小探头内镜超声对早期胃癌浸润深度的诊断价值

  目的  评价应用小探头内镜超声(endoscopic ultrasonography, EUS)对早期胃癌浸润深度的诊断价值及影响因素  目的  回顾性分析2010年3月至2012年12月于北京协和医院诊治且资料完整的59例早期胃癌患者资料, 患者在内镜治疗或手术治疗前均接受小探头EUS检查并判断病变浸润深度, 最终以内镜/手术病理结果为金标准, 评价EUS对早期胃癌浸润深度诊断的敏感性、特异性和准确性, 并分析影响EUS判断准确性的病变自身内镜特点及病理学因素  结果  EUS判断早期胃癌病变浸润深度总体病变诊断敏感性为79.7%, 特异性为81.4%, 准确性为79.7%。其中, EUS诊断黏膜层病变的敏感性为66.1%, 特异性为80.0%, 准确性为79.7%;诊断黏膜下层病变的敏感性为80.0%, 特异性为81.6%, 准确性为81.4%, 两者之间差异无统计学意义(P > 0.05)。EUS判断胃癌病变过高分级比例为16.9%, 以胃上1/3(20.0%)和中1/3(27.3%)、大体形态为隆起型(0-Ⅰ:25.0%, 0-Ⅱa:38.5%)以及合并溃疡(33.3%)的病变更为多见, 这类病变诊断的准确性也相应较低。EUS判断胃癌病变过低分级比例为3.4%  结论  小探头EUS对于判断早期胃癌浸润深度有较高的准确性, 有助于作出适当的治疗决策, 病变部位、大体类型及溃疡的存在会影响判断的准确性。

Diagnostic Value of Miniprobe Endoscopic Ultrasonography in Assessment of Tumor Invasion Depth in Early Gastric Cancer

  Objective  To evaluate the role of miniprobe endoscopic ultrasonography (EUS) in assessing the depth of tumor invasion in early gastric cancer and to analyze the factors affecting the accuracy of EUS.  Methods  This retrospective study included 59 cases of pathologically confirmed early gastric cancer diagnosed and hospitalized in Peking Union Medical College Hospital in the period of March 2010 to December 2012. They all received miniprobe EUS for predicting the depth of invasion before endoscopic or surgical resection. We assessed the diagnostic sensitivity, specificity and accuracy of EUS by comparing the pre-treatment EUS results with the postoperative histopathological findings. The endoscopic features and pathological factors possibly influencing the accuracy of EUS were also analyzed.  Results  The overall diagnostic sensitivity, specificity and accuracy of EUS in assessing the depth of early gastric cancer invasion were 79.7%, 81.4% and 79.7%, respectively. The sensitivity, specificity and accuracy for mucosal layer lesion were 66.1%, 80.0% and 79.7%, respectively; and the sensitivity, specificity and accuracy for submucosal lesion were 80.0%, 81.6% and 81.4%, respectively, showing no significant diference(P > 0.05). The overgrading rate of EUS was 16.9%, and the overgrading mainly happened in leisons located in upper third (20.0%) and middle third (27.3%) of the stomach, with a superficial appearance of elevated type (0-Ⅰ:25.0%, 0-Ⅱa:38.5%) or with ulcers (33.3%). The above mentioned lesions were also associated with a relatively lower diagnostic accuracy of EUS. The undergrading rate of EUS was 3.4%.  Conclusions  Miniprobe EUS has a fairly high diagnostic accuracy in assessing the depth of gastric cancer invasion, which helps the planning of treatment strategy. The location, macroscopic type of lesions and coexisting ulcer would affect the dignostic accuracy of EUS.