探讨一种利用 Photoshop 辅助内镜超声鉴别胃肠道间质瘤和肌瘤的新方法。

Exploration of a new method for Photoshop-assisted endoscopic ultrasound to distinguish gastrointestinal stromal tumor and leiomyoma.

机构信息

Department of Gastroenterology, Second Hospital of Tianjin Medical University, Tianjin, China.

出版信息

Scand J Gastroenterol. 2023 Mar;58(3):291-295. doi: 10.1080/00365521.2022.2118556. Epub 2022 Sep 7.

DOI:10.1080/00365521.2022.2118556

PMID:36069211

Abstract

BACKGROUND

Gastrointestinal stromal tumors (GISTs) and leiomyomas (GILs) are difficult to be distinguished by endoscopic ultrasound (EUS). Photoshop software combined with EUS has limitations in distinguishing GIST and GIL by detecting gray values. Therefore, the research aims to explore the new method by Photoshop in distinguishing the features of GISTs from GILs.

METHODS

Patients who underwent EUS and were confirmed as GIST and GIL pathologically were included. The images of EUS were analyzed by Photoshop software. The mean gray value of tumor (Tmean), muscularis propria (Mmean), submucosa (Smean) water (Wmean) and T that originated from the same image, were calculated one by one. Then the ratio of the mean gray value of tumor to muscularis propria (TMratio), submucosa (TSratio), and water (TWratio) were calculated, respectively.

RESULTS

Four hundred seventy-two patients (239 GILs and 233 GISTs) were enrolled in this study retrospectively. All the tumors were located in the stomach. Tmean and T were significantly higher in GISTs than in the GILs group (63.10 ± 23.29 vs. 57.70 ± 22.67, = .011; 26.24 ± 8.99 vs. 24.30 ± 8.26, = .015). TMratio, TSratio, and TWratio were also significantly higher in GISTs group (0.97 ± 0.37 vs. 0.81 ± 0.28, < .001; 0.42 ± 0.14 vs. 0.38 ± 0.12, < .001; 2.65 ± 1.36 vs. 2.16 ± 1.02, < .001). The AUC of Tmean was 0.952 (95% CI 0.897-1.000), which can better distinguish GIST from GIL; the sensitivity was 0.900, the specificity was 0.975, and the Youden Index was 0.875, and the cutoff was 79.64. The AUCs of TMratio, TSratio, and TWratio were 0.917 (95% CI 0.844-0.991), 0.897 (95% CI 0.812-0.981), and 0.929 (95% CI 0.8870-0.987), respectively. The aforementioned data was verified in the clinical cases of known results, including 40 GISTs and 40 GILs. The sensitivity of Tmean, TMratio, TSratio, and TWratio for diagnosis of GIL was 97.5%, 82.5%, 95%, and 97.5%, respectively. And they were 62.5%, 95%, 80%, and 92.5% for GIST.

CONCLUSION

The application of Photoshop combined with EUS to detect the gray value and standard deviation has a specific value in distinguishing GIST from GIL, but with some deviation. Applying the gray value ratio also has great discrimination significance and can avoid the differences in operation from different instrument and equipment personnel. Therefore, it is worthy of clinical promotion in the future.

摘要

背景

胃肠道间质瘤（GIST）和平滑肌瘤（GIL）很难通过内镜超声（EUS）进行鉴别。Photoshop 软件结合 EUS 通过检测灰度值在鉴别 GIST 和 GIL 方面存在局限性。因此，本研究旨在探讨 Photoshop 在鉴别 GIST 与 GIL 特征方面的新方法。

方法

纳入经 EUS 检查并经病理证实为 GIST 和 GIL 的患者。使用 Photoshop 软件对 EUS 图像进行分析。依次计算肿瘤（Tmean）、固有肌层（Mmean）、黏膜下层（Smean）和水（Wmean）的平均灰度值，并计算源于同一图像的肿瘤与固有肌层（TMratio）、黏膜下层（TSratio）和水（TWratio）的平均灰度值比值。

结果

本研究回顾性纳入 472 例（239 例 GIL 和 233 例 GIST）患者。所有肿瘤均位于胃内。GIST 组的 Tmean 和 T 明显高于 GIL 组（63.10 ± 23.29 比 57.70 ± 22.67， = .011；26.24 ± 8.99 比 24.30 ± 8.26， = .015）。GIST 组的 TMratio、TSratio 和 TWratio 也明显更高（0.97 ± 0.37 比 0.81 ± 0.28， < .001；0.42 ± 0.14 比 0.38 ± 0.12， < .001；2.65 ± 1.36 比 2.16 ± 1.02， < .001）。Tmean 的 AUC 为 0.952（95%CI 0.897-1.000），可更好地区分 GIST 与 GIL；其敏感度为 0.900，特异性为 0.975，Youden 指数为 0.875，截断值为 79.64。TMratio、TSratio 和 TWratio 的 AUC 分别为 0.917（95%CI 0.844-0.991）、0.897（95%CI 0.812-0.981）和 0.929（95%CI 0.8870-0.987）。在包括 40 例 GIST 和 40 例 GIL 的已知结果的临床病例中验证了上述数据。Tmean、TMratio、TSratio 和 TWratio 诊断 GIL 的敏感度分别为 97.5%、82.5%、95%和 97.5%，诊断 GIST 的敏感度分别为 62.5%、95%、80%和 92.5%。