超声在小肠间质瘤恶性风险评估中的价值  

Estimation of risk of malignancy in small intestinal stromal tumors by ultrasonography

作　　者：崔宁宜[1] 王勇[1] 张蕊[1] 邹霜梅[2] 李琳[1] 刘隽颖[1] 牛丽娟[1] 郝玉芝[1] 周纯武[1] 姜玉新[3] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院影像诊断科,北京100021 [2]中国医学科学院北京协和医学院肿瘤医院病理科,北京100021 [3]中国医学科学院北京协和医学院北京协和医院超声诊断科,北京100073

出　　处：《癌症进展》2015年第3期331-334,337,共5页Oncology Progress

基　　金：首都特色临床应用研究(Z131107002213016);北京希望马拉松专项基金(LC2013A034)

摘　　要：目的：探讨超声评估小肠间质瘤恶性风险的价值。方法回顾性分析经手术病理和免疫组化证实的55例小肠间质瘤患者的声像图表现，依据胃肠道间质瘤（gastrointestinal stromal tumor，GIST）病理危险度分级将其分为低危组、中危组、高危组；声像图分析包括肿瘤的大小、形态、边界、内部回声，并对各组的上述征象进行方差分析或Fisher精确检验。结果55例小肠间质瘤中，低危组患者有8例，中危组患者有3例，高危组患者有44例。病灶最大径为3.5～28.0 cm；低危组病灶平均大小为4.3 cm，中危组为7.2 cm，高危组为11.2 cm。与低危组患者中出现回声不均、分叶、囊变的比例（25.0%、37.5%、25.0%）相比，中危组和高危组的比例高，分别为100.0%、100.0%、66.7%和88.6%、86.4%、81.8%；肿瘤大小、回声均质性、分叶、囊变在不同组间的差异有显著的统计学意义（均P＜0.05）。不同危险度分组中，肿瘤内有气体回声的比例在中危组（1/3，33.3%）和高危组（8/44，18.2%）中均高于低危组（0/8，0）；血流丰富的比例在高危组（17/44，38.6%）中的比例高于低危组（0/8，0）和中危组（1/8，12.5%），但无统计学意义（P＞0.05）。结论超声对评估小肠间质瘤恶性风险有一定价值。Objective To investigate the value of ultrasonography （US） in estimating the risk of malignancy in small intestinal stromal tumors. Method The US features were evaluated retrospectively in 55 patients with patholog-ically and immunohistochemically confirmed small intestinal stromal tumors, who were divided into high-risk （n =44）, moderate-risk （n = 3）, and low-risk （n = 8） of malignancy groups based on mitotic activity, location and size of the tumors. The US features included tumor size, lobulation, heterogeneity, cystic change, hyperechoic foci, calcifica-tion and color Doppler flow. The correlation of US features with the risk of malignancy was evaluated using either Fisher ’s exact test or ANOVA. Result The maximum diameter of the tumors was 3.5 - 28.0 cm, and the mean di-ameters of tumors were 4.3 cm, 7.2 cm, 11.2 cm in low-, moderate-, and high-risk groups, respectively. The propor-tions of heterogeneity, lobulation, cystic change in low-risk group were less than that of moderate- and high-risk＆amp;nbsp;group （25% vs 100.0% vs 88.6%, 37.5% vs 100.0% vs 86.4%, and 25.0% vs 66.7% vs 81.8%）, indicating a correla-tion with the risk of malignancy （P 〈 0.05）. Tumor size, heterogeneity, lobulation and cystic changes differed signifi-cantly among groups （P 〈 0.05）. Hyperechoic foci appeared more in moderate- （1/3, 33.3%） and high-risk group （8/44, 18.2%） than in low-risk group （0/8, 0）; and abundant color signals were more frequent in high-risk group （17/44, 38.6%） than in intermediate-risk group （1/8, 12.5%） and low-risk group （0/8, 0）, but without significant difference. Conclusion Certain US features are associated with increased risk of malignancy in small intestinal stromal tumors.

关 键 词：小肠间质瘤 超声 病理危险度分级 

分 类 号：R735.3[医药卫生—肿瘤]