基于对比增强谐波超声内镜的胃肠间质瘤无创预测模型。

Noninvasive prediction model for diagnosing gastrointestinal stromal tumors using contrast-enhanced harmonic endoscopic ultrasound.

机构信息

Department of Internal Medicine, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea.

Department of Internal Medicine, Yonsei University College of Medicine, 03722, Seodaemun-gu, Seoul, Republic of Korea; Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea.

出版信息

Dig Liver Dis. 2019 Jul;51(7):985-992. doi: 10.1016/j.dld.2019.02.017. Epub 2019 Mar 27.

DOI:10.1016/j.dld.2019.02.017

PMID:30926282

Abstract

BACKGROUND & AIMS: Subepithelial tumors (SETs) are difficult to diagnose accurately without invasive pathological confirmation. We created a noninvasive prediction model for diagnosing gastrointestinal stromal tumors (GISTs) using contrast-enhanced harmonic endoscopic ultrasound (CEH-EUS).

METHODS

We retrospectively reviewed 176 patients who underwent CEH-EUS from October 2011 to August 2017. Seventy patients with a diagnosis of GIST (n = 37) or leiomyoma (n = 33) were included. The long-to-short axis ratio (LSR) and enhancement patterns (vascularity, diffuse enhancement) on CEH-EUS were assessed. Logistic regression and classification and regression tree (CART) analyses were performed.

RESULTS

The mean age of all patients was 54.9 ± 13.68 years. The GIST group showed significantly higher rates of positive vascularity (81.1% vs. 15.2%, p < 0.001) and diffuse enhancement (51.4% vs. 15.2%, p = 0.001), and lower LSR (1.30 vs. 1.76, p < 0.001). In multivariate logistic regression, positive vascularity (odds ratio [OR] 27.765, 95% confidence interval [CI] 5.336-144.458) and low LSR (OR 18.940, 95% CI 3.623-99.007) were independent predictors of GIST. A noninvasive prediction model for GISTs was developed using the CART model, by allocating patients according to statistically significant variables.

CONCLUSIONS

The LSR and vascularity of SETs on CEH-EUS can be used as parameters for a noninvasive prediction model of GISTs. This model may be helpful in the early identification and treatment of GISTs.

摘要

背景与目的

在没有侵袭性病理确认的情况下，很难准确诊断黏膜下肿瘤（SET）。我们使用对比增强谐波内镜超声（CEH-EUS）创建了一种用于诊断胃肠道间质瘤（GIST）的非侵入性预测模型。

方法

我们回顾性分析了 2011 年 10 月至 2017 年 8 月期间接受 CEH-EUS 的 176 名患者。纳入了 70 名诊断为 GIST（n=37）或平滑肌瘤（n=33）的患者。评估了 CEH-EUS 上的长径短径比（LSR）和增强模式（血管性、弥漫性增强）。进行了逻辑回归和分类回归树（CART）分析。

结果

所有患者的平均年龄为 54.9±13.68 岁。GIST 组显示出更高的阳性血管性（81.1% vs. 15.2%，p<0.001）和弥漫性增强（51.4% vs. 15.2%，p=0.001）的发生率，以及更低的 LSR（1.30 vs. 1.76，p<0.001）。多变量逻辑回归显示，阳性血管性（优势比[OR]27.765，95%置信区间[CI]5.336-144.458）和低 LSR（OR 18.940，95%CI 3.623-99.007）是 GIST 的独立预测因子。使用 CART 模型，根据统计学显著变量为患者分配，建立了 GIST 的非侵入性预测模型。