS对于食管胃交界癌浸润深度判断亦有一定临床价值。

High Frequency EUS for Depth Diagnosis of Early Gastric Cancer with Suspected Submucosal Invasion

Objective To explore the value of High Frequency endoscopic ultrasonography( HFUS) in judging staging depth of invasion in early gastric cancer with Suspected Submucosal Invasion. Methods The clinical data of 126 patients with early gastric cancer who underwent HFUS before operation in the Jiangsu Province Hospital of Chinese Medicine from December 2015 to August 2018 was analyzed retrospectively. The preoperative HFUS results were compared with the pathological findings. Results The accuracy and sensitivity of HFUS in evaluating the depth of invasion were 86. 3%. The main influencing factors were the type of differentiation,the size and the shape of the lesion. Furthermore,we focused on the lesions suspected to have submucosal invasion by conventional endoscopy,it was found that the accuracy was improved to 94. 3%. The lesions in the gastric angle and partial gastrectomy may be overdiagnosed by white light endoscopy and HFUS. The accuracy of HFUS in evaluating the depth of invasion of the lesions in the esophagogastric junction of siewert Ⅱ/Ⅲ types were 90. 2%. Conclusion HFUS has limited clinical value in the staging depth of invasion in early gastric cancer. But it’s more valuable if we do it selectively. Based on the data from this study,we suggest that it is feasible to identify non-ulcer lesions with conventional endoscopy when submucosal invasion is suspected.