超声双重造影对进展期胃癌病理组织类型的初步评价

Pilot study of double contrast ultrasonography for pathological typing of advanced gastric cancer

目的探讨超声双重造影（DCUS）对进展期胃癌病理组织类型进行初步评估的意义。方法对术前胃镜活检确诊、术后病理证实的61例胃癌患者术前行DCUS检查，所有病例按病理组织类型分为胃黏液癌（26例）和胃非黏液癌（35例），将造影结果与术后病理组织类型进行对照，分析病灶起始增强特点与病理组织类型的关系。结果26例胃黏液癌中，21例病灶起始增强区域主要集中在浆膜面或黏膜面呈不相连的线样，随后呈分层增强（持续时间至少3S）；而35例胃非黏液癌中，3（）例病灶起始增强区域呈弥漫分布．3s后呈整体增强。以起始增强特点诊断胃黏液癌的灵敏性为80．8％，特异性为88．6％；DCUS对进展期胃癌进行病理组织分型的Youden指数为0．69。通过ACQ分析发现，35例胃非黏液癌中的低未分化癌组与中高分化腺癌组相比，峰值强度及增强强度较高，差异有统计学意义（P〈0．05）。而黏液癌组与中高分化腺癌组相比，峰值强度及增强强度差异无统计学意义（P〉0．05）；而黏液癌组与低未分化癌组相比，峰值强度及增强强度较低。差异有统计学意义（P〈0．05）。结论利用DCUS检查可以在术前初步判断进展期胃癌的病理组织类型。

Objective To explore the value of double contrast-enhanced uhrasonography（DCUS） in the evaluation of pathological typing of advanced gastric cancer. Methods Sixty one patients who had been diagnosed as gastric cancer by gastroscope and confirmed by pathology after operation were examined using DCUS. According to pathological typing, all cases were divided into mucoid gastric cancer （26 cases） and non mucoid gastric cancer （35 cases）. A comparison with final pathologic results was made after surgery. The correlation of initial enhanced features of the lesions was compared with pathological typing of gastric cancer. Results Among 26 cases of mucoid gastric cancer,21 cases of initial enhanced region were mainly focused on serosa surface or mucosa surface, which were disconnected as line-typed, and followed by ＂lamellar＂ signs （at least 3 seconds duration）. As for 35 cases of non mncoid gastric cancer,30 cases were presented as diffused distribution at initial enhanced region,and were enhanced thoroughly after 3 seconds. The sensitivity and specificity of initial enhanced features in diagnosing mucoid gastric cancer was 80.8% and 88.6% respectively,and the Youden＇s index was 0.69. In thirty five cases of non-mucoid gastric cancer, the peak intensity（PI） and enhanced intensity（EI） in poorly differentiated and undifferentiated group was higher than that in well and moderatel differentiated group significantly（ P 〈0.05） analyzed by using ACQ software. There was no significant difference in PI and EI between mucoid gastric cancer and well and moderatel differentiated group of non mucoid gastric cancer （ P 〉0. 05）. The PI and EI in mucoid gastric cancer was lower than that in poorly differentiated and undifferentiated group of non mucoid gastric cancer （P 〈0. 05）. Conclusions DCUS could initial estimate the pathological typing of advanced gastric caner before operation.