线阵超声内镜联合CT对中晚期胃癌患者术前TN分期的临床诊断价值

Clinical diagnostic value of linear endoscopic ultrasonography combined CT examination for middle and late stage gastric cancer preoperative TN staging

目的探讨线阵超声内镜(LEUS)和全腹部CT检查对中晚期胃癌患者术前TN分期诊断的准确性,评价二者临床价值。方法收集2014年1月-2016年11月河北医科大学第二医院消化内科经内镜下活检或内镜细针穿刺活检(EUS-FNA)确诊的胃癌患者73例,术前行LEUS检查及全腹CT检查诊断TN分期,并与术后病理结果分期进行分析对比。结果 LELUS与术后组织病理比较,诊断T1、T2、T3、T4期的准确率分别为80.0%、77.3%、71.4%、60.0%;CT与术后组织病理比较,诊断T1、T2、T3、T4的准确率分别为60.0%、63.6%、76.2%、66.7%。LEUS与术后组织病理比较,诊断N0、N1、N2、N3的准确率分别为86.7%,76.5%、45.5%、63.2%;CT与术后组织病理比较,诊断N0、N1、N2、N3的准确率分别为80.0%、70.6%、63.6%、94.7%,LEUS联合CT与术后组织病理比较,诊断T1、T2、T3、T4的灵敏度分别为80.0%、77.3%、76.2%、66.7%,特异度为98.3%、90.2%,82.7%、94.8%,准确率为94.5%、86.3%、80.8%,89.0%。经Kappa检验具有高度一致性(Kappa=0.726),ROC曲线下面积(AUC)具有较高的准确性(AUC=0.958)。LEUS联合CT与术后组织病理比较,诊断N0、N1、N2、N3灵敏度分别为86.7%、76.5%、63.6%、94.7%,特异度为98.3%、92.9%、92.2%、88.9%,准确率为95.9%、89.0%、83.6%、90.4%.,经Kappa检验具有高度一致性(Kappa=0.725),ROC曲线下面积(AUC)具有较高的准确性(AUC=0.972)。结论 LEUS和CT联合检查与术后病理诊断一致度、准确度较高,可以作为术前判断胃癌TN分期的手段。

Objective To evaluate the clinical value and the reasonable combination way through the linear array endoscopic ultrasonography(LEUS) and total abdominal CT examination for locally advanced gastric cancer treatment TN staging. Methods Collected from January 2014 to November 2016, in the Department of Gastroenterology, the second hospital of Hebei Medical University, 73 patients with gastric cancer underwent endoscopic biopsy or fine needle aspiration biopsy( EUS FNA) were enrolled, preoperative LEUS examination and abdominal CT examination for the diagnosis of TN staging and postoperative pathology results of comparative analysis were performed. Results Comparison of LEUS and pathology after operalion, the diagnostic accuracy of T1, T2 T3, T4 were 80.0%, 77.3%, 71.4%, 60.0%; compared with postoperative pathological CT, the diagnostic accuracy of T1, T2, T3 and T4 were 60. 0%, 63. 6%, 76. 2%. 66. 7%. Comparison of LEUS and pathology after operation, the diagnostic accuracy of NO, N1, N2 and N3 were 86. 7%, 76. 5%, 45.5%, 63. 2%; compared with postoperative pathological CT, the diagnostic accuracy of N0, N1, N2 and N3 were 80. 0%, 70. 6%, 63. 6%,94.7%.LEUS combined with CT and postoperative pathological diagnosis of T1, T2, T3 comparison, the sensitivity of T4 was 80.0%, 77. 3%, 76. 2%, 66. 7%, the specificity was 98. 3%, 90. 2%, 82. 7%, 94. 8%, the accuracy rate was94.5%, 86. 3%, 80.8%, 89.0%. The Kappa test was highly consistent( Kappa =0. 726), and the area under the ROC curve( AUC) had higher accuracy( AUC =0. 958). LEUS combined with CT and postoperative pathological diagnosis of N0,N1, N2 comparison, the sensitivity of N3 was 86.7%, 76. 5%, 63. 6%, 94.7%, the specificity was 98. 3%, 92. 9%, 92.2%, 88.9%, the accuracy rate was 95. 9%, 89. 0%, 83. 6%, 90. 4%, the Kappa test has a high degree of consistency(Kappa =0.725), ROC curve under(AUC) with high accuracy( AUC =0.972). Conclusion The combination of LEUS and CT has good consistency and accuracy in postoperative pathological diagnosis. It can be used as a preoperative method to judge TN staging of gastric cancer.