超声内镜弹性成像对胃癌术前淋巴结分期的诊断价值

Diagnostic value of endoscopic ultrasound elastography in preoperative lymph node staging of gastric cancer

目的探讨超声内镜(EUS)弹性成像对胃癌术前淋巴结分期(N分期)的诊断价值。方法 96例胃癌患者术前行EUS弹性成像和CT检查,以术后病理诊断为金标准,评估EUS弹性成像对胃癌术前N分期的诊断价值,分析EUS弹性成像诊断术前N分期准确度的影响因素。结果96例中,EUS弹性成像诊断无区域淋巴结转移44例,有区域淋巴结转移52例,术后病理诊断无区域淋巴结转移32例,有区域淋巴结转移64例。EUS弹性成像诊断N分期的准确度为75.0%,灵敏度为71.9%,特异度为81.3%,阳性预测值为88.5%,阴性预测值为59.1%。EUS弹性成像联合CT诊断N分期的准确度为85.4%,灵敏度为84.4%,特异度为87.5%,阳性预测值为93.1%,阴性预测值为73.7%。多因素Logistic回归分析显示,肿瘤分化程度是影响EUS弹性成像诊断N分期准确度的独立因素(P<0.05)。结论 EUS弹性成像诊断胃癌术前N分期的准确度较高,联合CT检查能进一步提高准确度。肿瘤分化程度是影响EUS弹性成像诊断N分期准确度的独立因素。

Objective To investigate the diagnostic value of endoscopic ultrasound elastography in preoperative lymph node staging of gastric cancer.Methods A total of 96 patients with gastric cancer was examined by endoscopic ultrasound elastography and CT before operation.Taking the postoperative pathology as the golden standard,the diagnostic value of endoscopic ultrasound elastography in preoperative lymph node staging of gastric cancer was evaluated.The factors influencing the accuracy rate of endoscopic ultrasound elastography in diagnosing preoperative lymph node staging of gastric cancer was analyzed.Results The endoscopic ultrasound elastography showed that 44 cases were without regional lymph node metastasis and 52 cases were with regional lymph node metastasis.There were 42 patients without regional lymph node metastasis and 64 patients were with regional lymph node metastasis diagnosed by postoperative pathology.The accuracy rate,sensitivity,specificity,positive predictive value and negative predictive value of endoscopic ultrasound elastography in diagnosing preoperative lymph node staging of gastric cancer were 75.0%,71.9%,81.3%,88.5% and 59.1%,respectively.The accuracy rate,sensitivity,specificity,positive predictive value and negative predictive value of endoscopic ultrasound elastography combined with CT in diagnosing preoperative lymph node staging of gastric cancer were 85.4%,84.4%,87.5%,93.1% and 73.7%,respectively.Multivariate Logistic regression analysis showed that the tumor differentiation degree was an independent factor affecting the accuracy of endoscopic ultrasound elastography in diagnosing lymph node staging of gastric cancer(P<0.05).Conclusion The accuracy rate of endoscopic ultrasound elastography in diagnosing preoperative lymph node staging of gastric cancer is higher,which can be further improved when combined use of CT examination.The tumor differentiation degree is an independent factor affecting the accuracy of endoscopic ultrasound elastography in diagnosing lymph node staging of gastric cancer.