超声内镜和多层螺旋CT对Borrmann Ⅳ型胃癌术前分期的比较研究

Comparison of endoscopic ultrasonography and multislice spiral computed tomography for the preoperative staging of Borrmann type Ⅳ gastric cancer

摘要:

目的  对超声内镜（EUS）和多层螺旋CT（MSCT）检查在Borrmann Ⅳ型胃癌术前分期中的作用进行比较。方法  回顾性分析48例Borrmann Ⅳ型胃癌患者的影像学术前TNM分期，并与术后病理分期进行比较。结果  EUS和MSCT检查对T分期的准确率分别为54.2%和79.2%（P =0.009），分层分析表明MSCT对T3、T4分期的准确率高于EUS（T3：84.6% vs 57.7%，P =0.032；T4：82.4% vs 41.2%，P =0.032）。两者对N分期的准确率，均为56.3%（P =1.000），无明显差异，EUS和MSCT对淋巴转移检查的特异度和灵敏度分别为83.3%/72.2%和66.7%/91.7%。结论  EUS更适合对早期胃癌分期，而已浸润至浆膜层及有远处转移的Borrmann Ⅳ型胃癌患者，应优先选择MSCT检查进行分期。

Abstract:

Objective To compare the performances of endoscopic ultrasonography (EUS) and multislice spiral computed tomography (MSCT) in the preoperative staging of Borrmann type Ⅳ gastric cancer. Methods 48 patients involved in this study, all the patients had undergone surgical resection, Borrmann Type Ⅳ gastric cancer had confirmed and evaluated by EUS and MSCT. Tumor staging was evaluated by Tumor-Node-Metastasis (TNM) staging. The results from the imaging modalities were compared with postoperative histopathological outcomes. Results The overall accuracies of EUS and MSCT for the T staging category were 54.2 % and 79.2 % (P = 0.009), respectively. Stratified analysis revealed that the accuracy of MSCT in T3 and T4 staging was significantly higher than that of EUS (P = 0.032 for both). The overall accuracies of EUS and MSCT for the N staging category were both 56.3%. The sensitivity and specificity of EUS and MSCT in N staging were 83.3 %/72.2 % and 66.7 %/91.7 %, respectively. Conclusion MSCT prevail over EUS for Borrmann Type Ⅳ gastric cancer patients with invasion into serosal layer or adjacent organs or with distant metastasis.