Ⅱc期胃癌的X线表现与组织病理类型对照研究

The correlation study of radiological findings with pathological classification of superficial depressed (Ⅱc type)early gastric cancer

目的探讨Ⅱc期胃癌的 X 线气钡双对比造影表现和组织病理类型之间的相关性。方法回顾性分析经病理证实的102例Ⅱc期胃癌的 X 线低张气钡双对比造影表现,结合胃内镜图像分析 X 线影像上凹陷病灶的边界锐利清晰程度、皱襞纠集情况、病灶底部情况,并分析 X 线表现与各种组织病理类型,包括高分化管状腺癌(tub1)、中分化管状腺癌(tub2)、低分化腺癌(por)和印戒细胞癌(sig)之间的关系。结果Ⅱc期胃癌102例中,tub1 27例,tub2 11例,por 26例和sig 38例。X 线影像上,24例 tub1和9例 tub2Ⅱc期癌灶的凹陷边界不锐利,而15例 por 和31例 sig 的凹陷边界清晰锐利,差异有统计学意义(P<0.01)。17例 tub1和所有 tub2的癌灶凹陷面可呈较为均匀的颗粒状,41例 por 和 sig 的胃癌凹陷底部多呈大小不一的结节状影,两组间差异有统计学意义(P<0.01)。结论不同组织病理类型的Ⅱc期胃癌的 X 线表现有明显差异,可以根据 X 线表现的特征推断大致的组织病理类型。

Objective To investigate the relations between radiological findings and pathological classification of superficial depressed （ Ⅱ c type） early gastric cancer. Methods Radiological features in subtonic double contrast barium examination and the endoscopic pictures of early gastric cancer compared with the global pathological specimens and micro-pathological features were prospectively studied. Combined with the gastric endoscopic pictures, the sharpness of margin of the lesions, the changes of converging mucosal folds and the changes of the depressed surface on the film of double contrast barium examination were analyzed. The correlation between the radiological features and histological classification of gastric cancer including well differentiated tubular adenocarcinoma （ tubl ）, moderately differentiated tubular adenocarcinoma （ tub2 ）, poorly differentiated adenocarcinoma （ por ） and signet-ring cell carcinoma （sig） were studied. Results In 102 cases of Ⅱ c type early gastric cancer, there were tubl 27 cases, tub2 11, por 26 and sig 38 cases histologically. The margin of the depressed lesions of tubl （24 cases） and tub2 （9 cases） cancers were mostly unsharply demarcated or with fine spicular border, while the margin of lesions of por（ 15 cases） and sig（31 cases） were mostly clearly and sharply demarcated, with statistical significance （P 〈 0. 01 ）. The depressed surface of tubl and tub2 lesions （17 cases ） revealed little unevenness, sometimes with evenly granulations, single nodule and scar-like depression, while that of por and sig lesions （41 cases） manifested as nodules of varying sizes, with statistical significance （P 〈0. 01 ）. Conclusion The radiological findings of superficial depressed early gastric cancer in different histological types were different, the possible histological type could be speculated according to the radiological findings of the lesions.