超声内镜对浅表胃癌诊断及治疗决策的影响

Evaluation of preoperative endoscopic ultrasonography for diagnostic and therapeutic decision making in superficial gastric cancers

目的探讨术前EUS在浅表胃癌诊断及治疗决策中的价值。方法2006年1月至2014年12月期间，于北京协和医院行胃镜检查及病理活检确诊为浅表胃癌，并接受病灶切除及术前EUS检查的患者共77例（83处病灶，其中早期胃癌72处、进展期胃癌11处）纳入回顾性研究，以ESD或外科手术后病理为金标准，采用敏感度、特异度和准确率等指标评估术前EUS对浅表胃癌浸润深度的判断价值，并运用多因素Logistic回归对影响判断准确性的因素进行分析。结果EUS判断早期胃癌的敏感度、特异度和准确率分别为91.7%（66/72）、81.8%（9/11）和90.4%（75/83）；对于早期胃癌，EUS鉴别黏膜内癌与黏膜下癌的准确率为66.7%（48/72），阳性预测值达91.3%（42/46）。多因素Logistic回归分析发现，合并溃疡（OR＝7.513, 95%CI：1.735-32.541，P〈0.05）和病理类型为未分化型癌（OR＝8.194，95%CI：1.602-41.903，P〈0.05）是影响EUS判断浅表胃癌浸润深度准确性的独立危险因素。结论EUS对于判断浅表胃癌是否为早期胃癌的准确性较高。其中，EUS判断浸润深度局限于黏膜层的可以考虑内镜下治疗；但对于EUS判断病变浸润至黏膜下层的患者，需要结合内镜下表现综合考虑。

Objective To study the value of endoscopic ultrasonography （EUS） for diagnostic and therapeutic decision making in superficial gastric cancers. Methods In the period between January 2006 and December 2014, 77 patients diagnosed as having gastric cancers pathologically on biopsies who under- went EUS prior to therapy were reviewed. All lesions were resected either endoscopically or surgically. Final pathology was achieved in 83 lesions, including 72 early gastric cancers （EGC） and 11 advanced gastric cancers. Diagnostic value of EUS was evaluated by sensitivity, specificity and diagnostic accuracy, with the pathology of the resected specimen as the golden standard. Risk factors for EUS diagnosis were investigated by multivariable analysis. Results The sensitivity, specificity and diagnostic accuracy of EUS for EGC were 91.7% （66/72）, 81.8% （ 9/11 ） and 90.4% （ 75/83）, respectively. The diagnostic accuracy for mucosal cancer and submucosal cancer was 66. 7% （48/72）, and positive predictive value was 91.3% （42/46）. Logistic multivariable analysis showed independent factors of EUS mis-staging included ulcers （OR= 7. 513, 95%CI： 1. 735-32. 541, P〈0. 05） and undifferentiated carcinoma （ OR = 8. 194, 95%CI： 1. 602-41. 903, P〈 0. 05）. Conclusion EUS has a high diagnostic accuracy of early gastric cancers. Endoscopic resection could be considered for those mucosal lesions reported by EUS. But for those submucosal lesions by EUS, endoscopic manifestations are needed for therapeutic decisions.