Chak A, Canto M I, Rösch T, Dittler H J, Hawes R H, Tio T L, Lightdale C J, Boyce H W, Scheiman J, Carpenter S L, Van Dam J, Kochman M L, Sivak M V
Case Western Reserve University, Cleveland, OH, USA.
Gastrointest Endosc. 1997 Jun;45(6):468-73. doi: 10.1016/s0016-5107(97)70175-5.
Endosonography (EUS) is a valuable technique for diagnosing gastrointestinal stromal cell tumors. However, EUS features that are predictive of malignancy in these tumors have not been defined.
Videotapes and photographs of EUS examinations performed prior to surgical resection of 35 stromal cell tumors (9 malignant) were blindly reviewed by a single examiner. EUS features associated with malignancy were determined. Interobserver agreement in interpreting these features was then measured among a panel of five expert endosonographers who judged EUS videotapes of 35 resected stromal cell tumors (10 malignant).
Stepwise logistic regression analysis demonstrated that tumor size (diameter > 4 cm), irregular extraluminal border, echogenic foci, and cystic spaces were independently associated with malignancy in stromal cell tumors (p < 0.05). Interobserver agreement for irregular extraluminal border, echogenic foci, and cystic spaces, as measured by mean kappa statistic, was 0.43, 0.39, and 0.28, respectively. For the five experts, the sensitivity for detecting malignancy ranged between 80% to 100% when at least two of the three features were judged to be present. The likelihood of finding malignancy ranged between 0% to 11% for the experts when all three features were judged absent.
Tumor size and certain EUS features are useful for predicting malignancy in stromal cell tumors. Absence of these features indicates benign disease. Agreement among experts in interpreting these EUS features is fair to moderate.
内镜超声检查（EUS）是诊断胃肠道间质细胞瘤的一项重要技术。然而，这些肿瘤中预测恶性程度的EUS特征尚未明确。
一名检查者对35例间质细胞瘤（9例为恶性）手术切除前的EUS检查录像带和照片进行了盲法回顾。确定与恶性相关的EUS特征。然后在由五名专家内镜超声检查医师组成的小组中测量观察者间对这些特征的解释一致性，这些专家对35例切除的间质细胞瘤（10例为恶性）的EUS录像带进行了判断。
逐步逻辑回归分析表明，肿瘤大小（直径>4cm）、不规则的腔外边界回声灶和囊腔与间质细胞瘤的恶性独立相关（p<0.05）。通过平均kappa统计量测量，观察者间对不规则腔外边界、回声灶和囊腔的一致性分别为0.43、0.39和0.28。对于这五名专家，当判断这三个特征中至少有两个存在时，检测恶性的敏感性在80%至100%之间。当判断所有三个特征均不存在时，专家发现恶性的可能性在0%至11%之间。
肿瘤大小和某些EUS特征有助于预测间质细胞瘤的恶性程度。这些特征的缺失表明为良性疾病。专家们对这些EUS特征的解释一致性为中等至良好。
