内镜超声在评估小胃肠道间质瘤中的疗效。

Efficacy of endoscopic ultrasound in the evaluation of small gastrointestinal stromal tumors.

机构信息

Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China.

Department of Pathology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China.

出版信息

World J Gastroenterol. 2022 Oct 7;28(37):5457-5468. doi: 10.3748/wjg.v28.i37.5457.

DOI:10.3748/wjg.v28.i37.5457

PMID:36312832

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9611709/

Abstract

BACKGROUND

Gastrointestinal stromal tumors (GISTs) with a diameter of < 2 cm are called small GISTs. Currently, endoscopic ultrasound (EUS) is widely used as a regular follow-up method for GISTs, which can also provide a preliminary basis for judging the malignancy potential of lesions. However, there are no studies on the accuracy of EUS to assess the malignant potential of small GISTs.

AIM

To evaluate the efficacy of EUS in the diagnosis and risk assessment of small GISTs.

METHODS

We collected data from patients with small GISTs who were admitted to Shengjing Hospital of China Medical University between October 2014 and July 2019. The accurate diagnosis and risk classifications of patients were based on the pathological assessment according to the modified National Institute of Health criteria after endoscopic resection or laparoscopic surgery. Preoperative EUS features (marginal irregularity, cystic changes, homogeneity, ulceration, and strong echogenic foci) were retrospectively analyzed. The assessment results based on EUS features were compared with the pathological features.

RESULTS

A total of 256 patients (69 men and 187 women) were enrolled. Pathological results included 232, 16, 7, and 1 very low-, low-, intermediate-, and high-risk cases, respectively. The most frequent tumor location was the gastric fundus (78.1%), and mitoses were calculated as > 5/50 high power field in 8 (3.1%) patients. Marginal irregularity, ulceration, strong echo foci, and heterogeneity were detected in 1 (0.4%), 2 (0.8%), 22 (8.6%), and 67 (65.1%) patients, respectively. However, cystic changes were not detected. Tumor size was positively correlated with the mitotic index ( < 0.001). Receiver operating curve analysis identified 1.48 cm as the best cut-off value to predict malignant potential (95% confidence interval: 0.824-0.956). EUS heterogeneity with tumor diameters > 1.48 cm was associated with higher risk classification ( < 0.05).

CONCLUSION

Small GISTs (diameters > 1.48 cm) with positive EUS features should receive intensive surveillance or undergo endoscopic surgery. EUS and dissection are efficient diagnostic and therapeutic approaches for small GISTs.

摘要

背景

直径<2cm 的胃肠道间质瘤（GISTs）称为小 GISTs。目前，内镜超声（EUS）被广泛用作 GIST 的常规随访方法，也可为判断病变恶性潜能提供初步依据。但目前尚无研究评估 EUS 对小 GISTs 恶性潜能的评估准确性。

目的

评估 EUS 对小 GISTs 的诊断和风险评估效能。

方法

收集 2014 年 10 月至 2019 年 7 月在中国医科大学附属盛京医院接受内镜下切除或腹腔镜手术治疗的小 GISTs 患者资料。根据改良的美国国立卫生研究院标准，术后病理评估明确诊断和危险度分级。回顾性分析术前 EUS 特征（边缘不规则、囊性变、回声均匀性、溃疡、强回声灶），并与病理特征进行对比。

结果

共纳入 256 例患者（男 69 例，女 187 例）。病理结果分别为极低危 232 例、低危 16 例、中危 7 例、高危 1 例。肿瘤最常见的部位是胃底（78.1%），8 例（3.1%）患者核分裂象计数>5/50 高倍视野。1 例（0.4%）患者可见边缘不规则，2 例（0.8%）患者可见溃疡，22 例（8.6%）患者可见强回声灶，67 例（65.1%）患者可见回声不均匀。但未见囊性变。肿瘤大小与核分裂象计数呈正相关（<0.001）。受试者工作特征曲线分析发现，直径>1.48cm 是预测恶性潜能的最佳截断值（95%可信区间：0.824～0.956）。EUS 不均匀性伴肿瘤直径>1.48cm 与较高的危险度分级相关（<0.05）。