Toyonaga Haruka, Hayashi Tsuyoshi, Ueki Hidetaro, Chikugo Kouki, Ishii Tatsuya, Nasuno Hiroshi, Kin Toshifumi, Takahashi Kuniyuki, Takada Minoru, Ambo Yoshiyasu, Shinohara Toshiya, Yamazaki Hajime, Katanuma Akio
Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan.
Department of Surgery, Teine Keijinkai Hospital, Sapporo, Japan.
J Hepatobiliary Pancreat Sci. 2021 Dec;28(12):1121-1129. doi: 10.1002/jhbp.961. Epub 2021 Apr 20.
The depth of invasion determines the surgical method for treating gallbladder cancer (GBC). However, the preoperative correct diagnosis of invasion depth, especially discrimination of T1 lesions among sessile elevated GBCs, is difficult. We investigated the utility of preoperative endoscopic ultrasound (EUS) findings for diagnosing the invasion depth.
We studied a sessile elevated GBC specimen diagnosed as a T1 lesion before developing our study protocol. EUS evidenced an intact boundary between the tumor and the inner hypoechoic layer (the intact boundary sign). To evaluate the potential of using this sign to diagnose T1 GBC as a primary outcome indicator, we retrospectively analyzed patients who underwent surgical resection of sessile elevated GBCs between April 2009 and March 2020.
Of the 26 surgically resected sessile elevated GBC specimens, 20 were included and six were excluded due to difficulty in evaluating the overall tumor or layer structure. The Kappa coefficient for interobserver agreement regarding the intact boundary sign was 0.733. The sensitivity and specificity of the sign for diagnosing T1 lesions were 0.857 and 1.000, respectively.
This new EUS finding could guide the accurate diagnosis of T1 lesions in patients with sessile elevated GBC.
浸润深度决定了胆囊癌（GBC）的手术治疗方法。然而，术前准确诊断浸润深度，尤其是在广基隆起型GBC中鉴别T1期病变具有一定难度。我们研究了术前内镜超声（EUS）检查结果在诊断浸润深度方面的应用价值。
在制定本研究方案之前，我们研究了一个被诊断为T1期病变的广基隆起型GBC标本。EUS显示肿瘤与内部低回声层之间存在完整边界（完整边界征）。为了评估将该征象作为诊断T1期GBC的主要结局指标的潜力，我们回顾性分析了2009年4月至2020年3月期间接受广基隆起型GBC手术切除的患者。
在26个手术切除的广基隆起型GBC标本中，纳入了20个，另外6个因难以评估整体肿瘤或层结构而被排除。观察者间关于完整边界征一致性的Kappa系数为0.733。该征象诊断T1期病变的敏感性和特异性分别为0.857和1.000。
这一新的EUS检查结果可指导准确诊断广基隆起型GBC患者的T1期病变。
