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。     

超声内镜和CT对食管癌术前分期的诊断价值

目的探讨超声内镜（EUS）和CT检查对食管癌术前分期的诊断价值。方法于2002年7月至2004年1月对51例食管癌手术患者行术前EUS和CT及术后病理检查，将EUS和CT分期结果和手术病理分期结果进行对照。结果（1）EUS检查T、N分期的准确率分别为82．4％（42／51）和88.0％（45／51）；CT检查T、N分期的准确率分别为52.9％（27／51）和51．0％（26／51）；EUS与CT联合检查T、N分期的准确率分别为86.3％（44／51）和90．2％（46／51）。（2）3种检查方式分期结果与病理分期结果的一致性统计结果：EUS检查T、N分期的Kappa分别为0．700（P〈0．001）和0．763（P〈0.001）；CT分别为0．275（P=0．002）和0．006（P=0.964）；EUS加CT则分别为0．769（P〈0.001）和0．801（P〈0.001）。（3）各组间差异的统计结果：EUS与CT比较，PT=0．001（X^2=10.079），PN〈0.001（X^2=16．730）；EUS加CT与EUS比较，PT=0.586（X^2=0．297），PN=0．750（X^2=0.102）。结论EUS对食管癌术前T、N分期诊断准确率较高，诊断价值优于CT；EUS与CT联合应用未能显著提高食管癌T、N分期的诊断准确率。     

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.     

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.     

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。     

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。     

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.     

腹腔镜联合影像设备对胃癌患者手术前分期的评估价值

目的:探讨腹腔镜联合CT对胃癌患者术前分期的临床评估价值。方法:选取2012年6月至2014年6月182例胃癌根治手术患者为研究对象,患者术前均行CT序贯腹腔镜检查对临床分期进行评估,并与病理结果进行对比。结果:对胃癌T分期诊断准确率:CT为80.77%(147/182),CT联合腹腔镜为91.21%(166/182),差异有统计学意义(P0.05)。对胃癌手术N分期诊断准确率:CT为74.73%(136/182),CT联合腹腔镜为90.11%(164/182),差异有统计学意义(P0.05)。对胃癌手术TNM分期诊断准确率:CT为69.78%(127/182),CT联合腹腔镜为92.31%(168/182),差异有统计学意义(P0.05)。结论:CT诊断胃癌TNM分期准确、有效,联合腹腔镜可最大限度地提高诊断准确性。     

超声内镜在胃癌术前诊断中的应用分析

目的探讨超声内镜(EUS)在胃癌术前TN分期中的应用经验。方法术后病理检查证实为胃癌而且使用超声内镜进行了术前TN分期的患者352例,对其资料进行回顾性分析。结果 EUS胃癌术前T分期总正确率为81.25%,其中T1为85.58%,T2为73.91%,T3为82.14%,T4为83.33%,与术后病理结果比较具有高度一致性(Kappa系数为0.75)。EUS对胃癌术前N分期总的正确率为52.84%,其中N0为85.56%,N1为56.69%,N2为28.09%,N3为26.09%,与术后病理结果比较具有一般一致性(Kappa系数为0.33)。将病变部位分为贲门、胃底、胃体、胃窦、幽门,不同部位之间的检测正确率比较,差异无统计学意义(P0.05)。结论EUS在胃癌术前诊断中具有临床意义,其中T分期可为合理制定治疗方案提供依据,N分期准确性有待提高。     

腔内超声与高分辨薄层直肠MRI新序列在术前评估与直肠癌术后病理结果的对比分析

背景与目的:准确的术前评估对选择新辅助治疗和制定手术方式优化完全切除至关重要。本研究对比分析直肠腔内超声(EUS)与高分辨薄层直肠磁共振成像(MRI)新序列(3.0T RESOLVE-DWI)术前评估与直肠癌术后病理结果。方法:前瞻性选择2016年2月-2018年5月行EUS与高分辨薄层直肠MRI新序列检查且行直肠癌根治性切除术的89例患者(排除术前联合放化疗及临床资料不全者等)为研究对象,以手术后病理分期为金标准,比较EUS与高分辨薄层直肠MRI新序列检查对直肠癌浸润深度(T分期)、区域淋巴结转移(N分期)判断的敏感度、特异度、准确度、阳性预测值、阴性预测值。结果:EUS、MRI对直肠癌T分期总准确度分别为65.0%、75.3%(P<0.05)。分析EUS与MRI对直肠癌T1~T4各分期的诊断价值数据发现,两组间无差异无统计学意义(P>0.05)。EUS、MRI对T过高分期分别占15.0%、11.2%;EUS、MRI对T过低分期分别占20.0%、13.5%;组间比较均无统计学差异(均P>0.05)。EUS、MRI对N分期总准确度分别为70.0%、78.5%,组间比较亦均无统计学差异(均P>0.05)。EUS、MRI对N过高分期分别占17.5%(14/80)、11.2%(10/89);EUS、MRI对N过低分期分别占12.5%(10/80)、11.2%(10/89);组间均无统计学差异(均P>0.05)。结论:高分辨薄层直肠MRI新序列扫描对直肠癌T分期的准确度较EUS有一定优势。     

