胃神经内分泌癌与胃神经内分泌瘤及胃腺癌的CT特征及鉴别  

Differential diagnosis between gastric neuroendocrine cancer, gastric neuroendocrine tumor and gastric adenocarcinoma by CT features

作　　者：蒋世烨 华杰[2] 徐超 蒋谦[4] 何晓璞[1] JIANG Shiye;HUA Jie;XU Chao;JIANG Qian;HE Xiaopu(Department of Geriatric Gastroenterology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Gastroenterology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of General Surgery,the Lukou Community Health Service Center,Nanjing 211113,China;Department of General Surgery,Jiangsu Cancer Hospital,Nanjing 210009,China)

机构地区：[1]南京医科大学第一附属医院老年消化科,江苏南京210029 [2]南京医科大学第一附属医院消化内科,江苏南京210029 [3]南京市江宁区禄口街道社区卫生服务中心普外科,江苏南京211113 [4]江苏省肿瘤医院普外科,江苏南京210009

出　　处：《中国肿瘤外科杂志》2019年第2期93-97,101,共6页Chinese Journal of Surgical Oncology

基　　金：江苏省自然科学基金面上项目(BK20171508)

摘　　要：目的探讨胃神经内分泌癌(G-NEC)与胃神经内分泌瘤(G-NET)及胃腺癌(G-ADC)的CT特征,为临床诊治提供参考。方法选取2014年1月至2018年9月于南京医科大学第一附属医院老年消化科就诊的G-NEC、G-NET及G-ADC患者各15例,分别为G-NEC组、G-NET组及G-ADC组,对多个CT特征进行评估,以鉴别G-NEC与G-NET及G-ACD的影像学差异。结果 3组中存在差别的CT特征有肿瘤最大径(P=0.023)、肿瘤位置(贲门、胃底及胃体为上部,胃体中下部及胃窦为下部,P=0.020)、病灶数量(单发、多发及散发,P=0.003)、肿瘤边缘是否清晰(P<0.001)、黏膜是否完整(P<0.001)、淋巴结是否转移(P<0.001)、转移淋巴结最大径(P=0.008)和有无淋巴结的坏死(P=0.006);随后进行G-NEC与G-NET两组间比较,经单因素分析发现G-NEC的病灶更大[(4.72±1.73)cm比(2.08±1.02)cm,P<0.001)],位于胃体中下部及胃窦的概率更高(60.0%比13.3%,P=0.021),单发病例更多(100%比66.7%,P=0.042),更易发生淋巴结转移(93.3%比20.0%,P=0.001)。G-NEC和G-ADC两组间的CT特征的单因素分析显示,G-NEC的转移淋巴结直径比G-ADC的大[(1.82±0.69)cm比(1.23±0.65)cm,P=0.045],G-NEC的肿瘤边缘较G-ADC清晰(60.0%比0,P=0.001), G-NEC的肿瘤黏膜较G-ADC肿瘤黏膜完整(53.3%比66.7%,P=0.014)。结论 CT的特征有助于G-NEC与G-NET及G-ADC的诊断。Objective To evaluate the differential CT features of gastric neuroendocrine cancer(G-NEC) from gastric neuroendocrine tumor(G-NET) and gastric adenocarcinoma(G-ADC),and provide reference for clinical diagnosis and treatment. Methods CT features of 15 patients with G-NET,15 patients with G-NEC and 15 patients with G-ADC from January 2014 to April 2018 were retrospectively analyzed. Results Tumor size( P = 0.023),tumor location(upper half of the stomach including cardia,fundus and body of gastric,while lower half including mid,low and antrum of gastric,P = 0.02),the number of nidus(single,multiple,diffuse,P = 0.003),tumor edge ( P < 0.001),intact overlying mucosa with mucosal tenting( P < 0.001),Lymph nodes (LNs) metastasis( P < 0.001),diameter of the largest LNs ( P = 0.008)and LNs necrosis( P = 0.006) were significantly different among G-NEC,G-NET and G-ADC patients.Compared with G-NET,G-NEC was more easily metastasized to LNs (93.3% vs 20.0%,P = 0.001),larger([4.72±1.73]cm vs [2.08±1.02]cm,P < 0.001),solitary in number (100% vs 66.7%,P = 0.042) which was prefer to be located in mid,low and antrum of gastric (60.0% vs 13.3%,P = 0.021).While intact overlying mucosa(53.3% vs 66.7%,P = 0.014),well-defined margin(60.0% vs 0,P = 0.001)and larger size of metastatic LNs([1.82±0.69]cm vs [1.23±0.65]cm,P = 0.045)were the significant CT features for differentiating G-NEC from G-ADC. Conclusions CT is of great significance to differentiate G-NEC from G-NET and G-ADC.

关 键 词：胃神经内分泌肿瘤 胃腺癌 淋巴结转移 CT检查 鉴别诊断 

分 类 号：R735.2[医药卫生—肿瘤] R730.44[医药卫生—临床医学]