Wu Jiali, Zhuang Mengqi, Zhou Yubao, Zhan Xiang, Xie Weiwei
Department of Gastroenterology, The Second Hospital of Anhui Medical University, Hefei, China.
Scand J Gastroenterol. 2023 May;58(5):542-548. doi: 10.1080/00365521.2022.2144437. Epub 2022 Nov 11.
Contrast-enhanced harmonic endoscopic ultrasound (CEH-EUS) has been used in the differential diagnosis of benign and malignant tumors by visualization of tumor microcirculation and perfusion. However, its diagnostic role in submucosal tumors (SMTs), especially leiomyomas and gastric submucosal tumors (GISTs) was rarely studied. The aim of this study was to analyze the diagnostic role of CEH-EUS for SMTs (<50 mm) and the value of assessing the malignant potential of GISTs.
We retrospectively included patients with tumors <50 mm in diameter who underwent preoperative EUS and CEH-EUS examination and had pathologically confirmed as leiomyomas and GISTs. To analyze the imaging features of CEH-EUS with pathological diagnosis as the gold standard and evaluate its diagnostic value.
This study included 10 cases of leiomyomas and 38 cases of GISTs. Under CEH-EUS detection, 86.9% of GISTs showed hyper-enhancement, 89.5% showed diffuse enhancement, 39.5% showed non-enhancing spots, and 97.4% showed obvious capsule enhancement. In contrast, the leiomyoma cases mostly showed hypo-enhancement (50.0%) or non-enhancement (30.0%) ( < 0.05). Then, the value of CEH-EUS in the differential diagnosis of benign and malignant tumors based on blood flow is significantly higher than that of B-EUS. Signal appearance time was significantly faster in the intermediate-high risk GISTs than in the very low-low risk group (5.1 s versus 15.5 s, < 0.05), and the AUROC values predicted the risk at this time to be 0.903 (0.763-0.975). Heterogeneous perfusion and non-enhancing spots were also more common in the intermediate-high risk group. Univariate and multivariate analysis revealed that intratumoral irregularitie was an independent predictor of moderate to high risk (OR 3.99, 95%CI 1.04-90.95), with sensitivity, specificity and accuracy of 73.33%, 91.30% and 84.21%, respectively.
Through this study, CEH-EUS has a good differential diagnostic ability for leiomyomas and GISTs, and has a high value in predicting the risk of GISTs.
对比增强谐波内镜超声（CEH-EUS）已用于通过观察肿瘤微循环和灌注来鉴别诊断良性和恶性肿瘤。然而，其在黏膜下肿瘤（SMTs），尤其是平滑肌瘤和胃黏膜下肿瘤（GISTs）中的诊断作用鲜有研究。本研究旨在分析CEH-EUS对直径<50 mm的SMTs的诊断作用以及评估GISTs恶性潜能的价值。
我们回顾性纳入了直径<50 mm且术前行EUS和CEH-EUS检查并经病理确诊为平滑肌瘤和GISTs的患者。以病理诊断为金标准分析CEH-EUS的影像学特征并评估其诊断价值。
本研究包括10例平滑肌瘤和38例GISTs。在CEH-EUS检测下，86.9%的GISTs表现为高增强，89.5%表现为弥漫性增强，39.5%表现为无增强区，97.4%表现为明显的包膜增强。相比之下，平滑肌瘤病例大多表现为低增强（50.0%）或无增强（30.0%）（P<0.05）。然后，基于血流的CEH-EUS在鉴别诊断良性和恶性肿瘤方面的价值显著高于B-EUS。中高危GISTs的信号出现时间明显快于极低-低风险组（5.1秒对15.5秒，P<0.05），此时预测风险的AUROC值为0.903（0.763-0.975）。中高危组中不均匀灌注和无增强区也更常见。单因素和多因素分析显示，肿瘤内不规则是中到高风险的独立预测因素（OR 3.99，95%CI 1.04-90.95），敏感性、特异性和准确性分别为73.33%、91.30%和84.21%。
通过本研究，CEH-EUS对平滑肌瘤和GISTs具有良好的鉴别诊断能力，在预测GISTs风险方面具有较高价值。
