消化道间质瘤和平滑肌瘤在超声内镜、多层螺旋CT和免疫组化的特点分析

目的对消化道间质瘤(GIST)和平滑肌瘤(LM)在超声内镜(EUS)、多层螺旋CT(MSCT)和免疫组化的特点进行分析,并评价EUS、MSCT、免疫组化对二者鉴别诊断的价值。 方法回顾性分析2013年4月至2019年6月经天津医科大学第二医院普通胃镜及EUS检查行内镜黏膜下剥离术(ESD)、内镜下黏膜切除术(EMR)、内镜下全层切除术(EFR)切除的消化道黏膜下病变,经病理和免疫组化确诊为GIST或LM,分析资料记录完整的67例患者病变在胃镜及EUS、MSCT、免疫组化的特点,并评价EUS、MSCT与病理的符合情况。 结果经病理及免疫组化诊断LM 43例、GIST 24例,其中,44例病变EUS诊断与病理结果相符,符合率为65.7%(44/67)、GIST和LM诊断准确率分别为67.2%、71.6%。23例诊断与病理不符(EUS将17例LM误诊为GIST、1例GIST误诊为LM、5例EUS未明确分类,术后诊断GIST 4例、LM 1例)。分析GIST和LM病变在EUS下病变平均大小、形状、分叶、表面情况方面差异均无统计学意义(P>0.05);在病变部位、起源层次、回声、生长方式、钙化上相比,差异有统计学意义(P<0.05)。67例病变,其中56例(LM 35例、GIST 21例)行MSCT检查,EUS诊断符合率58.9%(33/56)高于MSCT符合率17.9%(10/56)。LM的Desmin、SMA阳性率高于GIST,GIST的CD34、CD117、DOG-1阳性率高于LM(P<0.05) 。 结论GIST和LM在EUS下诊断易被混淆,EUS对二者诊断准确率相近,但EUS对LM和GIST的诊断准确率明显高于MSCT,MSCT对于GIST的诊断准确率高于LM,免疫组化可帮助鉴别LM和GIST。

Analysis of the characteristics of gastrointestinal stromal tumors and leiomyomas by endoscopic ultrasound,multi-slice spiral CT,and immunohistochemistry

Objective The characteristics of gastrointestinal stromal tumor(GIST)and leiomyoma(LM)in EUS,multi-slice spiral CT(MSCT),and immunohistochemistry were analyzed,and the differential diagnosis of EUS,MSCT,and immunohistochemistry was evaluatedvalue.Methods In the endoscopic center of our hospital from April 2013 to June 2019,general gastroscopy and EUS examinations were performed,and the submucosal lesions of the digestive tract resected by ESD/EMR/EFR were diagnosed as GIST or LM by pathology and immunohistochemistry.Sixty-seven patients with complete data records were included in the retrospective study.The characteristics of the lesions in gastroscopy,EUS,MSCT,and immunohistochemistry were analyzed,and the conformity of EUS,MSCT and pathology was evaluated.Results 43 cases of LM and 24 cases of GIST were diagnosed by pathology and immunohistochemistry.The diagnosis of 44 cases of EUS was consistent with the pathological results,with a coincidence rate of 65.7%(44/67).The accuracy rates of GIST and LM diagnosis were 67.2%and 71.6%,respectively.The diagnosis of 23 cases did not match the pathology(EUS misdiagnosed 17 cases of LM as GIST,1 case of GIST as LM,5 cases of EUS were not clearly classified,and 4 cases of GIST and 1 case of LM were diagnosed after surgery).There was no significant difference in the average size,shape,defoliation,and surface condition of the GIST and LM lesions under EUS(P>0.05);compared with the lesion site,origin level,echo,growth pattern,and calcification,the differences Statistically significant(P<0.05).Among 67 cases,56 cases(35 cases of LM and 21 cases of GIST)underwent MSCT examination.The EUS diagnosis coincidence rate was 58.9%(33/56),which was higher than the MSCT coincidence rate of 17.9%(10/56).The positive rates of Desmin and SMA of LM were higher than those of GIST,and the positive rates of CD34,CD117 and DOG-1 of GIST were higher than those of LM(P<0.05).Conclusions The diagnosis of GIST and LM under EUS is easy to be confused.The diagnostic accuracy of the two is similar,but the diagnosis rate of LM and GIST by EUS is significantly higher than that of MSCT.The diagnostic accuracy of MSCT for stromal tumors is higher than LM.Good discrimination between LM and GIST.