凹陷型早期胃癌的X线诊断:组织型及浸润深度诊断流程图制作

X-ray features of Depressed Early Gastric Carcinoma:Flowchart for Histological Type and Invasive Depth Diagnosis

目的归纳对早期凹陷型胃癌(DEGC)组织型(HT)及浸润深度(ID)诊断有意义的X线征象,制作诊断流程图。资料与方法纳入术前行X线钡餐检查、术后病理证实的凹陷型胃癌(DGC)21例(早期胃癌17例,浅表凹陷型进展期胃癌4例)。查阅文献,归纳对DEGC的HT及ID诊断有意义的X线征像及其定义,制作简易诊断标准。观察21例X线像病灶形态特征、部位、大小等,分析与HT及ID诊断的关系,总结规律,制作诊断流程图。分别用简易标准与流程图对21例DGC进行HT及ID诊断,与病理对照计算一致率及各征象敏感性。结果HT诊断时,简易标准使用病灶凹陷边界及凹陷面作为诊断指标,流程图中加入病变部位(是否位于胃底腺区域内)为新指标。ID诊断时,简易标准使用病变是否具有厚度或硬度作为诊断指标,流程图中加入病灶大小及凹陷周围隆起影的宽度为新指标。HT及ID诊断,简易标准与病理对照一致率分别为92.86%和90.48%,流程图诊断分别为95.23%和80.95%。结论对于DEGC的HT及ID诊断而言,X线诊断流程图有较高的诊断价值,可用于临床工作的参考诊断,但仍需改进。

Objective To find significant X ray features in diagnosing histological type （HT） and invasive depth （ID） of depressed early gastric carcinoma（DEGC）,and to make a diagnostic flowchart.Materials and Methods 21 cases with depressed gastric carcinoma （17 cases were early gastric carcinomas,and 4 cases were IIc advanced gastric carcinomas） proved by pathology were included in this study.All the patients underwent double contrast barium meal examination before operation.Step 1,reviewd the relevant literatures,significant X ray signs for diagnosing HT and ID were summarized to make a general diagnostic standard （method 1）.Step 2,observed the X-ray images of 21 cases,the valuable features for diagnosing were summarized to make a.diagnistic flowchat （method 2）.Step 3,HT and ID of the 21 cases were evaluated using the general diagnostic standard and the diagnostic flowchart respectively.Compared with pathology,the accuracy and sensitivity according to these two methods were calculated and compared.Results For HT diagnosis,the surface and border of depressed lesion were used as two diagnosis criteria in the general diagnostic standard,while in the diagnistic flowchat,besides these diagnosis criteria,the locations of lesions （located in the fundic gland areas or not） was added as a new criteria.For ID diagnosis,thickness and hardness of lesion were used as diagnosis criteria in the general diagnostic standard,while in the diagnistic flowchat,besides the above-mentioned criteria,lesion size and width of elevating part around lesions were added as a new criteria.Comparing with pathologic results,the accuracy of diagnosing HT and ID were 92.86% and 90.48% using the general diagnostic standard,and 95.23% and 80.95% using the diagnostic flowchart respectively.The location of lesion was a helpful sign for diagnosing HT,especially for undifferentiated carcinoma.Observing the width of elevating part around lesions was helpful for diagnosing ID,especially for DEGC with only mucosal layer infiltration.Conclusion The diagnostic flowchart is a valuble method for diagnosing HT and ID of DEGC,and can be used in clinical work although it still need to be improved.