经腹胃超声与胃镜对胃癌的诊断准确性对照分析初步报告

目的 探讨经腹胃超声检查在胃癌诊断中的临床应用价值.方法 回顾性分析2010年1月至2020年5月上海交通大学医学院附属新华医院崇明分院、上海市杨浦区控江医院和上海健康医学院附属嘉定区中心医院诊治的129例胃癌患者资料.所有患者均由经腹胃超声检查首诊发现胃部病变,再行胃镜检查并以胃黏膜活检病理组织学结果最终诊断为胃癌.采用McNemar方法比较胃镜和经腹胃超声检查的提示性病灶检出率、总体定性诊断准确率和胃不同部位定性诊断准确率.结果 本组胃癌患者中进展期胃癌占93.0％(120/129),早期胃癌占7.0％(9/129).以最终病理组织学诊断为金标准,经腹胃超声检查无假阳性病例,病灶检出率为100.0％(129/129);胃镜检出胃部病灶128例,检出率为99.2％(128/129).1例胃镜未检出病灶的患者,经腹胃超声检查显示胃窦部胃壁显著增厚,而胃镜检查显示胃黏膜充血水肿及粗大皱褶,未发现其他明显异常,但术后病理证实为低分化腺癌.胃癌声像图显示为增厚性、凹陷性和隆起性病变分别占46.5％(60/129)、41.1％(53/129)和12.4％(16/129),病变胃壁的最大厚度和长径分别为(13.5±5.1)mm和(56.8±24.9)mm.经腹胃超声和胃镜检查对胃癌的诊断准确率分别为74.4％(96/129)和82.2％(106/129),两者比较差异无统计学意义(P>0.05);经腹胃超声和胃镜检查对胃窦癌、胃体癌、胃角癌、胃底癌、贲门癌、残胃癌的诊断准确率差异均无统计学意义(P均>0.05).结论 经腹胃超声具有良好的胃壁病变检出能力,积极推广应用可进一步提高胃癌的检出率和诊断准确性.

Comparative analysis of diagnostic accuracy of transabdominal gastric ultrasonography and gastroscopy for gastric cancer: a preliminary report

Objective To explore the clinical value of transabdominal gastric ultrasonography in the diagnosis of gastric cancer. Methods The data of 129 gastric cancer patients diagnosed and treated in Chongming Branch of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Kongjiang Hospital of Yangpu District, and Jiading Central Hospital of Shanghai University of Medicine & Health Science from Jan. 2010 to May 2020 were retrospectively analyzed. All patients were diagnosed with gastric lesions on the first examination of transabdominal gastric ultrasonography, then underwent gastroscopy, and were finally pathologically proven with gastric cancer by gastric mucosal biopsy. McNemar method was used to compare the detection rates of suggestive lesions, the overall qualitative diagnosis accuracy and the qualitative diagnosis accuracy of different gastric parts between gastroscopy and ultrasonography. Results Advanced gastric cancer accounted for 93.0% (120/129) and early gastric cancer accounted for 7.0% (9/129). With the histopathological diagnosis as the gold standard, no false positive cases were detected by transabdominal gastric ultrasonography, and the detection rate was 100.0% (129/129); 128 cases of gastric lesions were detected by gastroscopy, and the detection rate was 99.2% (128/129). For the one misdiagnosed case by gastroscopy, ultrasonography showed significant thickening of gastric antrum wall, while gastroscopy showed hyperemia, edema and coarse folds of gastric mucosa without other obvious abnormalities, but it was confirmed as poorly differentiated adenocarcinoma by postoperative pathology. The sonographic features of gastric cancers showed that thickened, excavated and protruded lesions accounted for 46.5% (60/129), 41.1% (53/129) and 12.4% (16/129), respectively. The maximum thickness and diameter of the lesions were (13.5±5.1) mm and (56.8±24.9) mm, respectively. The diagnostic accuracy of ultrasonography and gastroscopy for gastric cancer was 74.4% (96/129) and 82.2% (106/129), respectively, showing no significant difference (P>0.05). There was no significant difference in the diagnostic accuracy for cancers in the gastric antrum, gastric body, gastric angle, gastric fundus, cardia or gastric stump between ultrasound and gastroscopy (all P>0.05). Conclusion Transabdominal gastric ultrasonography has a good ability to detect gastric wall lesions, and its application can further improve the detection rate and diagnostic accuracy of gastric cancer.