Establishment of a Differential Diagnosis between benign and malignant Gastrointestinal Submucosal Tumors

胃肠粘膜下肿瘤良恶性鉴别诊断的建立

• 批准号: 11670894
• 负责人: INO Akihiro
• 金额: $ 2.24万
• 依托单位: KYUSHU UNIVERSITY
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 1999
• 资助国家: 日本
• 起止时间: 1999 至 2001
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-11670894/
• 关键词: submucosal tumor; ultrasonography-guided; fine needle aspiration cytology; fine needle aspiration histology; tumor diagnosis; malignancy evaluation

Endoscopic ultrasonography-guided fine needle aspiration was performed in 42 cases, 25 of which were submucosal tumors and 17 of which were extragastrointestinal tumor between 1999 and 2001. In the diagnosis of submucosal tumors the annual percentages of successful sampling for fine needle aspiration cytology (FNAC) were 57.1% (8/14), 83.3% (5/6) and 100% (5/5) in chronological order, and specimens for fine needle aspiration biopsy (FNAB) were obtained with reliability of 0% (0/14), 50% (3/6) and 100% (5/5) each year. Thus, the preparation of histologic specimens has technically become feasible with considerable reliability due to improvements in needles and other devices as well as in puncture techniques. Regarding extragastrointestinal tumors, both samples for FNAC and FNAB were obtained with comparatively favorable outcomes from the earliest stages of the study. Specimens were obtained from 8 cases with submucosal tumors, including 7 with a suspected diagnosis of gastrointestinal st … More romal tumors (GIST) and one with ectopic pancreas. We conducted immunostaining in 7 suspected cases of GIST and consequently characterized them as follows: smooth muscle type (4), neural type (3), combined type (0), and uncommitted type (1). In 6 (85.7%) of 7 cases, the preoperative diagnosis was consistent with subcategories derived from the final diagnosis on surgical specimens. Because of minor differences in staining, only one case that was initially classified into the uncommitted type was diagnosed as a smooth muscle type in the postoperative investigation. This suggests that it is possible to subcategorize submucosal tumors by using our preoperative diagnostic procedures. Based on clinical courses and surgical outcomes, a total of 25 submucosal tumor cases were differentiated into 4 malignant (including low-grade malignancy) and 21 benign cases. The differential accuracy, which was 60% when diagnosed simply by observing mitotic figures in FNAB samples, was improved to 80% when cellular atypism in FNAB and FNAG samples was concomitantly evaluated in the diagnosis. These diagnostic procedure demonstrated high accuracy. However, considering other factors in this study such as a high percentage of benign cases in the target population and a low (50%) sensitivity for analyses, we conclude that mitotic figures as well as cellular atypism will not complete a preoperative differential diagnosis between benign and malignant tumors. We have established reliable sampling procedure throughout the study and currently demonstrate that the specimens can be labeled with ki67, which is considered to indicate the proliferative capacity of submucosal tumors. Further studies will be conducted in order to investigate correlations between ki67 labeling index in a preoperative specimen and that measured in a surgical specimen, and to evaluate if the proliferative capacity can be a predictive indicator of benign or malignant submucosal tumor during the preoperative period. Less

1999年至2001年，在超声内镜引导下细针穿刺活检42例，其中25例为粘膜下肿瘤，17例为消化道外肿瘤。在粘膜下肿瘤的诊断中，细针吸取细胞学（FNAC）的年成功率依次为57.1%（8/14）、83.3%（5/6）和100%（5/5），细针吸取活检（FNAB）的可靠性为0%（0/14）。每年50%（3/6）和100%（5/5）。因此，由于针头和其他装置以及穿刺技术的改进，组织学标本的制备在技术上变得可行，具有相当大的可靠性。关于胃肠道外肿瘤，FNAC和FNAB的样本从研究的最早阶段获得了相对有利的结果。标本取自8例粘膜下肿瘤，其中7例疑似诊断为胃肠道肿瘤。 ...更多信息 间质肿瘤（GIST）和异位胰腺。我们对7例疑似胃肠道间质瘤进行了免疫组化染色，结果表明：平滑肌型（4例），神经型（3例），混合型（0例），未定型（1例）。在7例病例中，6例（85.7%）术前诊断与手术标本最终诊断的亚类一致。由于染色的微小差异，只有1例最初被分类为未定型型的病例在术后调查中被诊断为平滑肌型。这表明，它是可能的亚分类粘膜下肿瘤，通过使用我们的术前诊断程序。根据临床病程和手术结果，25例粘膜下肿瘤分为4例恶性（包括低度恶性）和21例良性。鉴别诊断的准确性，这是60%时，简单地通过观察FNAB样品中的有丝分裂像诊断，提高到80%时，在FNAB和FNAG样品中的细胞增殖同时进行评估的诊断。这些诊断程序显示出很高的准确性。然而，考虑到本研究中的其他因素，如目标人群中良性病例的高百分比和分析的低灵敏度（50%），我们得出结论，有丝分裂像和细胞分裂不能完成良性和恶性肿瘤之间的术前鉴别诊断。我们在整个研究过程中建立了可靠的采样程序，目前证明样本可以用ki 67标记，这被认为是表明粘膜下肿瘤的增殖能力。将进行进一步的研究，以调查术前标本中的ki 67标记指数和手术标本中测量的ki 67标记指数之间的相关性，并评估增殖能力是否可以作为术前良性或恶性粘膜下肿瘤的预测指标。少