内镜超声检查和多层螺旋CT对胃癌术前T、N分期的比较研究

目的探讨内镜超声(endoscopicultrasonography,EUS)与多层螺旋CT(multi slicespiralCT,MSCT)在胃癌术前T、N分期中的临床应用价值。方法2000年10月至2002年5月,对89例活检证实的胃癌病人术前分别行内镜超声和多层螺旋CT检查,并与手术病理结果对照。结果EUS对胃癌术前T分期的准确率为75.6%,其中T176.5%,T268.8%,T384.4%,T464.7%;MSCT分别79.3%,58.8%,62.5%,90.6%和94.1%。两者差异无统计学意义(P>0.05)。EUS对胃癌术前N分期的准确率为57.5%,其中N095.8%,N145.8%,N232.0%;MSCT分别78.1%,70.8%,75.0%和88.0%。EUS和MSCT对胃癌淋巴结转移的敏感性分别为61.2%和91.8%。EUS对N0分期的准确率显著高于MSCT(P<0.05),MSCT对N和N2分期的准确率及淋巴结转移的敏感性均显著高于EUS(P<0.05,P<0.01,P<0.01)。结论内镜超声检查与多层螺旋CT对胃癌术前TN分期均有较高的准确性。     

胃双重超声造影结合血清巨噬细胞炎症蛋白1与血管细胞黏附分子1检测对胃癌术前分期的价值

目的:探讨胃双重超声造影(DCEUS)联合血清巨噬细胞炎症蛋白1(MIP-1)与血管细胞黏附分子1(VCAM-1)检测对胃癌术前分期的临床价值。方法:685例胃癌患者术前行胃镜和DCEUS检查并进行术前分期,同时运用ELISA法检测术前血清MIP-1与VCAM-1水平,根据术后病理分期,比较DCEUS与DCEUS联合MIP-1与VCAM-1检测对胃癌术前分期判断准确性。结果:DCEUS对胃癌T分期判断的敏感性(特异性)分别为T1 93.10%(92.05%)、T2 67.47%(65.50%)、T3 78.62%(80.47%)、T4 91.41%(90.70%),总准确率为80.15%;对N分期判断的敏感性(特异性)分别为N0 90.55%(80.99%)、N1 63.57%(73.87%)、N2 88.40%(92.50%)、N3 82.35%(73.68%),总准确率为82.92%;对M分期判断的敏感性(特异性)分别为:M0 99.29%(84.82%)、M1 71.48%(98.43%),总准确率为88.61%。血清MIP-1和VCAM-1水平与胃癌组织浸润程度、淋巴结转移、远处转移和病理分期均有关(均P0.05)。DCEUS联合MIP-1、VCAM-1检测对T分期判断的敏感性(特异性)分别为T1 93.10%(92.05%)、T2 87.95%(94.19%)、T3 95.07%(92.33%)、T4 91.41%(90.70%),总准确率为92.41%;对N分期判断的敏感性(特异性)分别为:N0 98.43%(96.90%)、N1 89.15%(94.26%)、N2 95.22%(95.22%)、N3 92.65%(89.36%),总准确率为94.16%;对M分期判断的敏感性(特异性)分别为M0 99.76%(97.68%)、M1 96.20%(99.61%),总准确率为98.39%。DCEUS联合MIP-1、VCAM-1检测对判断胃癌T、N、M分期的准确率均明显高于DCEUS(均P0.05)。结论:胃癌的病理分期与血清MIP-1和VCAM-1表达密切相关,DCEUS联合术前检测MIP-1和VCAM-1血清水平,有利于提高胃癌术前分期判断的准确性。     

