超声内镜和多层螺旋CT对BorrmannⅣ型胃癌术前分期的比较研究

Comparison of endoscopic ultrasonography and multislice spiral computed tomography for the preoperative staging of Borrmann type Ⅳ gastric cancer

目的对超声内镜(EUS)和多层螺旋CT(MSCT)检查在BorrmannⅣ型胃癌术前分期中的作用进行比较。方法回顾性分析48例BorrmannⅣ型胃癌患者的影像学术前TNM分期,并与术后病理分期进行比较。结果 EUS和MSCT检查对T分期的准确率分别为54.2%和79.2%(P=0.009),分层分析表明MSCT对T3、T4分期的准确率高于EUS(T3:84.6%vs 57.7%,P=0.032;T4:82.4%vs 41.2%,P=0.032)。两者对N分期的准确率,均为56.3%(P=1.000),无明显差异,EUS和MSCT对淋巴转移检查的特异度和灵敏度分别为83.3%/72.2%和66.7%/91.7%。结论 EUS更适合对早期胃癌分期,而已浸润至浆膜层及有远处转移的BorrmannⅣ型胃癌患者,应优先选择MSCT检查进行分期。

Objective To compare the performances of endoscopic ultrasonography（EUS） and multislice spiral computed tomography（MSCT） in the preoperative staging of Borrmann type Ⅳ gastric cancer. Methods 48 patients involved in this study, all the patients had undergone surgical resection, Borrmann Type Ⅳ gastric cancer had confirmed and evaluated by EUS and MSCT. Tumor staging was evaluated by Tumor-Node-Metastasis（TNM） staging.The results from the imaging modalities were compared with postoperative histopathological outcomes. Results The overall accuracies of EUS and MSCT for the T staging category were 54.2 % and 79.2 %（P = 0.009）, respectively.Stratified analysis revealed that the accuracy of MSCT in T3 and T4staging was significantly higher than that of EUS（P = 0.032 for both）. The overall accuracies of EUS and MSCT for the N staging category were both 56.3%. The sensitivity and specificity of EUS and MSCT in N staging were 83.3 % /72.2 % and 66.7 % /91.7 %, respectively.Conclusion MSCT prevail over EUS for Borrmann Type Ⅳ gastric cancer patients with invasion into serosal layer or adjacent organs or with distant metastasis.