超声内镜在胃黏膜下肿瘤诊断中的局限性

Limitations of endoscopic ultrasonography in diagnosis of gastric submucosal tumors

目的评估超声内镜(EUS)对胃黏膜下肿瘤(SMTs)的诊断价值,并分析胃SMTs的EUS下特点。方法收集2008年9月-2016年12月614例于该院内镜中心经EUS检查后行内镜黏膜下剥离术(ESD)切除治疗的胃SMTs患者资料纳入回顾性研究。病变起源层次以ESD术中诊断为金标准,病变类型以术后病理学及免疫组化结果为金标准,统计EUS诊断的符合率,并分析EUS结果。结果 EUS对病变起源的诊断与ESD术中结果的符合率为91.25%,其中起源于黏膜肌层、黏膜下层和固有肌层的诊断符合率分别为66.67%、80.85%和94.50%;对病变类型的诊断与ESD术后病理结果的符合率为65.99%,其中胃肠间质瘤(GIST)、平滑肌瘤、异位胰腺和脂肪瘤的诊断符合率分别为91.85%、18.56%、79.76%和90.70%。结论 EUS能初步判断胃SMTs的起源层次与病变类型,可为内镜下治疗提供较为准确的依据,但对诊断平滑肌瘤、错构瘤、炎性纤维性息肉、类癌和纤维瘤等少见病变存在一定的局限性。因此,必要时应积极地切除病变,以明确诊断,防止恶变。

Objective To evaluate endoscopic ultrasonography （EUS） in diagnosis of gastric submucosal tumors （SMTs）, and analyze the characteristics of gastric SMTs under EUS. Methods Clinical data of 614 patients with gastric SMTs, who were evaluated by EUS and underwent endoscopic submucosal dissection （ESD） from September 2008 to December 2016, were retrospectively analyzed. The golden standard for lession origins was the intraoperative diagnosis of ESD, and that for pathological types was the combination of postoperative pathological and immunohistochemical findings. The consistency of diagnosis of EUS was evaluated, and the characteristics of lesions under EUS were analyzed. Results The total consistency in diagnosing lesion origins was 91.25% between EUS and intraoperative results of ESD, and the consistency in diagnosing lesion originated from the muscularis mucosa, submucosa and muscularis propria was 66.67%, 80.85% and 94.50%, respectively. The total consistency in pathological types was 65.99% between EUS and postoperative pathological results, and the consistency of gastrointestinal stromal tumor （GIST）, leiomyoma, ectopic pancreas and lipoma was 91.85%, 18.56%, 79.76% and 90.70%, respectively. Conclusion EUS can initially determine the origins and types of gastric SMTs, providing a more accurate basis for endoscopic treatment, but there were some limitations on the diagnosis of leiomyoma and some rare lesions such as hamartoma, inflammatory fibrous polyps, carcinoid, fibroma, etc. Thus, if necessary, the lesion should be removed so as to make a definite diagnosis and prevent malignant change.