[影响T2期胃癌内镜超声检查准确性的因素评估]

[Assessment of factors affecting the accuracy of endoscopic ultrasonography in T2 stage gastric cancer].

作者信息

Park Young Soo, Lee Donghun, Lee Dong Ho, Kim Na Young, Jeong Sook Hyang, Kim Jin Wook, Hwang Jin Hyeok, Lee Sang Hyup, Kim Joo Sung, Jung Hyun Chae, Song In Sung

机构信息

Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul, Korea.

出版信息

Korean J Gastroenterol. 2008 Aug;52(2):86-90.

PMID:19077499

Abstract

BACKGROUND/AIMS: To minimize injury, less invasive surgery including laparascopic surgery and endoscopic mucosal resection are increasingly used for the treatment of gastric cancer nowadays. Therefore, accurate preoperative staging is important to decide adequate treatment modality. Endoscopic ultrasonography (EUS) is reported to be an accurate diagnostic modality to evaluate the depth of tumor invasion. Especially, evaluation of T-2 stage is important to determine operation. We tried to reveal the factors affecting the accuracy of EUS for the evaluation of T-2 stage gastric cancer.

METHODS

Among 367 patients who underwent EUS to evaluate preoperative stage, we compared EUS findings and histopathological findings retrospectively.

RESULTS

A total of 270 patients were diagnosed as early gastric cancer, and 97 patients as advanced gastric cancer. The overall concordance rate was 78.2% (287/367), over-estimation rate 14.2% (52/367), and under-estimation rate 7.6% (28/367). Among T-2 stage cancer, over-estimation rate was 27.0% (20/74), and under-estimation rate 21.6% (16/74). These were relatively high compared with those with over-estimation. Among T1 lesions, 20.6% (22/107) were over-estimated as the invasion into proper muscle layer. Compared with sm1 lesion (17.9%), sm3 lesions showed higher over-estimateion rate (25.7%). In the presence of submucosal fibrosis, sm1 lesions were over-estimated as T-2 lesion. Sm2 and sm3 lesions were not related to submucosal fibrosis. Factors affecting over-estimation as T-2 lesions were the size of tumor, the presence of submucosal fibrosis and connective tissue hyperplasia, and ulcer (p<0.05). Microscopic invasion did not affect the accuracy of EUS findings.

CONCLUSIONS

In T-2 gastric cancer, the presence of submucosal fibrosis, tumor size, and ulcer were the affecting factors for the over-estimation of the depth of invasion using EUS in gastric cancer. To improve preoperative diagnostic accuracy in T-2 stage cancer, a new diagnostic improvement in EUS is needed.

摘要

背景/目的：为了将损伤降至最低，如今包括腹腔镜手术和内镜黏膜切除术在内的微创外科手术越来越多地用于治疗胃癌。因此，准确的术前分期对于确定合适的治疗方式很重要。据报道，内镜超声检查（EUS）是评估肿瘤浸润深度的一种准确的诊断方法。特别是，T2期的评估对于确定手术至关重要。我们试图揭示影响EUS评估T2期胃癌准确性的因素。

方法

在367例行EUS评估术前分期的患者中，我们回顾性比较了EUS检查结果和组织病理学检查结果。

结果

共有270例患者被诊断为早期胃癌，97例为进展期胃癌。总体符合率为78.2%（287/367），高估率为14.2%（52/367），低估率为7.6%（28/367）。在T2期癌症中，高估率为27.0%（20/74），低估率为21.6%（16/74）。与高估情况相比，这些比例相对较高。在T1病变中，20.6%（22/107）被高估为侵犯固有肌层。与sm1病变（17.9%）相比，sm3病变的高估率更高（25.7%）。在存在黏膜下纤维化的情况下，sm1病变被高估为T2病变。Sm2和sm3病变与黏膜下纤维化无关。影响被高估为T2病变的因素包括肿瘤大小、黏膜下纤维化和结缔组织增生的存在以及溃疡（p<0.05）。微小浸润不影响EUS检查结果的准确性。