胃癌术前内镜超声检查与肿瘤血管内皮生长因子表达的检测分析

目的探讨内镜超声检查(EUS)对胃癌术前诊断和分期的应用价值及其影像学改变与肿瘤转移相关基因表达的分子生物学基础。方法联合应用电子胃镜和超声内镜诊断胃癌63例,对比胃镜检查加活检与超声内镜对胃癌诊断的准确率,同时应用超声内镜对胃癌进行术前分期,并与病理分期及血管内皮生长因子(VEGF)表达进行比较。结果63例胃癌中胃镜加病理活检诊断的准确率是94%,超声内镜诊断的准确率是92%,胃镜联合超声内镜诊断的准确率是100%。超声内镜对胃癌侵犯深度判断的准确率为81%,其中T1期为78%、T2期为79%、T3期为82%、T4期为83%,对淋巴结转移的准确率为73%。VEGF蛋白在胃癌组织中的阳性表达率为56%,其表达与EUS分期、淋巴结转移关系密切(P<0.05)。结论胃镜联合超声内镜诊断胃癌具有较高的准确率;胃癌术前内镜超声分期与术后病理有较高的一致性;VEGF蛋白表达与胃癌术前EUS分期呈正相关;EUS对胃癌的分期与分子生物学改变有关。     

超声双重造影在胃癌术前TN分期中的价值

目的 在胃癌术前分期中,通过与超声内镜检查(EUS)对比分析超声双重造影(DCUS)检查的价值.方法 选择162例经病理活检证实为胃癌并进行手术切除的患者,手术前5 d内进行EUS及DCUS检查,并进行TNM分期,与术后病理检查结果对照得出正确率,并进行相互比较.结果 本组162例胃癌患者中TNM分期:42例为T1期,49例为T2期,56例为T3期,15例为T4期.DCUS和EUS术前T分期总的正确率分别为77.2%、74.7%(χ2=0.273,P=0.603),而在T3分期上DCUS优于EUS(χ2=5.009,P=0.025);在N分期上两者总的正确率分别为78.4%、57.4%(χ2=16.370,P=0.001),而两者的敏感性和特异性分别为78.4%比49.5%、78.5%比69.2%.在对阳性淋巴结诊断上DCUS的正确率较高(78.4%比49.5%,χ2=17.523,P<0.01),尤其是对低分化腺癌患者阳性淋巴结的诊断正确率较高(81.5%比42.6%,χ2=17.338,P<0.01).结论 DCUS检查在胃癌术前分期中有较好的应用价值,其在预测阳性淋巴结方面,尤其是判断低分化腺癌患者有无淋巴结转移上正确率高于EUS检查.     

核磁共振与腔内超声对直肠癌术前局部分期的价值比较

目的 比较核磁共振(MRI)和腔内超声(EUS)对直肠癌术前分期的价值.方法 分别应用MRI和EUS检查对72例和55例直肠癌患者行术前分期,与手术及病理结果对比,比较MRI和EUS对直肠肿瘤浸润深度、区域淋巴结转移判断的准确性.结果 MRI判断T分期总的准确率为76.4％ (55/72),MRI评价N分期的准确率为63.9％ (46/72),EUS判断T分期总的准确率为81.8％(45/55),评价N分期的准确率为65.5％ (36/55).结论 MRI与EUS判断T分期的准确性差异无统计学意义,EUS判断早中期直肠肿瘤浸润层次的准确率高于MRI,两者判断N分期的准确率均较低.     

多排CT对胃癌术前分期的单中心大宗病例研究

目的:探讨多排CT(multidetector-row CT,MDCT)对胃癌术前分期的价值。方法:对1 311例胃癌病人术前行MDCT检查,并与手术病理结果相对照。结果:MDCT检查对胃癌T分期的判断准确率为75.3%,其中T1期为74.3%,T2~3期为42.9%,T4a期为85.6%,T4b期为81.9%。MDCT检查判断胃癌淋巴结转移的灵敏度、特异度、阳性预测值、阴性预测值和准确率分别为83.3%、71.8%、81.2%、74.6%和78.6%;对胃癌远处转移的判断分别为70.4%、98.3%、86.9%、95.5%和94.5%;对胃癌肝脏转移的判断分别为74.1%、99.7%、83.3%、99.5%和99.2%;对胃癌腹膜转移的判断分别为54.5%、99.3%、87.1%、96.4%和96.0%;对胃癌远处淋巴结转移的判断分别为76.3%、99.1%、84.1%、98.6%和97.8%。结论:MDCT检查对胃癌术前分期具有较高的临床应用价值,但对胃癌腹膜转移的灵敏度相对偏低,对于腹膜转移概率较大的病人仍需行诊断性腹腔镜检查,以避免不必要的剖腹探查。     

