Chang D K, Chin Y J, Kim J S, Jung H C, Kim C W, Song I S, Kim C Y
Department of Internal Medicine, Seoul National University College of Medicine, Korea.
Hepatogastroenterology. 1999 Jul-Aug;46(28):2694-700.
BACKGROUND/AIMS: Anti-Helicobacter pylori (H. pylori) treatment for low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma has been the subject of attention. The aim of this study was to determine the proportion of such cases which could be suitable candidates for H. pylori eradication for the purpose of cure; we focused on gross morphology and lymph node metastasis.
We retrospectively reviewed the medical records of 53 patients diagnosed and treated for gastric MALT lymphoma at Seoul National University Hospital between 1992 and 1996.
According to Isaacson's classification, 60% of cases were low-grade, and H. pylori was detected in 88% of them. In low-grade disease, gastroscopy revealed superficial lesions in 56% of cases, ulcerofungating lesions were found in as much as 19%, and ulceroinfiltrating in 25%. Even in low-grade disease, invasion of proper muscle, or deeper, was seen in 28% of patients, and lymph node involvement in 36%; even in low-grade disease confined to mucosa and submucosa, the rate of lymph node involvement was 40%. All cases which, on gastroscopy, appeared to be gastritis or benign ulcer-like lesions were free of lymph node metastasis, but in low-grade disease, this proportion was only 16%. In 33% of cases, pre-operative clinical stage I--as shown by abdominal CT--was found post-operatively to be stage II. The negative predictive value of lymph node detection by CT was 68%.
In low-grade gastric MALT lymphoma, the lymph node involvement rate was too high to be neglected. In detecting lymph node metastasis, the diagnostic accuracy of CT was too low. The proportion of suitable candidates for anti-H. pylori treatment for low-grade gastric MALT lymphoma was not high, and in clinical practice, anti-H. pylori treatment in such cases should at present be very carefully applied.
背景/目的：抗幽门螺杆菌（H. pylori）治疗低度胃黏膜相关淋巴组织（MALT）淋巴瘤一直备受关注。本研究旨在确定此类病例中适合通过根除幽门螺杆菌实现治愈的比例；我们重点关注大体形态和淋巴结转移情况。
我们回顾性分析了1992年至1996年期间在首尔国立大学医院诊断和治疗的53例胃MALT淋巴瘤患者的病历。
根据艾萨克森分类，60%的病例为低度病变，其中88%检测到幽门螺杆菌。在低度病变中，胃镜检查显示56%的病例为浅表病变，高达19%的病例为溃疡型蕈伞状病变，25%为溃疡浸润型。即使在低度病变中，28%的患者可见固有肌层或更深层侵犯，36%有淋巴结受累；即使是局限于黏膜和黏膜下层的低度病变，淋巴结受累率也为40%。所有胃镜检查显示为胃炎或良性溃疡样病变的病例均无淋巴结转移，但在低度病变中，这一比例仅为16%。33%的病例术前腹部CT显示为临床I期，术后发现为II期。CT检测淋巴结的阴性预测值为68%。
在低度胃MALT淋巴瘤中，淋巴结受累率过高不容忽视。在检测淋巴结转移方面，CT的诊断准确性过低。低度胃MALT淋巴瘤适合抗幽门螺杆菌治疗的病例比例不高，在临床实践中，目前对此类病例应用抗幽门螺杆菌治疗应非常谨慎。
