Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Department of Medicine, Division of Gastroenterology, Queen's University, Kingston, Ontario, Canada.
J Gastroenterol Hepatol. 2020 Jan;35(1):118-123. doi: 10.1111/jgh.14819. Epub 2019 Sep 1.
There is a lack of literature comparing linear endoscopic ultrasound (EUS) and radial EUS for the prediction of the depth of invasion in early gastric cancer (EGC). The aim of this study is to evaluate the accuracy of linear EUS for the diagnosis of submucosal (SM) invasion and compare linear EUS with radial EUS in suspected EGC patients.
Seventy-two consecutive patients with suspected EGC who underwent a preoperative assessment using linear EUS or radial EUS were prospectively enrolled. The depth of invasion was categorized into mucosal to SM (< T1b) and SM or deeper (≥ T1b), and the EUS-determined diagnosis was compared with postoperative histopathological findings.
Thirty-nine patients underwent radial EUS, and 33 patients underwent linear EUS examination. The baseline characteristics between the groups were well balanced. The diagnostic accuracy was much higher for patients who underwent linear EUS compared with radial EUS (90.9% vs 69.2%, P = 0.024). The sensitivity was 92.3% (95% confidence interval [CI] 66.7-98.6%) for linear EUS and 90.9% (95% CI 62.3-98.4%) for radial EUS. The specificity was 90.0% (95% CI 69.9-97.2%) in the linear EUS group, while the specificity was 60.7% (95% CI 42.4-76.4%) in the radial EUS group. Univariate analysis showed that EUS type (odds ratio 0.225, 95% CI 0.057-0.884, P = 0.033) was an associated risk factor of incorrect T1b staging in EGC patients. The area under the receiver operating curve was 0.912 and 0.758 for linear and radial EUS, respectively.
Linear EUS was more accurate for determining SM invasion and therapeutic strategy in suspected EGC patients compared with radial EUS.
目前缺乏比较线性内镜超声（EUS）和径向 EUS 对早期胃癌（EGC）浸润深度预测的文献。本研究旨在评估线性 EUS 对黏膜下（SM）浸润的诊断准确性，并比较疑似 EGC 患者中线性 EUS 与径向 EUS 的差异。
前瞻性纳入 72 例连续接受术前线性 EUS 或径向 EUS 评估的疑似 EGC 患者。将浸润深度分为黏膜至 SM（< T1b）和 SM 或更深（≥ T1b），并将 EUS 诊断结果与术后组织病理学结果进行比较。
39 例患者接受了径向 EUS 检查，33 例患者接受了线性 EUS 检查。两组患者的基线特征相当。与径向 EUS 相比，线性 EUS 的诊断准确性更高（90.9% vs 69.2%，P=0.024）。线性 EUS 的敏感性为 92.3%（95%置信区间[CI]66.7-98.6%），径向 EUS 的敏感性为 90.9%（95% CI 62.3-98.4%）。线性 EUS 组的特异性为 90.0%（95% CI 69.9-97.2%），而径向 EUS 组的特异性为 60.7%（95% CI 42.4-76.4%）。单因素分析显示，EUS 类型（比值比 0.225，95% CI 0.057-0.884，P=0.033）是 EGC 患者 T1b 分期错误的相关危险因素。线性 EUS 和径向 EUS 的受试者工作特征曲线下面积分别为 0.912 和 0.758。
与径向 EUS 相比，线性 EUS 更准确地判断疑似 EGC 患者的 SM 浸润程度和治疗策略。