超声内镜在胰腺及壶腹周围占位术前评估中的临床作用

目的评估超声内镜(EUS)对胰腺及壶腹周围占位的诊断及术前TNM分期的作用。方法回顾性分析34例壶腹部占位患者术前EUS资料,并与术后病理结果比较,评估EUS术前诊断准确性。结果 EUS对胰腺占位病灶显示率92.31%,诊断准确率84.62%,T分期判断准确性为76.92%,N分期判断准确性为53.85%;对壶腹部占位病灶显示率为93.75%,诊断准确率93.75%,T分期判断准确性为62.50%,N分期判断准确性为68.75%。结论 EUS对胰腺及壶腹周围占位的诊断及术前TNM分期具有一定作用。     

胃癌术前分期的临床应用及其价值

准确的胃癌术前分期是胃癌综合治疗方案实施的需要.早期胃癌,特别是黏膜内癌,可以行内镜下切除以避免不必要的外科手术;为了获得局部进展期胃癌R0切除,新辅助治疗倍受关注并已展开探索.随着内镜超声检查(EUS)、经腹超声检查(TAUS)、多层螺旋CT(MSCT)、磁共振成像(MRI)、正电子发射型断层成像(PET)、PET-CT和腹腔镜探查分期等影像学技术的发展,胃癌术前分期的准确率已得到明显改善.本文旨在对胃癌术前分期的临床应用现状及其价值作一阐述.     

食管癌与贲门癌患者术前内镜超声检查28例分析

目的 通过对比内镜超声及CT在食管癌、贲门癌术前进行T、N分期中的准确度,评价内镜超声的临床应用价值. 方法 对28例食管癌、贲门患者术前均行内镜超声扫描和CT扫描,并分别进行T、N分期,以术后病理为金标准,比较两者分期的准确性有无差异,同时对比两者对淋巴结转移的准确率(即真实性)的差异,判断内镜超声的应用价值. 结果 本组28例病例中,T分期准确率内镜超声为89.3%(25/28),高于CT的46.4%(13/28),差异有统计学意义(P=0.004,P＜0.01).N分期中,内镜超声与CT的准确率分别为82.1%(23/28)及50.0%(14/28),差异有统计学意义(P=0.035,P＜0.05).对转移淋巴结的分组统计中,内镜超声与CT的准确率分别为88.7%及72.2%,有显著性差异(χ2=7.031,P=0.008,P＜0.01).结论 内镜超声在食管癌、贲门癌术前分期中有重要作用,其T分期准确率明显高于传统CT扫描.以淋巴结短径、S/L(淋巴结短径/淋巴结长径)并结合淋巴结的超声显像特征进行分析,提高了判断淋巴结转移以及N分期的准确性.     

对比增强超声造影在胃癌术前T分期中的诊断价值

目的探讨对比增强超声造影对胃癌术前T分期的临床诊断价值。方法采用六氟化硫微气泡造影剂和连续实时成像的对比脉冲序列技术．对8例健康志愿者进行超声造影．并与正常胃螺旋CT增强造影结果相对照：对62例经胃镜活检证实的胃癌患者术前行超声造影．并与术后病理检查结果对照。结果8例正常胃壁在对比增强超声造影动脉期、平衡期呈3层结构，门脉期呈单层结构。3层结构中内层轻度增强相应于黏膜层：中间层低增强相应于黏膜下层：外层明显增强相应于肌肉-浆膜层。62例经腹超声检查胃癌术前T分期的准确率为72．9％．对比增强超声造影T分期准确率为88．1％，两者T分期的差异有统计学意义（X2=4．37，P=0．036）。结论正常胃壁在对比增强超声造影下可显示单层或3层结构．这为判断胃癌浸润深度提供了理论基础。对比增强超声造影对胃癌术前T分期具有较高的临床应用价值。     

