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小探头内镜超声对早期胃癌浸润深度的诊断价值

姚方,  杨爱明,  伍东升,  吴晰,  郭涛,  周炜洵,  陆星华

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文章导航 > 协和医学杂志  > 2015 >  6(2): 83-88
姚方, 杨爱明, 伍东升, 吴晰, 郭涛, 周炜洵, 陆星华. 小探头内镜超声对早期胃癌浸润深度的诊断价值[J]. 协和医学杂志, 2015, 6(2): 83-88. doi: 10.3969/j.issn.1674-9081.2015.02.002
引用本文: 姚方, 杨爱明, 伍东升, 吴晰, 郭涛, 周炜洵, 陆星华. 小探头内镜超声对早期胃癌浸润深度的诊断价值[J]. 协和医学杂志, 2015, 6(2): 83-88. doi: 10.3969/j.issn.1674-9081.2015.02.002
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Fang YAO, Ai-ming YANG, Dong-sheng WU, Xi WU, Tao GUO, Wei-xun ZHOU, Xing-hua LU. Diagnostic Value of Miniprobe Endoscopic Ultrasonography in Assessment of Tumor Invasion Depth in Early Gastric Cancer[J]. Medical Journal of Peking Union Medical College Hospital, 2015, 6(2): 83-88. doi: 10.3969/j.issn.1674-9081.2015.02.002
Citation: Fang YAO, Ai-ming YANG, Dong-sheng WU, Xi WU, Tao GUO, Wei-xun ZHOU, Xing-hua LU. Diagnostic Value of Miniprobe Endoscopic Ultrasonography in Assessment of Tumor Invasion Depth in Early Gastric Cancer[J]. Medical Journal of Peking Union Medical College Hospital, 2015, 6(2): 83-88. doi: 10.3969/j.issn.1674-9081.2015.02.002
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小探头内镜超声对早期胃癌浸润深度的诊断价值

doi: 10.3969/j.issn.1674-9081.2015.02.002
  • 1.

    中国医学科学院 北京协和医学院 北京协和医院 消化内科, 北京 100730

  • 2.

    中国医学科学院 北京协和医学院 北京协和医院 病理科, 北京 100730

详细信息
    通讯作者:

    姚方 电话:010-69155017, E-mail:yaofang99@sina.com

  • 中图分类号: R735.2;R445.1

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

  • 1.

    Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

  • 2.

    Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

More Information

    摘要
  • 摘要:   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。
    Abstract:   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.
    • HTML全文

  • 图  1  正常胃壁EUS图像

    由内向外呈现为亮、暗、亮、暗、亮五层结构，依次为黏膜层(M层)、黏膜肌层(MM层)、黏膜下层(SM层)、固有肌层(MP层)、浆膜下及浆膜层(SS层)
    EUS：内镜超声

    下载: 全尺寸图片 幻灯片

    图  2  早期胃癌EUS正确分级

    A.白光内镜发现胃角前壁侧0-Ⅱc红色病变，中央糜烂；B.EUS发现局限在黏膜层的低回声病变(箭头)，直径约8 mm；C.内镜下黏膜剥离术切除的标本；D.病理提示为中分化腺癌，局限在黏膜层，直径约8 mm
    EUS：同图 1; 0-Ⅱc:同表 1

    下载: 全尺寸图片 幻灯片

    图  3  早期胃癌EUS过高分级

    A.白光内镜发现胃角前壁侧0-Ⅱa+0-Ⅱc病变，中央溃疡；B.EUS发现低回声病变突破黏膜下层，累及固有肌层(箭头)；C.病理提示为高分化腺癌，局限在黏膜层
    EUS：同图 1; 0-Ⅱa、0-Ⅱc:同表 1

    下载: 全尺寸图片 幻灯片

    表  1  59例早期胃癌病变的内镜和病理检查特点

    特点 例数 构成比(%)
    病变部位    
      上1/3 10 16.9
      中1/3 22 37.3
      下1/3 27 45.8
    病变大小    
      ＞2 cm 21 35.6
      ≤2 cm 38 64.4
    大体形态    
      0-Ⅰ 4 5.8
      0-Ⅱa 13 22.0
      0-Ⅱb 5 8.5
      0-Ⅱc 30 50.8
      0-Ⅲ 7 11.9
    合并溃疡    
      有 6 10.2
      无 53 89.8
    病变浸润深度    
      M层 49 83.1
      SM层 10 16.9
    病变分化类型    
      分化型 53 89.8
      未分化型 6 10.2
    0-Ⅰ：早期隆起型；0-Ⅱa：早期表浅隆起型；0-Ⅱb：早期平坦型；0-Ⅱc：早期表浅凹陷型；0-Ⅲ：早期凹陷型；M层：黏膜层；SM层：黏膜下层
    下载: 导出CSV

    表  2  早期胃癌EUS诊断病变深度和病理最终结果比较

    EUS与病理
    比较结果    		 EUS诊断
    结果    		 病理
    结果    		 例数 百分比
    (%)
    M层胃癌        
      EUS和病理相符 M层 M层 39 66.1
      EUS过高分级 SM层(9例)
    MP层(1例)    		 M层 10 16.9
    SM层胃癌        
      EUS和病理相符 SM层 SM层 8 13.6
      EUS过低分级 M层 SM层 2 3.4
      EUS过高分级 MP层 SM层 0 0
    总体        
      EUS和病理相符     47 79.7
      EUS过高分级     10 16.9
      EUS过低分级     2 3.4
    EUS：同图 1; M层、SM层：同表 1；MP层:固有肌层
    下载: 导出CSV

    表  3  早期胃癌不同内镜及病理特点下EUS诊断病变深度的准确性

    特点 例数 EUS诊断病变
    深度准确性
    (%)    		 过高分级
    比例(%)    		 过低分级
    比例(%)
    总体病变 59 79.7 16.9 3.4
    病变部位        
      上1/3 10 70.0 20.0 10.0
      中1/3 22 68.2 27.3 4.5
      下1/3 27 92.6 7.4 0
    病变大小        
      ＞2 cm 21 80.9 14.3 4.8
      ≤2 cm 38 78.9 18.5 2.6
    大体形态        
      0-Ⅰ 4 75.0 25.0 0
      0-Ⅱa 13 61.5 38.5 0
      0-Ⅱb 5 100 0 0
      0-Ⅱc 30 86.7 10.0 3.3
      0-Ⅲ 7 71.4 14.3 14.3
    合并溃疡        
      有 6 66.7 33.3 0
      无 53 81.1 15.1 3.8
    病变分化类型        
      分化型 53 79.2 17.0 3.8
      未分化型 6 83.3 16.7 0
    EUS：同图 1; 0-Ⅰ、0-Ⅱa、0-Ⅱb、0-Ⅱc、0-Ⅲ：同表 1
    下载: 导出CSV
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  • 收稿日期:  2014-11-19
  • 刊出日期:  2015-03-30

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