超声双重造影对进展期胃癌Lauren分型的初步研究

A pilot study on Lauren classification of advanced gastric carcinoma using double contrast-enhanced ultrasonography

目的探讨超声双重造影（DCus）在进展期胃癌Lauren分型中的应用价值。方法对58例胃癌患者术前行DCUS检查，术后对胃癌标本行HE染色及AB-PAS黏液染色，并据此进行Lauren分型。回顾性分析不同亚型胃癌的超声造影特点。结果58例胃癌标本组织学诊断为肠型34例，弥漫型24例。DCUS检查肠型胃癌表现为整体均匀增强者30例，不均匀增强者4例；弥漫型胃癌表现为不均匀增强者22例，整体均匀增强者2例。以不均匀增强诊断弥漫型胃癌的灵敏度为91．7％，特异度为88．2％；DCUS对进展期胃癌进行Lauren分型的Youden指数为0．8。结论DCUS对进展期胃癌Lauren分型中不同亚型具有不同的增强特点，可作为术前判断胃癌Lauren分型，评价肿瘤侵袭、转移及预后的一种有效方法。

Objective To investigate the clinical value of double contrast-enhanced ultrasonography （DCUS） in diagnosing Lauren classification of advanced gastric carcinoma. Methods Fifty eight patients with gastric cancer proved by endoscopic biopsy underwent preoperative DCUS examination, and the findings were compared with postoperative pathologic results via hematoxylin-eosin and alcian blue-periodic acid schiff（AB-PAS） staining. Results In 58 patients,34 cases were diagnosed as intestinal type and 24 cases as diffuse type by pathology after operation. In intestinal type,30 cases were enhanced as global homogeneous intensity by using DCUS, another 2 cases as ＂lamellar＂ model and the other 2 cases as heterogeneous intensity. However,in diffuse type,22 cases were enhanced heterogeneously with ＂barrier＂ signs in 5 cases, ＂map＂ signs in 9 cases and ＂lamellar＂ signs in 8 cases, the remaining 2 cases of diffuse type enhanced as homogeneous model. The sensitivity and specificity of heterogeneous enhancement in diagnosing diffuse type of advanced gastric cancer was 91.7% and 88.2% respectively, and the Youden＇s index was 0.8. Conclusions DCUS could be considered as a new valuable method to distinguish the Lauren classification and evaluate the invasiveness,metastasis and prognosis in patients with gastric carcinoma.