超声内镜对上消化道黏膜下肿瘤的诊断价值

Diagnostic Value of Endoscopic Ultrasonography for Submucosal Tumors of Upper Digestive Tract

目的评价超声内镜（endoscopic ultrasonography,EUS）对上消化道黏膜下肿瘤（submucosal tumor,SMT）的诊断价值。方法回顾性分析2011年1月~2014年9月154例（共165处病变）我院EUS诊断上消化道SMT,并在我院接受内镜或手术治疗,最终获取病理结果的临床资料,对比术前EUS诊断与术后病理诊断。结果 EUS诊断上消化道SMT的阳性预测值为78.8%（130/165）。EUS诊断间质瘤、平滑肌瘤、脂肪瘤和异位胰腺的准确率分别为87.3%（144/165）、91.5%（151/165）、97.6%（161/165）和95.8%（158/165）。EUS诊断间质瘤、平滑肌瘤、脂肪瘤和异位胰腺的敏感性分别为98.0%（48/49）、85.1%（63/74）、100.0%（7/7）和64.3%（9/14）,特异性分别为82.8%（96/116）、96.7%（88/91）、97.5%（154/158）和98.7%（149/151）。35处病灶EUS诊断与病理诊断不符合,不符合率21.2%（35/165）,其中低回声（60.0%,21/35）、病灶起源于第4层（45.7%,16/35）EUS诊断与病理不符合率高,EUS诊断为间质瘤的不符合率高（57.1%,20/35）。结论 EUS可对SMT的类型做出较为准确的诊断。

Objective To evaluate the diagnostic value of endoscopic ultrasonography（ EUS） for submucosal tumors（ SMT）.Methods This was a retrospective study on 154 patients diagnosed as upper gastrointestinal SMT by EUS,who were admitted to our hospital between January 2011 and September 2014. All the patients received endoscopic treatment or surgical treatment and had the final pathological results. We compared the preoperative EUS diagnosis with the postoperative pathological diagnosis. Results The positive predictive value of EUS diagnosis for SMT was 78. 8% with 130 cases out of a total of 165. The diagnostic accuracy of EUS for the stromal tumor,leiomyoma,lipoma and ectopic pancreas was 87. 3%（ 144 /165）,91. 5%（ 151 /165）,97. 6%（ 161 /165） and95. 8%（ 158 /165）,respectively. The diagnostic sensitivity of EUS for the stromal tumor,leiomyoma,lipoma and ectopic pancreas was 98. 0%（ 48 /49）,85. 1%（ 63 /74）,100. 0%（ 7 /7） and 64. 3%（ 9 /14）,respectively,while the specificity was 82. 8%（ 96 /116）,96. 7%（ 88 /91）,97. 5%（ 154 /158） and 98. 7%（ 149 /151）,respectively. The EUS diagnosis and pathological diagnosis were not in line in 35 lesions,with a rate of 21. 2%（ 35 /165）. It showed that EUS diagnosis is comparably less accurate in cases with lower echo（ 60. 0%,21 /35）,lesion located at the forth layer（ 45. 7%,16 /35）,or indicating a GIST（ 57. 1%,20 /35）.Conclusion High accuracy of EUS diagnosis for SMT can be achieved.