Association of color Doppler vascularity index and microvessel density with survival in patients with gastric cancer

OBJECTIVE: The purpose of this study was to investigate the clinical usefulness of microvessel density (MVD) and an in vivo angiogenesis parameter, color Doppler vascularity index (CDVI), in patients with gastric cancer. SUMMARY BACKGROUND DATA: Many studies have reported a significant association between the degree of MVD-evaluated angiogenesis with the clinicopathologic factors and prognosis of patients with various solid tumors. All these studies were accomplished on tissue sections retrospectively obtained from surgical specimens. However, an in vivo method to assess tumor angiogenesis for human malignancies is highly desirable for diagnostic purpose, treatment planning, and follow-up. The CDVI is a new ultrasound parameter for evaluating in vivo angiogenesis, has a good correlation with status of lymph node metastasis in cervical carcinoma, and can predict distant metastasis and survival in colon cancer patients. Therefore, the CDVI may also be useful to assess in vivo angiogenesis in human gastric cancer. METHODS: A total of 79 patients with gastric cancer were enrolled in this study, and microvessel density was evaluated by using immunohistochemical staining of surgical specimens with anti-CD-34 antibody. Tumors were sonographically visible in 31 patients. The CDVI of each tumor was determined using transabdominal color Doppler ultrasound. The CDVI was defined as the ratio of the number of the colored pixels within a tumor section to the number of total pixels in that specific tumor section, and was calculated by using Encomate software (Electronic Business Machine Co. Ltd., Taipei, Taiwan). Correlation between MVD, CDVI and clinicopathologic factors and patient survival was studied. RESULTS: The MVD was significantly correlated with vascular invasion by multiple linear regression analysis. Although the survival of patients with high MVD (> 32) was significantly worse than those with low MVD (< 32) by univariate analysis, vascular invasion was an independent prognostic factor by Cox proportional hazard model. There was a linear correlation between CDVI and MVD (r =.495, P =.005). Moreover, in patients with a high CDVI (> 11%), the survival rate was significantly lower than that in those with low CDVI (< or = 11%, P =.005). None of the patients with high CDVI (> 11%) survived 2 years after curative resection. In addition to vascular invasion, the CDVI was another independent prognostic factor in the patients with stage III gastric cancer. CONCLUSIONS: Vascular invasion was an important prognostic indicator in gastric cancer. The high CDVI was a good preoperative indicator of early death in stage III gastric cancer patients. Thus, the CDVI may be helpful in selecting patients with gastric cancer for neoadjuvant chemotherapy and/or anti-angiogenic therapy.     

内镜活检对胃癌组织学分类术前诊断的价值

目的 探讨内镜活检对胃癌组织学分类术前诊断的价值。方法 术前对141例胃癌患的内镜活检标本分别根据Lauren分类和世界卫生组织（WHO）分类判断组织学分类，并与手术标本结果对照。结果 内镜活检对胃癌Lauren分类术前诊断的准确率为76.6%。对肠型胃癌诊断的敏感性和特异性分别为85.4%和80.6%。而对弥漫型胃癌则分别为82.7%和80.3%，在59例术前诊断为肠型胃癌的病例中，18例（30.5%)在手术标本中呈弥漫性行生长，而在75例术前诊断为弥漫型胃癌的病例中，仅6例（8.0%)术后诊断为肠型胃癌，内镜活检对胃癌WHO分类术前诊断的准确率为87.2%，其中对乳头状/管状腺癌，黏液腺癌和印戒细胞癌的敏感性分别为91.9%。33.3%和66.7%。结论 内镜活检对胃癌组织学分类的术前诊断具有较高的临床应用价值。     

