探讨经腹胃充盈超声应用于胃癌诊断及临床分期的价值  

Clinical value of transabdominal gastric filling ultrasound in the diagnosis and staging of gastric cancer

作　　者：李悦扬 方圆 刁雪红 姚明华 李鑫 陈惠莉 刘阳[1] 王庆国[2] 李康安[2] 吴蓉 黄陈 LI Yueyang;FANG Yuan;DIAO Xuehong;YAO Minghua;LI Xin;CHEN Huili;LIU Yang;WANG Qingguo;LI Kang’an;WU Rong;HUANG Chen(Department of Ultrasonic Diagnosis,the First People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200080,China;不详)

机构地区：[1]上海交通大学医学院附属第一人民医院超声诊断科,上海200080 [2]上海交通大学医学院附属第一人民医院放射科,上海200080 [3]上海交通大学医学院附属第一人民医院胃肠外科,上海200080

出　　处：《上海医学》2023年第8期548-556,共9页Shanghai Medical Journal

基　　金：国家自然科学基金(82072662、82071931)。

摘　　要：目的本研究通过对比增强CT(ECT),探讨经腹胃充盈超声(TGFUS)在胃癌诊断和临床分期评估中的价值。方法回顾性分析2021年1月1日—2022年7月31日在上海交通大学医学院附属第一人民医院因胃癌接受肿瘤切除手术的109例患者资料。以组织病理学检查结果为金标准(即阳性对照),分析TGFUS和ECT检查的诊断准确性。记录纳入患者的年龄、性别,不同检查方法下肿瘤的位置、大小、浸润深度、分型、分期,分别记录TGFUS和ECT下评估肿瘤浸润的层次(即ultrasound-stage,uT)和淋巴结转移(即ultrasound-lymph node,uN)。分析2种检查对各分期肿瘤的诊断效能,并应用观察者间测量一致性(interobserver consistency,ICC)分析2种检查诊断的稳定性。结果当依据TGFUS的uN评估肿瘤分期时,诊断的准确率和误诊率在不同肿瘤分型、不同大小肿瘤间的差异分别具有统计学意义(χ^(2)=12.329,P=0.002;χ^(2)=21.002,P<0.001)。当依据ECT的ECT-N时,诊断的准确率和误诊率在不同患者年龄、不同大小肿瘤间的差异具有统计学意义(χ^(2)=3.382,P=0.016;χ^(2)=5.215,P=0.008)。而当依据TGFUS的uT和ECT-T时,诊断的准确率和误诊率在上述变量亚组间的差异均无统计学意义(P值均>0.05)。ROC曲线分析显示,ECT和TGFUS在鉴别诊断pT1~T2期和pT3~T4期的准确率、灵敏度、特异度分别为71.24%、87.30%、55.20%和76.37%、87.30%、65.50%,两者的AUC分别为0.771、0.822;ECT和TGFUS在鉴别诊断pN0期和pN1~N3期的准确率、灵敏度、特异度分别为93.18%、86.20%、96.80%和83.88%、48.30%、96.80%,AUC分别为0.915和0.726。应用TGFUS的uT评估肿瘤分期的ICC的Kappa值为0.977(95%CI为0.967~0.984)。应用ECT的ECT-T评估肿瘤分期的ICC的Kappa值为0.974(95%CI为0.963~0.982)。应用TGFUS的uN评估肿瘤分期的ICC的Kappa值为0.950(95%CI为0.927~0.965)。应用ECT的ECT-N评估肿瘤分期ICC的Kappa值为0.995(95%CI为0.993~0.997)。结论与ECT比较,TGFUS在胃癌患�Objective To explore the value of transabdominal gastric filling ultrasound(TGFUS)in the diagnosis and clinical staging of gastric cancer by comparing with contrast-enhanced CT(ECT).Methods Clinical data of 109 patients with gastric cancer who underwent tumor resection in the First People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 1,2021 to July 31,2022 were retrospectively analyzed.Pathological examination results of endoscopic biopsy were taken as the golden standard(i.e.positive control)to evaluate the diagnostic accuracy of TGFUS and ECT.Patient’s age and gender,as well as the location,size,depth of infiltration,classification,and staging of the tumors were recorded.The degree of tumor infiltration(ultrasound-stage,uT)and lymph node metastasis(ultrasound-lymph node,uN)were evaluated with TGFUS and ECT,respectively.The diagnostic efficacy of TGFUS and ECT for tumors at different stages was analyzed.The diagnostic stability was assessed by interobserver consistency(ICC)test.Results According to the uN staging criteria of TGFUS,there were statistically significant differences in diagnostic accuracy and misdiagnosis rates among different tumor types and sizes(χ^(2)=12.329,P=0.002;χ^(2)=21.002,P<0.001).According to the N staging criteria of ECT,the accuracy and misdiagnosis rate showed significant differences among patients with different ages and different tumor sizes(χ^(2)=3.382,P=0.016;χ^(2)=5.215,P=0.008).However,according to the uT staging criteria of TGFUS or the T staging criteria of ECT,there was no statistically significant difference in diagnostic accuracy or misdiagnosis rates among the subgroups of the aforementioned variables(P>0.05).Receiver operating characteristic(ROC)curve showed that,in the differential diagnosis between pT1-T2 and pT3-T4,the accuracy,sensitivity and specificity were 71.24%,87.30%and 55.20%by ECT,76.37%,87.30%and 65.50%by TGFUS,and their areas under the curve(AUCs)were 0.771 and 0.822,respectively.In the differential diagnosis b

关 键 词：经腹胃充盈超声 增强计算机断层扫描 胃癌 临床分期 

分 类 号：R573[医药卫生—消化系统]