普通和放大及超声内镜对未分化型早期胃癌的诊断价值  

Diagnostic efficiency of conventional endoscopy,magnifying endoscopy and endoscopic ultrasonography for undifferentiated-type early gastric cancer

作　　者：李伟峰 王警[1] 李士杰[1] 袁鹏[1] 闫炎[1] 曹长琦[1] 吴齐[1] LI Weifeng;WANG Jing;LI Shijie;YUAN Peng;YAN Yan;CAO Changqi;WU Qi(Department of Endoscopy Center,Peking University Cancer Hospital&Institute,Beijing Institute for Cancer Research,Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education),Beijing 100142,China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所内镜中心·恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142

出　　处：《中华肿瘤防治杂志》2023年第18期1110-1115,共6页Chinese Journal of Cancer Prevention and Treatment

基　　金：北京市医院管理中心临床医学发展专项经费资助(XMLX202143);首都卫生发展科研专项(2020-2-2155);北京市属医院科研培育计划(PX2020047);北京市医院管理中心青年人才培养“青苗”计划(QML20211103);北京市海淀区培育计划(HP2022-19-503002)。

摘　　要：目的未分化型早期胃癌(UD-EGC)采用普通内镜(CE)、放大内镜窄带成像(ME-NBI)及超声内镜(EUS)评估临床适应证的诊断价值。方法回顾性分析2018-01-01-2022-01-01在北京大学肿瘤医院临床诊断UD-EGC的82例患者CE、ME-NBI和EUS资料及临床资料,采用活检联合ME-NBI对分化类型判断的准确性进行分析,采用CE、ME-NBI及EUS对肿瘤浸润深度判断的准确性进行分析。结果活检联合ME-NBI判断分化程度准确率(70.73%,58/82)高于单纯活检(62.20%,51/82),P=0.016。对于肿瘤浸润深度的判断,CE联合ME-NBI总体准确率为59.76%(49/82),与术后病理分期比较其一致性程度较差,Kappa=0.206,P=0.053。EUS总体准确率为71.95%(59/82),与术后病理分期比较其一致性程度中等,Kappa=0.441,P<0.001。在EUS评估浸润深度准确率的多因素分析中,肿瘤直径>2 cm(OR=4.56,95%CI为1.42~14.59,P=0.011)和低分化腺癌类型(OR=5.76,95%CI为1.12~29.54,P=0.036)是其准确性下降的独立危险因素。结论对于UD-EGC的临床诊断,术前活检联合ME-NBI可以提升病理类型判断的准确性,而EUS对肿瘤浸润深度的判断具有较好的诊断能力。Objective To evaluate the diagnostic efficiency of conventional endoscopy(CE),magnifying endoscopy with narrow-band imaging(ME-NBI)and endoscopic ultrasonography(EUS)in the evaluation of treatment indications for undifferentiated-type early gastric cancer(UD-EGC).Methods Retrospective analysis of the endoscopic data(CE,ME-NBI and EUS)and clinical data of patients diagnosed with UD-EGC at Peking University Cancer Hospital between January 1st,2018 and January 1st,2022.A total of 82 patients were included.The accuracy of biopsy combined with ME-NBI in evaluating differentiation types was evaluated.The accuracy of predicting the depth of tumor invasion was analyzed by using CE,ME-NBI and EUS.Results The accuracy of biopsy combined with ME-NBI(70.73%,58/82)was higher than that of biopsy alone(62.20%,51/82)to distinguish differentiation types(P=0.016).For predicting the tumor invasion depth,the overall accuracy of CE combined with ME-NBI was 59.76%(49/82),which had poor consistency with the pathological staging(Kappa=0.206,P=0.053).The overall accuracy of EUS was 71.95%(59/82),which had moderate consistency with pathological staging(Kappa=0.441,P<0.001).In multivariate analysis,tumor diameter greater than 2 cm(OR=4.56,95%CI:1.42-14.59,P=0.011)and poorly differentiated adenocarcinoma(OR=5.76,95%CI:1.12-29.54,P=0.036)were the independent risk factors that influenced EUS in predicting the depth of tumor invasion.Conclusions For UD-EGC,biopsy combined with ME-NBI can improve the diagnostic accuracy of differentiation types,and EUS has good diagnostic efficiency in predicting the depth of tumor invasion.

关 键 词：未分化型早期胃癌 普通内镜 放大内镜 超声内镜 诊断 

分 类 号：R735.2[医药卫生—肿瘤]