超声内镜联合64排双源计算机断层扫描检查对胃癌局部临床分期和腹膜转移的预测价值

Predictive value of combination of endoscopic ultrasound and 64-slice dual-source computed tomography in regional clinical staging and peritoneal metastases of gastric cancer

目的分析超声内镜联合64排双源计算机断层扫描（DSCT）检查对胃癌患者局部临床分期和腹膜转移的预测价值。方法纳入2011年7月至2017年5月经胃镜病理检查诊断为胃癌的365例患者，行超声内镜和DSCT检查，并以术后病理诊断为金标准，评估超声内镜、DSCT检查与联合检查判断胃癌原发肿瘤、区域淋巴结和腹膜转移的准确性，计算其准确度、敏感度、特异度、阳性预测值、阴性预测值、一致性（Kappa值）和AUC值。结果263例患者纳入肿瘤浸润深度、区域淋巴结临床分期研究，289例患者纳入腹膜转移临床预测研究。超声内镜检查对肿瘤浸润深度临床分期的准确度为75.29%，对区域淋巴结分期的敏感度、特异度、Kappa值和AUC值分别为86.26%、81.81%、0.681和0.840。DSCT检查对区域淋巴结分期的敏感度、特异度、Kappa值和AUC值分别为74.81%、87.12%、0.620和0.813。超声内镜检查对预测腹膜转移的敏感度、特异度、Kappa值和AUC值分别为38.24%、97.25%、0.432和0.668，DSCT检查对预测腹膜转移的敏感度、特异度、Kappa值和AUC值分别为41.18%、100.00%、0.553和0.706。超声内镜和DSCT联合检查对肿瘤浸润深度临床分期的准确度和Kappa值分别为75.29%和0.639；对区域淋巴结临床分期的敏感度、特异度、阳性预测值、阴性预测值、Kappa值和AUC值分别为93.13%、87.88%、88.41%、92.80%、0.810和0.905，对腹膜转移临床预测的敏感度、特异度、阳性预测值、阴性预测值、Kappa值和AUC值分别为58.82%、97.25%、74.07%、94.66%、0.616和0.774。结论超声内镜联合DSCT检查对胃癌肿瘤浸润深度、区域淋巴结临床分期有较大价值，对腹膜转移临床预测有一定价值，优于单项检查。联合检查能提高肿瘤浸润深度、区域淋巴结临床分期和腹膜转移临床预测的准确性，两种检查方法互为补充。

ObjectiveTo analyze the predictive value of combination of endoscopic ultrasound （EUS） and 64-slice dual-source computed tomography （DSCT） in regional clinical staging and peritoneal metastases of gastric cancer.MethodsFrom July 2011 to May 2017, 365 patients with gastric cancer diagnosed by endoscopic biopsy were enrolled. The patients received EUS and DSCT examination with the gold standard of postoperative pathological diagnosis, the accuracies of EUS alone, DSCT alone and the combination of EUS and DSCT were evaluated in original gastric tumor, regional lymph nodes and peritoneal metastases. The accuracy, sensitivity, specificity, the positive predictive value, the negative predictive value, consistency （the value of Kappa） and area under curve （AUC） of receiver operating characteristic （ROC） curve were calculated.ResultsA total of 263 patients were enrolled into the study on the depth of tumor invasion and clinical staging of regional lymph nodes and 289 patients were recruited into the clinical prediction study on peritoneal metastasis. The accuracy of EUS in clinical staging of the depth of tumor invasion was 75.29% and the sensitivity, specificity, the value of Kappa and AUC of EUS in clinical staging of regional lymph nodes were 86.26%, 81.81%, 0.681 and 0.840, respectively. The sensitivity, specificity, the value of Kappa and AUC of DSCT in clinical staging of regional lymph nodes were 74.81%, 87.12%, 0.620 and 0.813, respectively. The sensitivity, specificity, the value of Kappa and AUC of EUS in the prediction of peritoneal metastases were 38.24%, 97.25%, 0.432 and 0.668, respectively. The sensitivity, specificity, the value of Kappa and AUC of DSCT in the prediction of peritoneal metastases were 41.18%, 100.00%, 0.553 and 0.706, respectively. The accuracy and the value of Kappa of the combination of EUS and DSCT in clinical staging of the depth of tumor invasion were 75.29% and 0.639; the sensitivity, specificity, positive predictive value, negative predictive value, Kappa, AUC in clinical staging of regional lymph nodes were 93.13%, 87.88%, 88.41%, 92.80%, 0.810 and 0.905, respectively; and the sensitivity, specificity, positive predictive value, negative predictive value, Kappa, AUC in the prediction of peritoneal metastases were 58.82%, 97.25%, 74.07%, 94.66%, 0.616 and 0.774, respectively.ConclusionsThe combination of EUS and DSCT which is superior to single examination is very helpful in the depth of gastric cancer invasion and regional lymph nodes, and is helpful in the prediction of peritoneal metastasis. The combination of two complementary examinations can improve the accuracy of the depth of gastric cancer invasion, clinical staging of regional lymph nodes, and the prediction of peritoneal metastasis.