内镜超声检查在早期胃癌术前分期的应用

A preliminary study of endoscopic ultrasonography in the preoperative staging of early gastric carcinoma

目的 探讨内镜超声检查 (EUS)在早期胃癌术前分期中的临床应用价值。方法 对14 9例经胃镜活检证实的胃癌患者 (其中早期胃癌 33例 )术前行内镜超声检查 ,并与术后病理检查结果对照。结果 EUS对胃癌T分期的准确率为 80 .3% ,其中T1期为 81.8% ,T2期为 70 .4 % ,T3期为88.9% ,T4期为 71.4 %。EUS鉴别早期和进展期胃癌的准确率达 95 .1% ,而鉴别胃黏膜和黏膜下癌的准确率仅为 6 3.6 %。EUS对黏膜和黏膜下癌的判断准确率分别为 5 2 .9%和 75 .0 % ,而阳性预测值分别达 90 .0 %和 70 .6 %。EUS对隆起型和平坦型早期胃癌浸润深度的判断准确率均为 10 0 % ,对凹陷型的准确率仅 5 8.6 % ;对分化型和未分化型早期胃癌浸润深度的判断准确率分别为 71.4 %和5 7.9% ,差异无显著性 (P >0 .0 5 )。EUS对早期胃癌浸润深度的判断准确率随着肿瘤直径的增大而降低 ,对早期胃癌淋巴结状况的判断准确率为 90 .9% ,对淋巴结转移的敏感性和特异性分别为 6 6 .7%和 96 .3%。结论 内镜超声检查对早期胃癌术前分期具有较高的临床应用价值。

Objective To study the clinical value of endoscopic ultrasonography (EUS) in the preoperative staging of early gastric carcinoma. Methods EUS was performed in 149 gastric carcinoma patients proved by biopsy (including 33 patients with early gastric cancer), of which the results were compared with postoperative pathologic findings. Results The accuracy of EUS in determining the T stage of gastric carcinoma was 80.3% (T1 81.8%, T2 70.4%, T3 88.9%, T4 71.4%). The accuracy of EUS in differentiating early gastric carcinoma from advanced ones was 95.1%, and the accuracy of EUS in differentiating mucosal cancer from submucosal cancer was only 63.6%. The diagnostic accuracy of EUS for mucosal and submucosal cancer was 52.9% and 75%, with positive predictive value of 90% and 70.6%, respectively. The accuracy of invasion depth of EUS for the bulging and flat type of early gastric carcinoma was 100%, whereas the accuracy was only 58.6% for the depressed type. The accuracy of invasion depth of the differentiated and undifferentiated early cancer was 71.4% and 57.9%, without any significant difference( P >0.05). The accuracy of invasion depth of EUS for early gastric carcinoma decreased as tumor size increased. The diagnostic accuracy of lymph node status of early gastric carcinoma by EUS was 90.9%, and the sensitivity and specificity of lymph node metastasis was 66.7% and 96.3% , respectively. Conclusion The clinical value of endoscopic ultrasonography in the preoperative staging of early gastric carcinoma is relatively high. [