小探头内镜超声检查在早期胃癌T分期中的应用

Application of miniprobe endoscopic ultrasonography in the T stage of early gastric cancer

    摘要
  • 摘要: 目的:评价小探头EUS检查在早期胃癌T分期中的应用价值，探讨影响分期评估准确性的因素。
    方法:回顾性分析2011年3月至2014年6月北京肿瘤医院收治的103例早期胃癌患者的临床资料，将小探头EUS检查分期与术后病理学检查分期对照得出分期准确率，同时比较不同病变部位、不同病变直径、不同组织分化类型、伴或不伴溃疡、不同Lauren分型的患者间分期准确率的差异。率的比较和单因素分析采用〖KG*4〗χ2检验，多因素分析采用Logistic回归模型。
    结果:共发现107处病变，小探头EUS检查发现75处病变为uT1a期；32处病变为uT1b期。病理学检查发现61处为T1a期，40处为T1b期，6处为T2期。小探头EUS检查对T1期病变的分期准确率为66.4%(71/107)，其中小探头EUS检查对uT1a期和uT1b期病变的准确率分别为70.7%(53/75)和56.3%(18/32)。对于不同病变直径、不同组织分化类型、伴或不伴溃疡的患者采用小探头EUS检查判断分期，其准确率比较，差异有统计学意义(χ2=7.834,7.432,6.461，P<0.05)。多因素分析结果显示：病变直径>30 mm、组织分化类型为未分化型是影响小探头EUS检查分期准确率的独立危险因素(OR=0.340，0.332，95%可信区间：0.563~0.932，0.582~1.022，P<0.05)。
    结论:小探头EUS检查对早期胃癌T分期有较好的应用价值，对T1a期病变的分期准确率高于T1b期病变，影响小探头EUS检查对早期胃癌T分期评估准确性的因素为病变直径>30 mm、组织分化类型为未分化型。

     

    Abstract: Objective:To evaluate the accuracy and influencing factors of miniprobe endoscopic ultrasonography (EUS) in determining the T stage for early gastric cancer (EGC).
    Methods:The clinical data of 103 patients with EGC who were admitted to the Peking University Cancer Hospital from March 2011 to June 2014 were retrospectively analyzed.  The diagnosis results of miniprobe EUS were compared with postoperative pathological findings, of which the differences in the accuracy of miniprobe EUS in determining the T stage of EGC were analyzed according to tumor location, diameter, differentiated types, with or without ulceration and Lauren classification. The rate comparison and univariate analysis were done by the chisquare test, and multivariate analysis was done using the Logistic regression model.
    Results:Among 107 lesions, 75 lesions were detected in uT1a stage by miniprobe EUS and 32 lesions in uT1b stage. The results of pathological examination showed that 61 lesions were detected in T1a stage, 40 lesions in T1b stage and 6 lesions in T2 stage. The accuracy of miniprobe EUS in the T1 stage of EGC was 66.4%( 71/107), including 70.7%(53/75) in the uT1a stage and 56.3%(18/32) in the uT1b stage of EGC.  There were significant differences in the accuracy of miniprobe EUS for determining the T stage of EGC among the patients with different tumor diameters, different differentiated types and with or without ulceration (χ2=7.834, 7.432, 6.461, P<0.05). The results of multivariate analysis showed that tumor diameter more than 30 mm and undifferentiated types of tumors were independent risk factors affecting the accuracy of miniprobe EUS in determining the T stage of EGC (OR=0.340, 0.332, 95% confidence interval: 0.563-0.932, 0.582-1.022, P<0.05).
    Conclusions:The clinical value of miniprobe EUS in the T stage of EGC is relatively high. The accuracy of miniprobe EUS detecting in the T1a stage of EGC is higher than the T1b stage of EGC, and the factors affecting the accuracy of miniprobe EUS in determining preoperative stage of EGC include tumor diameter more than 30 mm and undifferentiated type of tumors.

     

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