经直肠三维超声诊断直肠黏液腺癌与非黏液腺癌的配对病例对照研究  

Value of three-dimensional transrectal ultrasound in diagnosis of rectal mucinous adenocarcinoma and non-mucinous adenocarcinoma:a matched case-control study

作　　者：刘敏 郑玮[1] 刘颖[1] 裴小青[1] 韩峰[1] 林僖[1] 周建华[1] 李安华[1] Liu Min;Zheng Wei;Liu Ying;PeiXiaoqing;Han Feng;Lin Xi;Zhou Jianhua;Li Anhua(Department of Ultrasound,Sun Yat-sen University Cancer Center,State Key Laboratory of Oncology in South China,Collaborative Innovation Center for Cancer Medicine,Guangzhou 510000,China)

机构地区：[1]中山大学肿瘤防治中心超声科肿瘤医学协同创新中心华南肿瘤学国家重点实验室,广州510000

出　　处：《中华医学超声杂志（电子版）》2021年第4期337-343,共7页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的探讨经直肠三维超声对直肠黏液腺癌与非黏液腺癌的鉴别诊断价值。方法回顾性分析2017年1月至2019年12月中山大学肿瘤防治中心收治的直肠黏液腺癌患者35例。以患者年龄相差不超过2岁、相同性别、相同肿瘤病理T分期及病灶距肛缘距离相差不超过1 cm的基线信息作为匹配条件,按照1∶1比例选择条件匹配的直肠非黏液腺癌患者35例作为对照组。比较2组患者的经直肠三维超声图像特征,应用多因素Logistic回归方法分析黏液腺癌的超声特征预测因素,并应用四格表计算预测因素的诊断效能。结果黏液腺癌组病灶浸润肠壁节段的平均长度为(45.20±20.09)cm,非黏液腺癌组病灶浸润肠壁节段的平均长度为(37.69±11.38)cm,两者差异有统计学意义(P<0.05)。黏液腺癌组中,具有长轴切面肠壁分层征或横断面同心圆征的病灶占全部病灶的77.1%(27/35),而非黏液腺癌组超声图像均无上述特征,2组间差异有统计学意义(P<0.05)。非黏液腺癌组以隆起型为主(33/35,94.3%),而黏液腺癌组病灶以平坦型为主(51.5%,18/35),2组间差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,长轴切面肠壁分层征或横断面同心圆征是直肠黏液腺癌的独立预测因素(OR=10.720,95%CI:2.429-47.300,P<0.05)。其诊断黏液腺癌的敏感度为77.1%,特异度为100.0%,准确性为88.6%,阳性预测值为100.0%,阴性预测值为81.4%。结论经直肠三维超声可在治疗前对直肠黏液腺癌与非黏液腺癌进行有效的鉴别诊断,其有助于个体化治疗方案的选择及准确评估预后。Objective To evaluate the value of three-dimensional(3D)transrectal ultrasound(TRUS)in the diagnosis of rectal mucinous adenocarcinoma and non-mucinous adenocarcinoma.Methods This study retrospectively analyzed the clinicopathological data and the characteristics of 3D TRUS images of 35 patients with rectal mucinous adenocarcinoma.Rectal mucinous adenocarcinoma patients were paired with rectal nonmucinous adenocarcinoma patients in the same period at 1:1(patient's age,±2 years old,same gender and pathological T stage of the tumor,and distance form lesion to anal verge of±1 cm).The differences in the 3D ultrasonic image features of the two groups were compared.Multivariate logistic regression was used to analyze the predictors of ultrasonic characteristics of mucinous adenocarcinoma,and the diagnostic efficacy of the predictors was calculated by using a four-grid table.Results Compared with non-mucinous carcinoma,mucinous carcinoma had longer infiltrating segment[(45.20±20.09)cm vs(37.69±11.38)cm].The long-axis layered sign or concentric cross-sectional sign was a typical ultrasound feature in mucinous carcinoma,accounting for 77.1%(27/35),while it was not found in non-mucinous adenocarcinoma.The main pattern of mucinous carcinoma was flat type(51.5%,18/35)whereas non-mucinous carcinoma was characterized by elevated type(94.3%,33/35).The above differences were statistically significant(P<0.05 for all).Conditional logistic regression analysis showed that the long-axis layered sign or cross-sectional concentric sign was a typical feature in the diagnosis of rectal mucinous adenocarcinoma,with an odds ratio(odds ration=10.720,95%CI:2.429-47.300),and its sensitivity,specificity,accuracy,positive predictive value,and negative predictive value were 77.1%,100%,88.6%,100%,and 81.4%,respectively.Conclusion 3D TRUS can effectively diagnose rectal mucinous adenocarcinoma and non-mucinous adenocarcinoma before treatment.

关 键 词：直肠肿瘤 黏液腺癌 成像 三维 经直肠超声检查 

分 类 号：R445.1[医药卫生—影像医学与核医学] R735.37[医药卫生—诊断学]