超声“角征”联合胃癌病变厚度对胃癌T3及以上分期的诊断效能  

The Diagnostic Efficacy of Ultrasound"Horn Sign"Combined with Lesion Thickness in≥T3 Stage of Gastric Cancer

作　　者：钟敏莹 黄伟俊[1] 简国亮 刘勤学 Zhong Minying;Huang Weijun;Jian Guoliang;Liu Qinxue(Ultrasonic Diagnosis and Treatment Center,The First People's Hospital of Foshan,Foshan,Guangdong 5280o0,China)

机构地区：[1]佛山市第一人民医院超声诊疗中心,广东省佛山市528000

出　　处：《中国超声医学杂志》2023年第11期1257-1260,共4页Chinese Journal of Ultrasound in Medicine

基　　金：佛山市医学科研立项课题(No.20230042);佛山市“十四五”高水平医学重点专科建设项目(No.FSGSPl45037)。

摘　　要：目的探讨超声“角征”及胃癌病变厚度在鉴别胃癌T3期及以上分期的临床价值。方法回顾性分析在行胃充盈超声检查(TUS-OCCA)提示胃癌,并手术病理证实的患者94例。观察胃壁的层次结构及病灶的浸润程度,测量胃癌病变最厚处,以及依据胃壁是否存在“角征”判断胃癌的T分期。运用受试者工作特征(ROC)曲线找出鉴别≥T3期胃癌病变厚度的最佳临界值。把联合运用超声“角征”和胃癌病变厚度鉴别≥T3期胃癌。结果在94例患者中,病理分期≥T3期76例,<T3期18例。≥T3期的胃癌病变厚度明显大于<T3期的[(1.58士0.53)cmvs(1.05±0.33)cm,P<0.05],最佳截断值为1.25cm,此时ROC曲线下面积为0.819(95%CI0.710~0.929),灵敏度为73.70%,特异度为77.80%,准确度为75.50%。超声“角征”在鉴别T3期胃癌的灵敏度、特异度、准确度分别为93.40%、77.70%、90.40%。两者联合诊断的灵敏度、特异度、准确度分别为96.10%、66.70%、90.40%。结论超声“角征”在鉴别≥T3期胃癌的诊断效能较高;当胃癌病变厚度>1.25cm时,提示胃癌分期≥T3期;两者联合运用可提高诊断灵敏度,具有较高的临床运用价值。Objective The aim of this study was to evaluate the clinical value of ultrasound"horn sign"and gastric cancer thickness in identifying≥T3 stage of gastric cancer.Methods This retrospective study included 94 patients of gastric cancer diagnosed by transabdominal ultrasound after oral administration of an echoic cellulose-based gastric ultrasound contrast agent(TUS-OCCA)in our hospital.All the cases were confirmed by operation and pathology.The hierarchical structure of the gastric wall and the degree of infiltration of the lesions were observed,the thickest part of the gastric cancer lesion was measured,and the T stage of gastric cancer was judged based on whether there was a"horn sign"in the gastric wall.The receiver operating characteristic(ROC)curve was used to find the best cut-off value of thickness of gastric cancer lesions to identify≥T3 stage.The ultrasound"horn sign"and the thickness of gastric cancer lesions were combined to identify≥T3 stage.Results Among the 94 cases,76 cases were grouped into the≥T3 stage,and 18 into the<T3 stage.The gastric cancer thickness in≥T3 stage group was significantly greater than that in the group of<T3 stage[(1.57±0.52)cm vs(1.05±0.33)cm,P<0.05],and the area under the ROC curve was 0.819(95%CI 0.710-0.929).The best cut-off value was 1.25 cm,with the sensitivity,specificity and accuracy being 73.70%,77.80%and 75.50%,respectively.The sensitivity,specificity and accuracy of ultrasound"horn sign"in identifying≥T3 stage were 93.40%,77.70%and 90.40%.The sensitivity,specificity and accuracy of the combined diagnosis were 96.10%,66.70%and 90.40%.Conclusions The diagnostic efficacy of ultrasound"horn sign"in distinguishing≥T3 stage is relatively high.When the gastric cancer thickness is more than 1.25 cm,it tends to indicate that T stage is≥T3 stage.The combined use of the two methods can improve the sensitivity of diagnosis and has high clinical application value.

关 键 词：胃癌 ≥T3分期 超声“角征” 胃癌病变厚度 联合诊断 

分 类 号：R445.1[医药卫生—影像医学与核医学] R735.2[医药卫生—诊断学]