磁共振成像对膀胱肿瘤分期的评价

从１９９２年８月至１９９４年８月，采用ＭＲ、ＣＴ、经尿道腔内超志和经腹部超声对２７例膀胱肿瘤患者的３３个肿瘤进行了检查，并分别与术后病理分期结果进行比较。ＭＲ判断肿瘤分期的准确率为９２．５％，ＣＴ为７３．３％，经尿道腔内超声为８８．９％，经腹部超声为６０．０％。结果认为，经腹部超声可用于对膀胱肿瘤的筛选检查，判断肿瘤分期不可靠，经尿道腔内超声对限于膀胱壁以内的肿瘤分期是准确的，而ＣＴ对浸润到膀胱壁     

经尿道腔内超声在膀胱肿瘤诊断和分期中的价值

目的　探讨经尿道腔内超声在膀胱肿瘤诊断和分期中的价值。　方法　总结 70例膀胱癌患者经尿道腔内超声诊断及分期的结果 ,并与膀胱镜、经腹壁超声、CT、MRI、术后病理结果对比。　结果　经尿道腔内超声肿瘤检出率 99.1% ,高于膀胱镜和经腹壁超声检出率 ;膀胱肿瘤分期与病理符合率 :T110 0 .0 %、T2 95 .8%、T3 82 .4 %、T45 5 .6 %。　结论　经尿道腔内超声能清晰显示早期膀胱肿瘤及其浸润深度 ,是早期膀胱肿瘤诊断及分期的重要方法之一     

多层螺旋CT在胃癌术前分期中的临床应用

目的探讨多层螺旋CT（MSCT）在胃癌术前分期中的临床应用价值。方法2004年6月至2006年3月间经胃镜活检确诊为胃癌的患者89例，其中男性49例，女性40例，中位年龄63岁。所有患者均在手术前1周内进行MSCT检查。图像由2位资深放射科医师双盲阅读，术前判断患者的肿瘤TNM分期．并与患者的术后病理结果进行对照比较。结果与术后病理诊断比较，MSCT普通轴位图像结合多平面重建法判断胃壁侵犯程度的总准确率为72．3％，其中T1判断准确率为90．0％，T2为82．8％，T3为69．6％，T4为52．4％；判断淋巴结转移情况的总准确率为53．0％，其中N0判断准确率为44．0％，N1为72．0％，N2为46．4％，N3为2／5。MSCT对有远处转移即M1的患者判断准确率为90．0％。结论MSCT对胃癌患者进行术前TNM分期有较高的准确率，可以为胃癌患者术前提供一种无创且易于被接受的检查方法。     

Staging laparoscopy for gastric cancer

The growing role of multimodal treatment plans for advanced gastric cancer has contributed to the development of more accurate preoperative staging strategies. The high diagnostic efficacy of video-laparoscopy as regards the M factor has been reported by many; preoperative laparoscopy therefore permits to avoid unhelpful surgical exploration in case of peritoneal dissemination of tumor or liver metastases undetected by conventional staging. At Memorial Sloan Kattering Cancer Center preoperative staging laparoscopy is currently included in the diagnostic algorithm for gastric cancer. Data from a consecutive series of 103 patients demonstrated metastatic disease in 24 patients (37%) who were considered to have localized cancer by computed tomography (CT) or endoscopic ultrasonography (EUS), with an accuracy of 94% with respect to the M factor. These patients did not require open surgery. Laparoscopic washings were obtained from 127 patients with gastric cancer and a positive correlation between the extent of disease and prevalence of positive cytology was noted (T1/T2: 0%, T3/T4: 10%, M+: 59%). Our experience suggests that laparoscopy has added value in staging patients with gastric carcinoma. It appears to be a safe and effective staging modality, avoiding unnecessary explorations and providing new means of directing appropriate treatment strategy.