64层CT三期动态增强扫描对胃癌术前TNM分期的判断价值

目的探讨64层螺旋CT三二期动态增强扫描对胃癌进行术前TNM分期的临床价值．方法回顾性分析2009年5月至2011年5月赣南医学院第一附属医院收治的120例胃癌患者的术前64层螺旋CT三期动态增强扫描资料和术后病理资料,由两名高年资影像科医生采用双盲法进行术前影像学分期。结果术前64层螺旋CT增强扫描对胃癌T分期判断的总体准确率为79．2％（95／120）,其中对T1、T2、T3和T4期判断的准确率分别为66．7％（10／15）、66．7％（14／21）、84．0％（42／50）和85．3％（29／34）。对于单层胃壁结构和多层胃壁结构,CT增强扫描对T分期的准确率分别为59．4％（19／32）和81．8％（72／88）．差异有统计学意义（P〈0．05）。CT增强扫描对N分期判断的总体准确率为73．9％（85／115）,其中对N0N1和N2期判断的准确率分别为75．5％（37／49）、70．3％f26／37）和75．9％（22／29）：对M分期判断的准确率为89．2％（107／120）。结论64层螺旋CTi期动态增强扫描可早期动态观察肿瘤累及侵犯情况、淋巴转移及远处转移的情况．有望成为胃癌术前分期有重要意义的检佥项目之一。     

Clinical Correlation of Endoscopic Ultrasonography with Pathologic Stage and Outcome in Patients Undergoing Curative Resection for Gastric Cancer

Background Endoscopic ultrasonography (EUS) is considered valuable for preoperative staging of gastric cancer and defining patient eligibility for enrollment in neoadjuvant protocols. The aim of this study was to correlate EUS staging with pathologic evaluation and outcome in patients undergoing curative R0 resection for gastric cancer. Methods All patients who underwent preoperative clinical assessment of T/N stage with EUS and subsequent R0 resection for gastric adenocarcinoma between 1993 and 2003 were identified from a prospective database. Patients who received neoadjuvant chemotherapy were excluded. Clinical staging results from preoperative EUS were compared with postoperative pathologic staging results and correlated with clinical outcome. Results Two hundred twenty-five patients with gastric cancer underwent EUS followed by R0 resection, without preoperative chemotherapy. The accuracy of the individual EUS T stage was 57% (127 of 223) and was 50% for N stage (110 of 218). Although EUS was less able to predict outcome according to individual T stage, patients with lesions ≤T2 on EUS had a significantly better outcome than patients with lesions ≥T3. Preoperative assessment of risk was not predicted by EUS N stage alone. Patients identified as high risk on EUS and those with a combination of serosal invasion and nodal disease had both the highest concordance with pathology and a significantly worse outcome (P = .02). Conclusions The concordance between EUS and pathologic results was lower than expected for individual T and N stages. Patients with lesions ≤T2 had a significantly better prognosis than patients with more advanced lesions. Individual EUS N stage has limited value in preoperative risk assessment. Combined assessment of serosal invasion and nodal positivity on EUS identifies 77% of patients at risk for death from gastric cancer after curative resection.     

含弥散加权成像磁共振与增强CT对胃癌术前T分期诊断准确率的比较

目的比较增强cT与含弥散加权成像（DWI）的磁共振（MR）成像对胃癌术前T分期诊断的准确率。方法前瞻性纳入2011年11月至2012年8月间经胃镜活检病理证实的41例胃癌患者,术前分别予增强CT和MR检查（包含DWI、T2WI和动态增强扫描）。由两位放射科医师分别对癌灶进行检测和T分期．并以手术病理结果为金标准,比较CT与MR的T分期准确率以及观察者间一致性。结果含DWI的MR对胃癌患者总体T分期的诊断准确率为87．8％（36／41）,明显高于增强cT65．9％（27／41）的诊断准确率（P=0．004）。MR诊断的观察者问一致性（Kappa=O．813）优于增强cT诊断（Kappa=0．603）。结论含DWI的MR成像对胃癌术前T分期的诊断准确率较增强CT显著提高,有望于临床广泛应用。     

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.     

