超声内镜诊断胃间质瘤与术后病理的一致性观察及其诊断准确率的影响因素分析

Consistency between endoscopic ultrasonography and postoperative pathology in diagnosis of gastric stromal tumors

摘要:

目的 研究超声内镜诊断胃间质瘤与术后病理的一致性及其诊断准确率的影响因素。方法 纳入2018年10月－2020年10月该院收治的188例胃间质瘤疑似患者作为研究对象，开展回顾性分析。所有患者术前均接受超声内镜检查，并行手术治疗，术后病理诊断明确。收集患者一般资料，包括年龄、性别及超声内镜下特征（病变直径、病变部位、起源层次、边界是否规则、回声是否均匀、有无表面溃疡、黏膜桥、液化及钙化），对比超声内镜及病理检查结果，分析超声内镜与病理检查诊断胃间质瘤的一致性，并探讨超声内镜诊断胃间质瘤准确率的影响因素。结果 188例胃间质瘤疑似患者中，经超声内镜检查诊断为胃间质瘤者152例，内镜下特征表现为9例来源于黏膜肌层，10例来源于黏膜下层，133例来源于固有肌层；病变部位为97例胃底，35例胃体，14例胃窦，6例胃角。病理检查结果显示，188例胃间质瘤疑似患者中有162例胃间质瘤，19例平滑肌瘤，4例神经鞘瘤，3例神经纤维瘤。超声内镜诊断胃间质瘤的灵敏度为88.27%，特异度为65.38%，准确率为85.11%，阳性预测值为94.08%，阴性预测值为47.22%，Kappa值为0.462。符合诊断的患者160例，不符合诊断的患者28例。符合诊断的患者中，病变直径 ≥ 2 cm、回声不均匀、存在钙化的患者占比明显高于不符合诊断的患者（P < 0.05）。多因素Logistic回归分析显示，病变直径（O = 1.624，95%CI：1.108～2.380）、回声均匀（O = 1.407，95%CI：1.017～1.947）、钙化（O = 1.724，95%CI：1.351～2.200）是超声内镜诊断胃间质瘤准确率的独立影响因素（P < 0.05）。结论 超声内镜诊断胃间质瘤与术后病理诊断具有较好的一致性，病变直径、回声均匀、钙化是影响超声内镜诊断胃间质瘤准确率的独立影响因素。

Abstract:

Objective To study the consistency of endoscopic ultrasonography (EUS) in diagnosis of gastric stromal tumors (GISTs) with postoperative pathology and the influencing factors of diagnostic accuracy.Methods 188 patients with suspected gastric stromal tumor from October 2018 to October 2020 were selected as the research objects and retrospectively analyzed. All these patients underwent endoscopic ultrasonography and surgery before operation, and the postoperative pathological diagnosis was clear. The general data of patients were collected, including age, gender and endoscopic features (lesion diameter, lesion location, origin level, regular boundary, homogeneous echo, surface ulcer, mucosal bridge, liquefaction and calcification). The results of endoscopic ultrasonography and pathological examination were compared to analyze the consistency of endoscopic ultrasonography and pathological examination in the diagnosis of gastric stromal tumor, explore the factors influencing the accuracy of endoscopic ultrasonography in the diagnosis of gastric stromal tumors.Results Among the 188 cases of suspected gastric stromal tumors, 152 cases were diagnosed as gastric stromal tumors by endoscopic ultrasonography. Endoscopic features showed that 9 cases originated from muscularis mucosa, 10 cases from submucosa, 133 cases from muscularis propria; lesions were located in 97 cases of gastric fundus, 35 cases of gastric body, 14 cases of gastric antrum, 6 cases of gastric horn. The results of pathological examination showed that there were 162 cases of gastric stromal tumor, 19 cases of smooth muscle tumor, 4 cases of schwannoma and 3 cases of neurofibroma. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value and Kappa value were 88.27%, 65.38%, 85.11%, 94.08%, 47.22% and 0.462 respectively. 160 patients were diagnosed as consistent, 28 patients were diagnosed as inconsistent. The proportion of patients with lesion diameter ≥ 2 cm, uneven echo and calcification was significantly higher than that of patients without diagnosis (P < 0.05). Multivariate Logistic regression analysis showed that lesion diameter (O = 1.624, 95%CI: 1.108～2.380), homogeneous echo (O = 1.407, 95%CI: 1.017～1.947) and calcification (O = 1.724, 95%CI: 1.351～2.200) were independent influencing factors for the accuracy of EUS in the diagnosis of gastric stromal tumors (P < 0.05).Conclusion Endoscopic ultrasonography in the diagnosis of gastric stromal tumors is consistent with postoperative pathological diagnosis. Lesion diameter, homogeneous echo and calcification are independent factors affecting the accuracy of endoscopic ultrasonography in the diagnosis of gastric stromal tumors.