内镜超声检查对早期胃癌浸润深度判断的准确性。
Accuracy of Endoscopic Ultrasonography for Determining the Depth of Invasion in Early Gastric Cancer.
机构信息
Department of Gastroenterology, H Plus Yangji Hospital, Seoul, Republic of Korea; Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea Faculty of Medicine, Seoul, Republic of Korea.
Division of Gastroenterology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea Faculty of Medicine, Seoul, Republic of Korea.
出版信息
Turk J Gastroenterol. 2022 Sep;33(9):785-792. doi: 10.5152/tjg.2022.21847.
BACKGROUND
Accurate staging for depth of invasion (T stage) of early gastric cancer is critical for determining the treatment modality. Endoscopic ultrasonography is a reliable method for assessing the T stage. However, its diagnostic accuracy varies. The aim of this study is to investigate clinicopathologic factors affecting the diagnostic accuracy of endoscopic ultrasonography in early gastric cancer.
METHODS
Patients with early gastric cancer who had undergone endoscopic resection or gastrectomy were included. The diagnostic accuracy of endoscopic ultrasonography was evaluated by comparing the T stage by endoscopic ultrasonography with histopathology of the resected specimen. Subgroup analysis was performed according to the endoscopic resection criteria.
RESULTS
A total of 223 early gastric cancer lesions were included. The overall accuracy of endoscopic ultrasonography for T staging was 66.4%. The diagnostic accuracy for lesions ≤2 cm was significantly higher than for those of 2-3 cm (odds ratio 3.59) or those >3 cm (odds ratio 5.47). The diagnostic accuracy was significantly decreased in lesions with ulceration (odds ratio 2.62) or non-flat morphology (odds ratio 2.94). The accuracy of endoscopic ultrasonography for lesions corresponding to the absolute endoscopic resection criteria was significantly higher than for those corresponding to the expanded criteria (97.3% vs 71.9%, P = .002). Of the tumors that were overestimated by endoscopic ultrasonography treated with gastrectomy, 93.3% corresponded to the expanded criteria.
CONCLUSION
Endoscopic ultrasonography had poor accuracy in early gastric cancer lesions larger than 2 cm, those with ulceration, and those with non-flat morphology, that is, lesions corresponding to the expanded criteria were more frequently overstaged by endoscopic ultrasonography. Such early gastric cancers should be carefully considered when staging by endoscopic ultrasonography before gastrectomy.
背景
准确分期早期胃癌的浸润深度（T 分期）对于确定治疗方式至关重要。内镜超声检查是评估 T 分期的可靠方法。然而，其诊断准确性存在差异。本研究旨在探讨影响早期胃癌内镜超声诊断准确性的临床病理因素。
方法
纳入接受内镜切除术或胃切除术的早期胃癌患者。通过比较内镜超声检查的 T 分期与切除标本的组织病理学结果，评估内镜超声检查的诊断准确性。根据内镜切除标准进行亚组分析。
结果
共纳入 223 例早期胃癌病变。内镜超声检查 T 分期的总体准确性为 66.4%。对于≤2cm 的病变，其诊断准确性明显高于 2-3cm（比值比 3.59）或>3cm（比值比 5.47）的病变。溃疡（比值比 2.62）或非平坦形态（比值比 2.94）的病变诊断准确性明显降低。对应绝对内镜切除标准的病变的内镜超声检查准确性明显高于对应扩展标准的病变（97.3% vs 71.9%，P=0.002）。在接受胃切除术治疗的被内镜超声检查高估的肿瘤中，93.3%符合扩展标准。
结论
内镜超声检查对大于 2cm、溃疡和非平坦形态的早期胃癌病变准确性较差，即对应扩展标准的病变更常被内镜超声检查高估。在胃切除术前进行 T 分期时，对于此类早期胃癌应仔细考虑。
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