140例结肠癌术前CT TNM分期与术后病理分期的相关性

目的:探讨结肠癌CT TNM分期与病理分期的相关性。方法:行CT检查结肠癌140例,其中平扫104例,平扫加增强36例,将其结果进行TNM分期,并与术后临床病理分期进行对照。结果:104例平扫CT患者术前的T、N、M及TNM分期诊断准确率与术后病理相比分别为84.62%(88/104)、71.15%(74/104)、85.58%(89/104)、81.73%(85/104),均具有中度一致性(均P0.001)。36例平扫加增强CT患者的诊断准确率分别为91.67%(33/36)、75%(27/36)、100%(36/36)、83.33%(30/36),均具有中度、完全、中度一致性(均P0.001)。结论:CT与病理无论T、N、M分期还是TNM综合分期,都具有中度以上的一致性,可作为结肠癌术前分期的有效的评估方法。     

Endoscopic ultrasonography for gastric cancer

BACKGROUND: This study aimed to evaluate the utility and shortcomings of endoscopic ultrasound (EUS) in tumor node metastasis (TNM) staging of gastric cancer and its influence on treatment. METHODS: The series included 126 patients (65 men and 44 women) with gastric cancer who underwent EUS from July 1997 to June 2003 at the National University Hospital, Singapore. The final analysis included 109 patients ranging in age from 29 to 97 years (mean, 63.13 years). RESULTS: EUS staging for primary disease: Specimen histology was available for 102 of the 109 patients who underwent surgery. The accuracy was 79% for T1, 73.9% for T2, 85.7% for T3, and 72.7% for T4. The overall accuracy was 80.4%. EUS staging for nodes: The sensitivity of EUS for detecting nodal disease was 74.2% for N0, 78% for N1, 53.8% for N2, and 50% for N3. Overall, the N staging by EUS showed a sensitivity of 82.8%, a specificity of 74.2%, a positive predictive value of 85.4%, a negative predictive value of 70.2%, and an accuracy of 77.7%. Radical gastrectomy was proposed for 95 patients on the basis of the staging with EUS and computed tomography (CT) scan, and 87 patients (91.6%) underwent the surgery. Preoperative staging accurately predicted the operative strategy for 89% of the patients. No significant predictor for accuracy was achieved by performing a logistic regression analysis for the correct staging of T stage using EUS and adjusting for tumor location (middle part/distal third/whole stomach vs proximal/cardioesophageal) (p = 0.873), operator (p = 0.546), and subject's sequence (initial 50 vs last 50 cases) (p = 0.06). CONCLUSION: Ultrasound is the most accurate and reliable method for the preoperative staging of gastric carcinomas, and it is mandatory if a tailored therapeutic approach is planned according to stage.     

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??Role of endoscopic ultrasound in the staging of gastric stump carcinoma WU Qi*??LI Zi-yu??BU Zhao-de,et al. * Endoscopy Center??Institute of Clinical Oncology, Peking University School of Oncology, Beijing100142, China Corresponding author??ZHANG Ji-chang, E-mail??drzhangjichang@sina.com Abstract Objective To investigate the accuracity of endoscopic ultrasound (EUS) for staging the gastric stump carcinoma (GSC). Methods Twenty-one consecutive patients with pathological proved GSC were checked with endoscopic ultrasound between October 2001 and March 2009 at Peking University School of Oncology. All patients subsequently underwent remnant total gastric resection with lymph node dissection. The pathological staging with EUS staging was compared. Results Overall T2,T3,T4,N0,N1,N2,and N3 of EUS staging for GSC in the group were3,9,9,3,6,6 and 6 cases, respectively. On the contrast??T2,T3,T4,N0,N1,N2, and N3 of pathological staging in the group were3,13,5,3??4,4 and 10 cases, respectively. Diagnostic accuracy of EUS for GSC TN stage in the group were 81.0% and 76.2%. Conclusion EUS is a non-invasive technique with high accuracy for TN staging in the GSC patients. However, due to the low specificity with metastasis lymph nodes, it is suggested to ally with CT .