The role of endoscopic ultrasound on the preoperative T staging of gastric cancer: A retrospective study.
The role of endoscopic ultrasound on the preoperative T staging of gastric cancer: A retrospective study.
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DOI：
10.1097/md.0000000000004580
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发表时间：
2016-09
期刊：
影响因子：
1.6
通讯作者：
Hou X
中科院分区：
文献类型：
--
作者：
Han C;Lin R;Shi H;Liu J;Qian W;Ding Z;Hou X
内镜超声检查（EUS）用于胃癌术前评估。然而，最近的研究表明，EUS分期的准确性比以前认为的要低。我们的目的是评估EUS在术前胃癌T分期中的疗效和图像特征。回顾性分析232例术前行EUS T期评估的胃癌患者的临床和影像学特征。仅纳入无肿瘤切除边缘状态和无转移的病例。我们还比较了术前EUS和术后组织病理学分期，以确定评估胃癌的重要EUS图像特征。EUS对T分期的准确率为64.2% (149/232)，T3分期准确率最高（75.0%）。淋巴结肿大、分化良好的组织学类型和Borrmann IV型与预测肿瘤侵袭的诊断准确性相关。虽然没有与过分期相关的因素，但周围病变≥1/2、印戒细胞腺癌和Borrmann IV型的过分期风险明显较高。胃壁外缘不规则也是浆膜受累的一个指标，敏感性为82.0%。胰腺和结肠是比先前预测的更常见的疾病扩展部位。虽然EUS可能是我们用于胃癌分期的最佳和最准确的选择，但研究发现，包括周围病变、印戒细胞腺癌和Borrmann IV型癌在内的因素更频繁地与不正确的分期相关，这值得注意。
Endoscopic ultrasonography (EUS) is used for preoperative assessment of gastric cancer. However, recent studies suggested that EUS staging accuracy is lower than previously thought. We aimed to assess EUS efficacy and image characteristics in preoperative gastric cancer T staging. A retrospective review of clinical and imaging features of 232 gastric carcinoma patients who underwent preoperative EUS assessment of T stage was performed. Only cases with tumor-free resection margin status and no metastases were enrolled. Comparisons of preoperative EUS and postoperative histopathological stagings were also performed to identify vital EUS image features for evaluating gastric carcinoma. EUS accuracy for T staging was 64.2% (149/232) with the highest accuracy for T3 (75.0%). Enlarged lymph nodes, well differentiated histological type and Borrmann IV type were associated with diagnostic accuracy in predicting tumor invasion. Although no factors were associated with overstaging, circumferential lesions ≥1/2, signet ring cell adenocarcinoma, and Borrmann IV type had significantly higher risks of understaging. Gastric wall outer edge irregularity was also an indicator of serosal involvement with a sensitivity of 82.0%. The pancreas and colon were more frequent disease extension sites than previously predicted. Although EUS is likely the best and most accurate option that we have used to stage gastric cancer, the finding that factors including circumferential lesions, signet ring cell adenocarcinoma, and Borrmann IV type carcinoma were more frequently related to incorrect staging warrants attention.