环扫超声胃镜在进展期胃癌术前TN分期中的应用分析

Clinical application of radial endoscopic ultrasonography on preoperative T and N staging for advanced gastric cancer

目的评估内镜超声（EUS）及腹部增强CT对进展期胃癌TN分期的价值。方法选择拟行外科手术治疗的进展期胃癌患者188例，术前常规行EUS及腹部增强CT检查，并通过EUS及腹部增强CT评估肿瘤的T分期及淋巴结转移情况。所有结果以术后病理诊断为金标准，与病理诊断结果吻合被认为评估准确，否则为评估错误。分析比较这两种术前评估方法的准确性，并进行两者之间以及与病理结果之间的一致性检验。结果EUS对病变的T分期与术后病理比较总准确率87．2％（164／188），Kappa=0．726；CT与术后病理比较总准确率76．6％（144／188），Kappa=0．509：EUS的T分期总体准确率比CT高（χ^2=7．181，P=0．007）。淋巴结转移的判断，超声胃镜的准确率为72．9％（137／188），Kappa=0．397；CT的准确率为79．8％（150／188），Kappa=0．487：两种方法准确率比较没有统计学差异（疋。0．963，P=0．326）。超声胃镜与CT的一致性检验，T分期与淋巴结转移的评估Kappa值分别为0．507和0．649。EUS对不同部位的进展期胃癌T分期准确性分别是贲门癌93．0％、胃底癌93．3％、胃体癌96．8％以及胃窦癌91．5％，一致性检验4个部位的Kappa值分别是0．843、0．881、0．940、0．710。侵犯幽门的胃窦癌准确率只有63．2％，一致性检验Kappa值为0．340。结论环扫超声胃镜对于进展期胃癌的T分期及淋巴结转移的判断准确性较高，但对侵犯幽门的病变T分期准确性不足。

Objective To assess the value of endoscopic uhrasonography （EUS） and abdominal CT scan on preoperative T and N staging of advanced gastric cancer. Methods A total of 188 patients with advanced gastric cancer received EUS and CT scan to evaluate the T and N staging and lymphatic metastasis before surgical operation. The postoperative pathologic results acted as gold standard for comparison of the two methods. The results consistent with pathologic results were considered as correct otherwise were incorrect. The accuracy of EUS and CT and the each consistency of two methods with pathology were analyzed. Results For T staging, the accuracy of EUS and CT was 87. 2% （ 164/188 ）, 76. 6% （ 144/188 ）, respectively, and Kappa value of EUS and CT was 0. 726 and 0. 509, respectively. There was a statistical difference between the two methods （χ^2= 7. 181, P = 0. 007）. For lymph node metastasis, the accuracy of EUS and CT was 72. 9%（137/188） and 79. 8%（150/188） , respectively, and Kappa value of EUS and CT was O. 397 and 0. 487, respectively. No statistical difference was found between them （χ^2 = 0. 963, P = 0. 326）.The consistency test between the two methods for T and N staging and lymph node metastasis revealed that the Kappa value was 0. 507 and 0. 649, respectively. The accuracy of EUS on T staging was 93.0%, 93.3%, 96. 8% and 91.5% in cardiac cancer, gastric fundus cancer, gastric corpus cancer, and gastric antrum cancer, respectively. Corresponding Kappa value in the 4 different positions were 0. 843,0. 881,0. 940 and 0. 710, respectively according to consistency tests. The accuracy of gastric antrum cancer with pylorus invasion was 63.2% and the consistency test Kappa value was 0. 340. Conclusion EUS is an accurate method for T staging and lymphatic metastasis of advanced gastric cancer, but there is a lower accuracy for T staging of gastric antrum cancer with pylorus invasion.