Ginès Angels, Pellise Maria, Fernández-Esparrach Glòria, Soria María Teresa, Mata Alfredo, Membrillo Alejandro, Martínez-Pallí Graciela, Solé Manel M, Llach Josep, Bordas Josep M, Piqué Josep M
Endoscopy Unit, Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, Centre de Diagnòstic Biomèdic Hospital Clínic, IDIBAPS, Barcelona, Spain.
Am J Gastroenterol. 2006 Jan;101(1):64-9. doi: 10.1111/j.1572-0241.2005.00349.x.
The aims of the study were to assess in patients with large gastric folds at endoscopy and endoscopic biopsies that tested negative for malignancy: (i) the predictive variables of malignancy in endoscopic ultrasonography (EUS), (ii) the impact of EUS.
Patients with this condition evaluated with radial EUS (following the standard study protocol of our Unit in these patients) during a 5-yr period were included. Nine variables were evaluated as possible predictors of malignancy (chi2, t-test, and logistic regression procedure) using pathology results, or a minimum of 2 yr of follow-up as gold standard. Likelihood ratios (LR), pre-EUS, and post-EUS probabilities for the diagnosis of malignancy were used to assess the clinical impact of the technique.
Sixty-one patients were included (40 benign and 21 malignant). Predictive factors of malignancy were as follows: thickened gastric wall, thickened deep layers, impaired gastric distension, loss of the wall structure, and presence of ascites or lymph nodes, whereas the enlargement of superficial layers was a predictor of a benign condition. The enlargement of deep layers, as assessed by EUS was the only independent predictive factor for malignancy. When using this parameter, the pre-EUS probability of malignancy in our series (34%) increased up to 95% when EUS suggested malignancy (positive LR = 45), whereas it decreased to 4.7% when EUS precluded this diagnosis (negative LR = 0.102).
(i) The enlargement of deep layers is the only independent predictive factor for malignancy in patients with large gastric folds at endoscopy and biopsies testing negative for malignancy and (ii) EUS has a high clinical impact in these patients.
本研究旨在评估在内镜检查发现胃皱襞粗大且内镜活检恶性检测呈阴性的患者中：（i）内镜超声检查（EUS）中恶性肿瘤的预测变量；（ii）EUS的影响。
纳入在5年期间接受径向EUS评估（遵循我们科室对这些患者的标准研究方案）的此类患者。使用病理结果或至少2年的随访作为金标准，评估九个变量作为恶性肿瘤的可能预测指标（卡方检验、t检验和逻辑回归程序）。使用恶性肿瘤诊断的似然比（LR）、EUS检查前和检查后的概率来评估该技术的临床影响。
纳入61例患者（40例良性，21例恶性）。恶性肿瘤的预测因素如下：胃壁增厚、深层增厚、胃扩张受损、壁结构丧失以及存在腹水或淋巴结，而表层增大是良性状态的预测指标。EUS评估的深层增大是恶性肿瘤的唯一独立预测因素。使用该参数时，在我们的系列研究中，EUS提示恶性肿瘤时（阳性LR = 45），恶性肿瘤的EUS检查前概率（34%）升至95%，而EUS排除该诊断时（阴性LR = 0.102）降至4.7%。
（i）深层增大是内镜检查发现胃皱襞粗大且活检恶性检测呈阴性的患者中恶性肿瘤的唯一独立预测因素；（ii）EUS对这些患者具有较高的临床影响。
