超声内镜诊断胃黏膜早期病变浸润深度的准确性分析

The accuracy of endoscopic ultrasonography in evaluation of invasion depth in early gastric neoplasia

目的探讨超声内镜(endoscopic ultrasonography,EUS)诊断胃黏膜早期病变浸润深度的准确性。方法回顾性分析2013年1月-2015年12月在南京医科大学第一附属医院消化内镜中心诊断为胃黏膜高级别上皮内瘤变(high-grade intraepithelial neoplasia,HGIN)的100例患者的EUS资料,包括内镜下病变部位、大小、个数、侵犯层次、黏膜外观等。并与其术后病理进行比较,分析EUS对判断病变浸润深度的准确性及其影响因素。结果 100例活检诊断为胃HGIN患者中,超声示黏膜层57例,黏膜下层43例。内镜切除(endoscopic resection,ER)术后,黏膜层88例,黏膜下层12例;19例术后病理升级为早期胃癌(early gastric cancer,EGC)。活检诊断HGIN准确率为81.0%(81/100)。EUS诊断胃黏膜病变浸润深度的准确性为65.0%(65/100),其中,低估率和过判率分别为2.0%(2/100)和33.0%(33/100)。EUS判断黏膜层病变的敏感性和特异性分别为62.5%(55/88)和83.3%(10/12)。对于黏膜下层及凹陷型病变层次的判断,EUS更易误诊(P<0.05)。结论 EUS是判断胃黏膜早期病变浸润深度的有效方法。但对于黏膜下层及凹陷型病变,EUS判断的准确性相对较低。

Objective To investigate the accuracy of endoscopic ultrasonography（EUS）for determining the depth of early stage of gastric neoplasia.Methods The clinical datas of 100 patients who were diagnosed as high-grade intraepithelial neoplasia（HGIN）from Jan.2013 to Dec.2015 in the endoscopy center,including the lesion size,location,depth,appearance were analyzed retrospectively.Compared with the EUS results,postoperative pathological results for the lesion infiltration depth,and the risk factors for the inconsistence were analyzed.Results Among the 100 HGIN patients,57 patients were with mucosal invasion and 43 submucosal invasion according to EUS assessment.After endoscopic resection（ER）,88 were with mucosal invasion and 12 submucosal invasion.A total of 19 patients had their postoperative pathology upgraded to early gastric cancer（EGC）.The diagnosis accuracy rate of endoscopic biopsy for HGIN was 81.0%（81/100）.The overall accuracy of EUS assessment for the depth of tumor invasion was 65.0%（65/100）,the rate of underestimation and overestimation was seen in 2（2.0%）and 33（33.0%）,respectively.For mucosa lesions,the sensitivity and specificity of EUS was 62.5%（55/88）and 83.3%（10/12）,respectively.The accuracy of EUS decreased especially for depressed lesions and lesions with submucosal invasion（P〈0.05）.Conclusion EUS is an effective method to diagnose the infiltration depth of gastric neoplasia.For depressed and submucosal lesions,the accuracy of EUS was relatively low.