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。

Preoperative staging by endoscopic ulatrasonography and VEGF expression of gastric carcinoma

Objective To evaluate endoscopic ultrasonography in preoperative diagnosis and staging of gastric cancer, and to study the molecular biologic basis of its ultrasonic manifestation. Methods Gastric cancer patients were diagnosed by electric gastroscopy and endoscopic ultrasonography. Gastric cancer was preoperatively staged by EUS and results were compared with pathologic staging and VEGF expression. Results The diagnostic accuracy of gastric cancer by gastroendoscopy combined with biopsy in 63 patients was 94%,the accuracy of EUS was 92%,while that of gastroendoscopy combined with EUS was 100%.The total diagnostic accuracy of EUS in estimatating invasive deepth of gastric cancer was 81%,that for stage T_1,T_2,T_3,T_4 was 78%,79%,82%,83%,respectively.The total diagnostic accuracy of lymphaden metastasis was 73%.The positive expression rate of VEGF protein in cancer tissue was 56%,which was closely associated with EUS staging and lymphatic metastasis. Conclusions The accuracy of gastroendoscopy combined with EUS in the diagnosis of gastric cancer was high. The preoperative staging with EUS has a high correspondence with postoperative pathological staging. The VEGF protein expression is positively correlated with preoperative EUS staging.