小探头超声内镜对早期胃癌浸润深度诊断及个体化治疗方案选择的价值研究

The value of mini-probe endoscopic ultrasonography in estimating the depth of tumor invasion and individualized treatment for early gastric cancer

目的探讨小探头超声内镜(EUS)在评估早期胃癌的浸润深度及其在个体化治疗方案选择中的价值。方法将2017年1月—2019年12月在南京医科大学附属常州第二人民医院诊断为早期胃癌并行内镜下切除或外科手术,且术前接受了小探头EUS检查评估肿瘤浸润深度的70例患者纳入回顾性研究。以术后病理结果为“金标准”评估小探头EUS诊断早期胃癌浸润深度的准确性,采用χ^(2)检验和logistic回归模型分析影响小探头EUS评估准确性的临床病理因素。结果小探头EUS对T_(1)期早期胃癌浸润深度评估的总体准确性为72.9%(51/70)。其中,EUS检查对T_(1)a期、T_(1)b期病变评估灵敏度分别为68.3%(28/41)、79.3%(23/29),特异度分别为79.3%(23/29)、68.3%(28/41),阳性预测值分别为82.4%(28/34)、63.9%(23/36),阴性预测值分别为63.9%(23/36)、82.4%(28/34)。小探头EUS评估不同形态(χ^(2)=12.270)、有无溃疡(χ^(2)=7.964)的肿瘤浸润深度准确性的差异有统计学意义(P值均<0.01),即对平坦型、无溃疡病变浸润深度的评估准确性较高。经logistic回归分析发现,病变形态是影响EUS错误评估早期胃癌病变浸润深度的独立危险因素,EUS对平坦型病变错误评估的风险较隆起型下降(OR=0.071,P=0.035)。结论小探头EUS可用于准确评估早期胃癌的浸润深度,有助于早期胃癌个体化治疗方案的选择。

Objective To explore the value of mini-probe endoscopic ultrasonography(EUS)in evaluating the depth of tumor invasion and individualized treatment of early gastric cancer(EGC).Methods A retrospective study was conducted in 70 patients who were diagnosed as EGC in the the Second People’s Hospital of Changzhou,Nanjing Medical University from January 2017 to December 2019.They all received mini-probe EUS for estimating the depth of invasion before endoscopic resection or surgery.Postoperative pathological findings were taken as golden standard to assess the accuracy of mini-probe EUS in the evaluating the depth of invasion of EGC.Clinicopathological factors affecting the mini-probe EUS-based determination of invasion were analyzed by chi-square test and logistic regression model.Results The overall accuracy of T_(1) stage by mini-probe EUS was 72.9%(51/70).The diagnostic sensitivities of mini-probe EUS for T_(1)a stage and T_(1)b stage were 68.3%(28/41)and 79.3%(23/29),the specificities were 79.3%(23/29)and 68.3%(28/41),positive predictive values were 82.4%(28/34)and 63.9%(23/36),and negative predictive values were 63.9%(23/36)and 82.4%(28/34),respectively.Chi-square test showed that ulcer and lesion shape were associated with the accuracy of mini-probe EUS in evaluating the depth of tumor invasion(χ^(2)=7.964,12.270,both P<0.01).Logistic regression analysis showed that lesion shape was independently associated with the misdiagnosis of depth of tumor invasion(OR=0.071,P=0.035).Conclusion Mini-probe EUS can be used to accurately evaluate the depth of invasion of EGC and can help to choose individualized treatment for EGC.