Martinez-Ares David, Aguirre Pedro A Alonso, López Jesús Yáñez, Barrenechea Ignacio Martín-Granizo, Cadilla Jesús Martinez, Martinez Dolores Rodriguez, Peral Abel Pallarés
Servicio Digestivo, Complejo Hospitalario Xeral-Cies, Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain.
Dig Dis Sci. 2009 Jun;54(6):1257-64. doi: 10.1007/s10620-008-0474-9. Epub 2008 Aug 29.
Endoscopy with biopsy sampling is the gold standard used in gastric cancer diagnosis. However, the positive predictive value of signs and symptoms for the diagnosis of carcinomas is quite limited, and, therefore, many patients are subjected to non-diagnostic endoscopies, especially when symptoms are not so specific. This study shows that ultrasonography is sensitive enough for the diagnosis of gastric cancer, and, therefore, use of this technique would further ensure a better selection of patients for endoscopy. The study included 143 patients (86 men and 57 women, with an average age of 68.6 years) who were suspected of having gastric cancer. The diagnostic accuracy of ultrasonography was evaluated in a blind study. The conventional technique was used in all cases. Demographic parameters and a series of other clinical-analytical variables were studied to look for possible gastric cancer predictive factors, which when present would make ultrasonographic results irrelevant. Statistical analysis was done using SPSS 12.0, wherein a value of P < 0.05 was considered to be statistically significant. Of the 143 patients studied, 40 were diagnosed to have gastric cancer. Sonography was able to diagnose 37 cases correctly, while there were three false negative findings and eight false positive findings. This results in 92.5% sensitivity, 92.2% specificity, 82.2% positive predictive value, 96.9% negative predictive value, and a global accuracy of 92.3%. Univariate analysis showed that persistent vomiting (P = 0.021), hemoglobin level of less than 8 g/dl (P = 0.045) and a positive ultrasonography result (P < 0.0001) were associated with a higher frequency of gastric cancer. Multivariate analysis showed that persistent vomiting, with an odds ratio for gastric cancer of 3.68 (95% confidence interval 1.15-11.79; P = 0.039), and a positive ultrasonography result, with an odds ratio for gastric cancer of 117.78 (95% confidence interval 32.45-427.49; P < 0.0001), could be considered as independent predictive factors for gastric cancer. It was concluded that ultrasonography is a very sensitive and specific technique for diagnosing gastric cancer. Gastric cancer was found to be present in just 28% of the patients studied, and their condition was suspect because of the clinical manifestations. Only vomiting and a positive ultrasonography result can be considered as independent predictive factors of gastric cancer.
内镜活检取样是胃癌诊断的金标准。然而，症状和体征对癌症诊断的阳性预测价值相当有限，因此，许多患者接受了非诊断性内镜检查，尤其是当症状不那么特异时。本研究表明，超声检查对胃癌诊断足够敏感，因此，使用该技术将进一步确保更好地选择进行内镜检查的患者。该研究纳入了143例疑似患有胃癌的患者（86例男性和57例女性，平均年龄68.6岁）。在一项盲法研究中评估了超声检查的诊断准确性。所有病例均采用传统技术。研究了人口统计学参数和一系列其他临床分析变量，以寻找可能的胃癌预测因素，这些因素出现时会使超声检查结果无关紧要。使用SPSS 12.0进行统计分析，其中P<0.05的值被认为具有统计学意义。在研究的143例患者中，40例被诊断患有胃癌。超声检查能够正确诊断37例，有3例假阴性结果和8例假阳性结果。这导致敏感性为92.5%，特异性为92.2%，阳性预测值为82.2%，阴性预测值为96.9%，总体准确率为92.3%。单因素分析显示，持续性呕吐（P = 0.021）、血红蛋白水平低于8 g/dl（P = 0.045）和超声检查结果阳性（P < 0.0001）与胃癌的较高发生率相关。多因素分析显示，持续性呕吐，胃癌的比值比为3.68（95%置信区间1.15 - 11.79；P = 0.039），以及超声检查结果阳性，胃癌的比值比为117.78（95%置信区间32.45 - 427.49；P < 0.0001），可被视为胃癌的独立预测因素。得出的结论是，超声检查是一种诊断胃癌非常敏感和特异的技术。在所研究的患者中，仅28%存在胃癌，且由于临床表现其病情可疑。仅呕吐和超声检查结果阳性可被视为胃癌的独立预测因素。
