内镜超声对胃间质瘤侵袭危险性的预测价值

Endoscopic Ultrasonography in Predicting Invasive Risk of Gastric Stromal Tumors

背景:胃肠道间质瘤(GISTs)为具有潜在恶性的胃肠道间叶源性肿瘤,文献报道内镜超声检查(EUS)的声像图特征有助于GISTs的早期诊断和侵袭危险性评估。目的:评价EUS诊断胃间质瘤和预测肿瘤侵袭危险性的价值。方法:纳入2010年1月-2014年4月南京鼓楼医院经内镜和EUS检查初步诊断为胃间质瘤的患者148例,其中103例经术后病理确诊为胃间质瘤。采集入组患者的内镜、EUS和临床病理资料,分别根据EUS特征和组织病理学检查结果判断肿瘤侵袭危险性。结果:以病理诊断为金标准,EUS诊断胃间质瘤的准确性为69.6%,误诊病例多为平滑肌瘤和神经鞘瘤。EUS与组织病理学检查判断肿瘤侵袭危险性的符合率为77.7%,一致性检验κ=0.678(P=0.000)。结论:EUS对胃间质瘤具有较高的诊断价值,并可作为预测肿瘤侵袭危险性的方法,为治疗方案的选择提供依据。

Background： Gastrointestinal stromal tumors（ GISTs） are mesenchymal tumors with potential malignancy in gastrointestinal tract. Some endoscopic ultrasonographic（ EUS） features have been reported to be suggestive for GISTs and its invasive risk. Aims： To assess the value of EUS in diagnosis and prediction of invasive risk of gastric stromal tumors.Methods： A total of 148 cases of gastric stromal tumors preliminarily diagnosed by endoscopy and EUS between Jan. 2010 and Apr. 2014 at Nanjing Drum Tower Hospital were retrospectively recruited. Of them 103 were proved to be gastric stromal tumors by postoperative histopathology. The endoscopic,EUS and clinicopathological features were collected,and the risk of tumor invasiveness was estimated based on EUS and histopathological features,respectively. Results： Taken pathological diagnosis as gold standard,the diagnostic accuracy of EUS for gastric stromal tumors was 69. 6%,and most of the misdiagnosis cases were leiomyoma and schwannoma. The coincidence rate of EUS and histopathology in classifying tumor invasive risk was 77. 7%,with a κ value of 0. 678（ P = 0. 000） in consistency-checking test. Conclusions： An acceptable diagnostic performance can be achieved by using EUS for diagnosis of gastric stromal tumors. Furthermore,EUS can be used as a tool for prediction of invasive risk of gastric stromal tumors,and providing the basis for treatment regimen selection.