基于白光内镜和超声内镜的上消化道间质瘤与平滑肌瘤鉴别预测模型的建立和验证  

Development and validation of a prediction model for distinguishing upper gastrointestinal stromal tumor and leiomyoma based on white-light endoscopy and ultrasound endoscopy

作　　者：陆建英[1] 顾毅杰 沈文娟[1] 夏婷婷[3] Lu Jianying;Gu Yijie;Shen Wenjuan;Xia Tingting(Endoscopic Center,the First Affiliated Hospital of Soochow University,Suzhou 215006,China;Department of Gastroenterology,Suzhou Ninth People′s Hospital,Suzhou 215200,China;Department of Gastroenterology,the First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院内镜中心,苏州215006 [2]苏州市第九人民医院消化内科,苏州215200 [3]苏州大学附属第一医院消化内科,苏州215006

出　　处：《中华消化杂志》2024年第5期314-320,共7页Chinese Journal of Digestion

基　　金：苏州市临床试验机构能力提升项目(SLT201915);苏州市第九人民医院院级青年科研基金(YK202405)。

摘　　要：目的分析间质瘤与平滑肌瘤在白光内镜和超声内镜下的图像特征,构建列线图模型并进行验证。方法回顾性分析2019年8月1日至2022年12月1日于苏州大学附属第一医院行超声内镜检查的224例间质瘤和平滑肌瘤患者的临床资料。将224例患者分为建模组145例(包括78例间质瘤、67例平滑肌瘤)和验证组79例(包括41例间质瘤、38例平滑肌瘤)。筛选患者的基础资料、白光内镜和超声内镜参数,建立二元logistic回归模型并绘制列线图,使用受试者操作特征曲线(ROC)的曲线下面积(AUC)评估模型的检验效能,用校准曲线评估预测概率与观测概率的一致性,并与低年资医师(主治医师)、高年资医师(副主任医师)鉴别诊断结果进行比较;采用决策曲线分析评估模型的净收益。统计学方法采用独立样本t检验和卡方检验。结果白光内镜下,建模组间质瘤与平滑肌瘤病变位置[食管:0比56.7%(38/67);贲门区:11.5%(9/78)比13.4%(9/67);胃:88.5%(69/78)比29.9%(20/67)]、肿瘤形态[球形或类球形:80.8%(63/78)比28.4%(19/67);梭形:19.2%(15/78)比71.6%(48/67)]比较,差异均有统计学意义(χ^(2)=64.51、46.37,均P<0.001)。超声内镜下,间质瘤患者病灶起源于固有肌层、边界模糊、内部高回声灶占比均高于平滑肌瘤患者[96.2%(75/78)比62.7%(42/67)、53.8%(42/78)比13.4%(9/67)、35.9%(28/78)比10.4%(7/67)],差异均有统计学意义(χ^(2)=25.91、25.82、12.75,均P<0.001)。根据logistic回归模型,将年龄、肿瘤形态、病灶起源、边界清晰度、高回声灶作为预测指标,建立列线图模型。在建模组中,列线图模型诊断间质瘤和平滑肌瘤的准确度分别为89.7%和83.6%。在验证组中,列线图模型与高年资医师鉴别间质瘤和平滑肌瘤的灵敏度、特异度、准确度均高于低年资医师(90.2%、87.8%比82.9%,81.6%、84.2%比78.9%,86.1%、86.1%比81.0%),且列线图模型与高年资医师鉴别间质瘤与平滑肌瘤的灵敏度、�Objective To analyze the image characteristics of gastrointestinal stromal tumor(GIST)and leiomyoma under white-light endoscopy and ultrasound endoscopy,so as to establish a nomogram model and to validate its performance.MethodsFrom August 1,2019,to December 1,2022,the clinical data of 224 patients with GIST or leiomyoma who underwent endoscopic ultrasound examination at the First Affiliated Hospital of Soochow University were retrospectively analyzed.The 224 patients were divided into the modeling group of 145 cases(78 cases of GIST and 67 cases of leiomyoma),and the validation group of 79 cases(41 cases of GIST and 38 cases of leiomyoma).The basic data of patients,parameters of white-light endoscopy and ultrasound endoscopy were screened to establish a binary logistic regression model and draw a nomogram.The receiver operating characteristic curve(ROC)was drawn,and the area under the curve(AUC)was used to evaluate the diagnostic efficiency of the model,and calibration curve was used to evaluate the consistency of predicted and observed probabilities.The model′s performance was compared with the diagnostic results of junior physicians(attending physicians)and senior physicians(associated chief physician).Decision curve analysis(DCA)was performed to evaluate the net benefit of the model.Independent sample t-test and chi-square test were used for statistical analysis.ResultsUnder white-light endoscopy,there were statistically significant differences in the lesion locations(esophagus:0 vs.56.7%(38/67);cardia:11.5%(9/78)vs.13.4%(9/67);gastric:88.5%(69/78)vs.29.9%(20/67))and tumor morphyology(spherical or spheroid:80.8%(63/78)vs.28.4%(19/67);shuttle:19.2%(15/78)vs.71.6%(48/67))between GIST and leiomyoma in the modeling group(χ^(2)=64.51 and 46.37,both P<0.001).Under ultrasound endoscopy,the proportion of patients with GIST whose lesions originated from the muscularis propria layer,with indistinct borders and with internal hyperechoic area were all higher than those of patients with leiomyoma(96.2%(75/78)vs.62.7%(4

关 键 词：超声内镜 黏膜下肿瘤 胃肠道间质瘤 平滑肌瘤 列线图模型 

分 类 号：R735[医药卫生—肿瘤]