增强CT鉴别胃神经内分泌癌与胃腺癌的价值探讨

Study on the value of enhanced CT in differentiating gastric neuroendocrine carcinoma from gastric adenocarcinoma

目的探讨增强CT在胃神经内分泌癌(gastric neuroendocrine carcinoma,GNEC)与胃腺癌(gastric adenocarcinoma,GADC)鉴别诊断中的价值。方法回顾性纳入四川省人民医院经病理证实为GNEC和GADC的患者各59例,对两组病例的临床指标及CT影像学特征进行分析比较,将有统计学差异的影像学特征及临床指标作为独立预测因子,运用ROC曲线分析单独及联合运用各独立预测因子对两类肿瘤鉴别诊断的效能。结果GNEC与GADC两组病例中,临床指标CA19-9差异有统计学意义(P<0.05),CT影像学特征包括肿瘤发生部位、肿瘤长径、有无坏死囊变、肿瘤边缘清晰或模糊、胃黏膜是否完整及胃周有无阳性淋巴结显示差异有统计学意义(P<0.05);ROC曲线分析结果显示,单独应用具有统计学差异的各项CT影像特征和CA19-9作为独立预测因子鉴别GNEC和GADC的AUC值分别为0.612、0.647、0.636、0.619、0.585、0.593、0.424,各独立预测因子联合运用的AUC值为0.814,灵敏度和特异度均有提升(P<0.05)。结论GNEC与GADC的增强CT影像学特征具有一定差异性,综合分析这些影像特征,同时结合CA19-9等临床指标有助于提高二者术前无创性鉴别诊断的准确性。

Objective To investigate the value of enhanced CT in the differential diagnosis of gastric neuroendocrine carcinoma(GNEC)and gastric adenocarcinoma(GADC).Methods A total of 59 patients with pathologically confirmed GNEC and GADC in our hospital were retrospectively included.Clinical indicators and CT imaging features of the two groups were analyzed and compared.Imaging features and clinical indicators with statistical differences were used as independent predictors.ROC curve analysis was used to analyze the differential diagnosis efficiency of single and combined application of independent predictors for the two types of tumors.ResultsThere were statistically significant differences in clinical indicator CA19-9 between the GNEC group and the GADC group(P<0.05).There were statistically significant differences in CT image features such as tumor location,tumor length diameter,necrotic cystic change,clear or fuzzy tumor margins,intact gastric mucosa and positive lymph nodes around the stomach(P<0.05).The AUC values of separately applying statistically significant CT imaging features and CA19-9 as independent predictors to identify GNEC and GADC were 0.612,0.647,0.636,0.619,0.585,0.593,and 0.424,respectively.The AUC value of the combined application of all independent predictors was 0.814.The sensitivity and the specificity were all improved as well(P<0.05).Conclusions There are certain differences in enhanced CT characteristics of GNEC and GADC.Comprehensive analysis of these image features combined with CA19-9 are helpful to improve the accuracy of preoperative non-invasive differential diagnosis of the two types of tumors.