经腹超声检查对胃癌术前评估的价值

Value of transabdominal ultrasonography in preoperative assessment of gastric carcinoma

目的探讨经腹超声检查(transabdominalultrasonography,TAUS)对胃癌术前TNM分期和血管生成的评估价值。方法对64例胃癌患者术前行经腹超声检查,其中37例行经腹彩色多普勒超声检查,测定胃癌的彩色多谱勒血管指数(colorDopplervascularityindex,CDVI);并采用抗CD34抗体,通过免疫组织化学染色检测胃癌组织的微血管密度(microvesseldensity,MVD)。结果TAUS对胃癌T分期的判断准确率为56.0%,其中T12/3例,T228.6%,T373.1%,T450.0%;对胃癌淋巴结状况判断的总体准确率为63.3%,对淋巴结转移判断的敏感性和特异性分别为37.9%和100%。TAUS对胃癌N分期的判断准确率为57.1%,其中N0100%,N116.7%,N235.3%;对胃癌远处转移判断的敏感性和特异性分别为58.3%和100%。通过彩色多普勒超声检查测定的胃癌CDVI与血管浸润显著相关(P=0.0418),回归分析同时显示CDVI与MVD呈线性相关(r=0.5628,P<0.01)。结论TAUS可作为胃癌患者术前的常规检查。

Objective To investigate the value of transabdominal ultrasonography (TAUS) in preoperative assessment of TNM stage and tumor angiogenesis for patients with gastric carcinoma. Methods Sixty four patients with gastric carcinoma preoperatively underwent TAUS, in whom transabdominal color Doppler ultrasonography was used for measuring color Doppler vascularity index (CDVI) of each tumor in 37 cases and microvessel density (MVD) was evaluated by using immunohistochemical staining of surgical specimens with anti CD34 antibody. Results The overall accuracy rate was 56.0%for T staging of gastric carcinoma (T1 2/3 cases, T2 28.6%, T3 73.1%, T4 50.0%, respectively) by TAUS. The diagnostic accuracy rate was 63.3%for lymph node status of gastric carcinoma. The diagnostic sensitivity and specificity for lymph node metastasis was 37.9%and 100%respectively. The overall accuracy for N staging of gastric carcinoma was 57.1%(N0 100%, N1 16.7%, N2 35.3%, respectively). The diagnostic sensitivity and specificity for determining distant metastases was 58.3%and 100%respectively. The CDVI of gastric carcinoma determined by color Doppler ultrasonography was significantly correlated to vascular invasion (P=0.0418), a linear correlation between CDVI and MVD was determined by logistic regression analysis (r=0.5628, P< 0.01). Conclusion TAUS can be a routine diagnostic approach for preoperative gastric carcinoma patients.