胃肠道神经内分泌肿瘤的内镜误诊体会*

Experience of endoscopic diagnosis and treatment for gastrointestinal neuroendocriue tumor*

摘要:

目的??探讨胃肠神经内分泌肿瘤（GI-NETs）内镜诊治特点，减少误诊。方法?收集2012年1月-2014年11月该院内镜诊断的84例神经内分泌肿瘤（NET），回顾性分析其白光内镜、超声内镜（EUS）、组织病理学及治疗后情况等特点，总结其中误诊病例特点。结果?经内镜诊断NET 84例，最终经病理证实为NET 72例，12例内镜误诊为NET，误诊率达14.3%，12例分别为慢性炎症5例，异位胰腺2例，布氏腺增生1例，大肠增生性息肉1例，大肠静脉型血管瘤1例，大肠平滑肌瘤1例，转移性鳞癌1例。8例行EUS检查，均提示病灶来源黏膜下层，6例为低回声，1例偏高回声（布氏腺增生），1例混合回声（静脉型血管瘤）。结论?GI-NETs在内镜下有一定的特征性，但有部分病例表现可类似，经过更为细致的观察和必要的活检可增加诊断的准确率。

Abstract:

Objective?To study the characteristics of endoscopic diagnosis and treatment for gastrointestinal neuroendocriue tumor (GI-NETs).?Methods?We retrospectively collected the clinical data of 84 patients with endoscopic confirmed GI-NETs from January 2012 to November 2014, including white light, endoscopic ultrasonography, histopathology and post-treatment condition.?Results?Endoscopic diagnosis for NET were 84 cases, but finally confirmed by pathology were 72 cases, the misdiagnosis rate was 14.3%. Of the 12 misdiagnosed cases, 5 cases were chronic inflammation, ectopic pancreas in 2 cases, and 5 cases of hyperplasia of Brunner's glands, colorectal hyperplastic polyps, colorectal venous hemangioma, colorectal leiomyoma, metastatic squamous carcinoma respectively. Of 8 cases with EUS, all lesions derived from the submucosal layer, and 6 cases of low echo, and 2 cases of high echo (Brunner's glands) and mixed echo (venous hemangioma) respectively.?Conclusions?GI-NETs, which possess certain characteristics under endoscopy, may be similar with other digestive diseases, while it can increase the diagnosis accuracy by more careful observation and necessary biopsy.