超声内镜评分对消化道及壁外压迫性病变良恶性的诊断价值

Diagnostic value of EUS-BIRADS scoring system to assess malignant risk of lesions in gastrointestinal tract and outer wall oppression

目的建立基于乳腺影像报告和数据系统(breast imaging reporting and data system,BIRADS)的EUS-BIRADS评分体系并评价其对消化道黏膜层、黏膜下及壁外压迫性病变良恶性的诊断价值。方法回顾性分析我院2006年6月至2012年12月经病理学诊断明确的消化道及壁外病变509例。参照BI-RADS超声诊断标准建立EUS-BIRADS评分体系,依据EUS-BIRADS评分体系在未知病理诊断情况下为每1组超声内镜图像评分,并将评分结果与病理结果比对。ROC曲线分析示AUG=0.947,取EUS评6.5分时为临界值(对应Youden指数最高值),分值>6分的病例倾向于恶性病变,分值≤6分者倾向于非恶性病变。利用Pearsonχ2检验、Mc Nemarχ2检验、敏感度、特异度、阳性预测值、阴性预测值、Youden指数、诊断符合率、Kappa值等评估EUS-BIRADS评分体系的诊断价值。结果 EUSBIRADS评分对于黏膜层、黏膜下及壁外病变的良恶性评定的敏感度、特异度、阳性预测值、阴性预测值、Youden指数、诊断符合率、Kappa值分别为85.1%、92.9%、71.2%、96.8%、0.7795、91.6%、0.723 4。Pearsonχ2检验(χ2值=269.573,P<0.001)示EUS-BIRADS评分结果与病理检验结果不独立,其列联系数R=0.728示两者正相关,但Mc Nemarχ2检验(P值:0.014)示EUS-BIRADS评分体系与病理学诊断之间存在有差异。结论基于BI-RADS标准建立的EUS-BIRADS评分体系对消化道及壁外病变的良恶性的预判与病理诊断之间有较好一致性,可以辅助临床医师预判病变性质以利于进一步检查。

Objective To establish a new endoscopic ultrasonography（ EUS） scoring system based on the Breast imaging reporting and data system（ BI-RADS）,and evaluate its diagnosis value to identify the benign and malignant lesions in gastrointestinal mucosa or submucosa or outside wall oppression. Methods A retrospective study was carried on 509 cases with pathologically-diagnosed gastrointestinal mucosa or submucosa or outside wall oppression admitted in our department from June 2006 to December 2012. We firstly established the EUS-BIRADS scoring system with reference to BI-RADS ultrasound diagnostic criteria, and then 2experienced endoscopists scored each group of EUS images（ randomly from the 509 patients） by reference to EUS-BIRADS scoring system with no idea on clinical data and pathological diagnosis of the patients. The obtained results were compared scoring with pathological results. Receiver operating curve（ ROC） analysis showed the area under the curve（ AUG） was 0. 947. We chose EUS at score 6. 5 as the critical value（ corresponding to Youden index maximum）,and stipulated cases with the score 6 tended to be malignant lesions,and the others tended to be non-malignant ones. Pearson ＇s Chi-Square test, Mc Nemar test,sensitivity,specificity,positive predictive value（ PPV）,negative predictive value（ NPV）,Youden index,diagnostic accordance rate,and Kappa value were carried out to assess the diagnostic value of EUS-BIRADS scoring system. Results For the benign and malignant lesions in gastrointestinal mucosa or submucosa or outside wall oppression,the sensitivity,specificity,PPV,NPV,Youden index,diagnostic accordance rate,and Kappa value were 85. 1%,92. 9%,71. 2%,96. 8%,0. 779 5,91. 6%,and 0. 723 4,respectively in our EUS-BIRADS scoring system. Pearson＇s Chi-square test（ Chi-square = 269. 573,P〈0. 001） showed the results of EUS-BIRADS scoring system were not independent to those from pathological examination,and Pearson＇s R（ 0. 728） indicated that there was a positive correlation between the 2 kinds of results. But Mc Nemar test（ P = 0. 014） showed the EUS-BIRADS results did not substitute for pathological diagnosis.Conclusion EUS-BIRADS scoring system which is established based on BI-RADS standard is consistence with those from pathology for the lesions in digestive tract and outer wall oppression,and it can assist clinicians to predict the nature of lesions before further examination.