Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Japan.
Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan.
BMC Cancer. 2021 Mar 17;21(1):288. doi: 10.1186/s12885-021-08017-x.
If the depth of gallbladder malignant tumor (GBMT) invasion is deeper than the subserosa (ss), cholecystectomy is insufficient. In past reports that used endoscopic ultrasonography (EUS) to diagnose the depth of tumor invasion, it was difficult to diagnose GMBT invasion in the ss without a narrow or disrupted lateral hyperechoic layer (LHEL). Therefore, we developed a simple preoperative method to diagnose GBMTs with ss invasion.
Forty-nine GBMT patients who underwent both EUS and surgery were enrolled: 15 patients whose tumors invaded the mucosa (m) or muscularis propria (mp) were classified as the "shallow group", and 34 patients whose tumors invaded the ss were classified as the "deep group". The EUS findings were compared between the two groups.
An irregular (narrow or thickened) LHEL was significantly more frequently observed on EUS in the deep group than in the shallow group. The diagnosis of ss invasion based on an irregular LHEL had the highest sensitivity and accuracy among the EUS imaging parameters (sensitivity 97.1% (33/34), specificity 86.7% (13/15), accuracy 93.8% (46/49)). When the deep group was limited to patients with a tumor depth of ss, the results were similar. When an irregular LHEL was used, the diagnostic accuracy of GBMTs with ss invasion was not significantly different between EUS specialists and beginners.
The observation of an irregular (thickened or narrow) LHEL observed on EUS could be a reliable and simple method of diagnosing GBMTs with ss invasion and could contribute to choosing an appropriate surgical method.
如果胆囊恶性肿瘤（GBMT）的浸润深度超过浆膜下层（ss），则胆囊切除术是不够的。在过去使用内镜超声（EUS）诊断肿瘤浸润深度的报告中，由于缺乏狭窄或破坏的外侧高回声层（LHEL），很难诊断 ss 中的 GMBT 浸润。因此，我们开发了一种简单的术前方法来诊断 ss 浸润的 GBMT。
共纳入 49 例接受 EUS 和手术的 GBMT 患者：15 例肿瘤侵犯黏膜（m）或固有肌层（mp）的患者分为“浅组”，34 例肿瘤侵犯 ss 的患者分为“深组”。比较两组的 EUS 结果。
在深组中，EUS 上观察到不规则（狭窄或增厚）LHEL 的频率明显高于浅组。基于不规则 LHEL 的 ss 浸润诊断在 EUS 成像参数中具有最高的敏感性和准确性（敏感性 97.1%（33/34），特异性 86.7%（13/15），准确性 93.8%（46/49））。当将深组限于 ss 深度的肿瘤患者时，结果相似。当使用不规则 LHEL 时，EUS 专家和初学者对 ss 浸润的 GBMT 诊断准确性没有显著差异。
EUS 观察到不规则（增厚或狭窄）LHEL 可能是诊断 ss 浸润的 GBMT 的一种可靠且简单的方法，并有助于选择合适的手术方法。
