超声内镜诊断胃癌患者腹水及预测腹膜转移的准确性。
Accuracy of endoscopic ultrasonography in diagnosing ascites and predicting peritoneal metastases in gastric cancer patients.
作者信息
Lee Y T, Ng E K W, Hung L C T, Chung S C S, Ching J Y L, Chan W Y, Chu W C, Sung J J
机构信息
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin NT, Hong Kong, China.
出版信息
Gut. 2005 Nov;54(11):1541-5. doi: 10.1136/gut.2004.055772. Epub 2005 Jun 13.
BACKGROUND
Preoperative diagnosis of peritoneal metastases (PM) is difficult in patients with gastric cancer (GC).
AIMS
To assess the accuracy of endoscopic ultrasonography (EUS) in diagnosing ascites and its predictability for the presence of PM in GC patients.
SUBJECTS
Consecutive patients with newly diagnosed GC from 1998 to 2004 were studied.
METHODS
All patients underwent EUS, ultrasound (US), and computed tomography (CT) scan for preoperative staging and the presence of ascites. The results were compared with operative findings. The diagnosis of PM was confirmed by histopathology or peritoneal fluid cytology.
RESULTS
A total of 301 patients were recruited and in 250 patients the presence of ascites (n = 93) and PM (n = 71) were confirmed. EUS was more sensitive (87.1%) than combined US and CT scan examinations (16.1%) and operative findings (laparoscopy or laparotomy) (40.9%) in diagnosing ascites. Sensitivity, specificity, positive and negative predictive values, and accuracy for predicting the presence of PM were 73%, 84%, 64%, 89%, and 81% by EUS; 18%, 99%, 87%, 75%, and 76% by combining US and CT scan; and 77%, 94%, 83%, 91%, and 89% by operative findings, respectively. In multivariate logistic regression analysis, EUS detected ascites was the only significant independent predictor for the presence of PM (p<0.001; odds ratio 4.7 (95% confidence interval 2.0-11.2)).
CONCLUSION
EUS is a sensitive method for diagnosing ascites which is an important predictive factor for the presence of PM in GC patients.
背景
胃癌（GC）患者术前诊断腹膜转移（PM）较为困难。
目的
评估内镜超声检查（EUS）诊断腹水的准确性及其对GC患者PM存在情况的预测能力。
研究对象
对1998年至2004年新诊断的GC连续患者进行研究。
方法
所有患者均接受EUS、超声（US）和计算机断层扫描（CT）以进行术前分期及腹水检查。将结果与手术所见进行比较。PM的诊断通过组织病理学或腹水细胞学检查得以证实。
结果
共纳入301例患者，其中250例患者腹水（n = 93）及PM（n = 71）情况得以证实。在诊断腹水方面，EUS比US和CT联合检查（16.1%）及手术所见（腹腔镜检查或剖腹手术）（40.9%）更敏感（87.1%）。EUS预测PM存在情况的敏感性、特异性、阳性和阴性预测值及准确性分别为73%、84%、64%、89%和81%；US和CT联合检查分别为18%、99%、87%、75%和76%；手术所见分别为77%、94%、83%、91%和89%。在多因素逻辑回归分析中，EUS检测到腹水是PM存在的唯一显著独立预测因素（p<0.001；比值比4.7（95%置信区间2.0 - 11.2））。
结论
EUS是诊断腹水的敏感方法，而腹水是GC患者PM存在的重要预测因素。
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