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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2017, Vol. 14 ›› Issue (06) : 423 -427. doi: 10.3877/cma.j.issn.1672-6448.2017.06.006

所属专题： 文献；

腹部超声影像学

超声双重造影与超声内镜评估胃癌术前区域淋巴转移的价值比较
王亮1, 杨琰1,†(), 王小花1, 何慧疗1, 陈浩2, 郑志强3, 王宗敏4   
  1. 1. 325027　温州医科大学附属第二医院超声科
    2. 325027　温州医科大学附属第二医院消化内科
    3. 325027　温州医科大学附属第二医院胃肠外科
    4. 325027　温州医科大学附属第二医院病理科
  • 收稿日期:2016-11-26 出版日期:2017-06-01
  • 通信作者: 杨琰
  • 基金资助:
    温州市科技局项目(Y20140604)

Comparison of double contrast-enhanced ultrasonography and endoscopic ultrasonography in evaluating regional lymph node metastasis of gastric cancer

Liang Wang1, Yan Yang1,†(), Xiaohua Wang1, Huiliao He1, Hao Chen2, Zhiqiang Zheng3, Zongmin Wang4   

  1. 1. Department of Ultrasound, the 2nd Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China
    2. Department of Gastroenterology, the 2nd Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China
    3. Department of Gastrointestinal Surgery, the 2nd Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China
    4. Department of Pathology, the 2nd Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China
  • Received:2016-11-26 Published:2017-06-01
  • Corresponding author: Yan Yang
  • About author:
    Corresponding author: Yang Yan, Email:
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引用本文：

王亮, 杨琰, 王小花, 何慧疗, 陈浩, 郑志强, 王宗敏. 超声双重造影与超声内镜评估胃癌术前区域淋巴转移的价值比较[J]. 中华医学超声杂志（电子版）, 2017, 14(06): 423-427.

Liang Wang, Yan Yang, Xiaohua Wang, Huiliao He, Hao Chen, Zhiqiang Zheng, Zongmin Wang. Comparison of double contrast-enhanced ultrasonography and endoscopic ultrasonography in evaluating regional lymph node metastasis of gastric cancer[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2017, 14(06): 423-427.

目的

评价超声双重造影、超声内镜在胃癌术前区域淋巴转移（N分期）中的价值。

方法

2015年6月至2016年9月温州医科大学附属第二医院收治的经胃镜证实为胃癌并进行手术治疗的患者65例。所有患者于术前5 d内均行超声双重造影、超声内镜检查。以组织病理学结果作为金标准，计算超声双重造影、超声内镜判断胃癌术前区域淋巴转移（N分期）的敏感度、特异度及Youden指数。采用χ2检验比较超声双重造影、超声内镜判断胃癌术前区域淋巴转移（N分期）总的符合率差异。

结果

病理证实25例患者为N（-）期，40例患者为N（＋）期。25例N（-）期患者，超声双重造影判断正确18例，超声内镜判断正确20例；40例N（＋）期患者，超声双重造影判断正确32例，超声内镜判断正确31例。超声双重造影、超声内镜判断胃癌术前区域淋巴转移（N分期）的敏感度、特异度及Youden指数分别为80.0%、72.0%、0.52，77.5%、80.0%、0.58；总的符合率分别为76.9%（50/65）、78.5%（51/65），两者差异无统计学意义（χ2=0.044，P =0.833）。

结论

超声内镜和超声双重造影判断胃癌术前N分期总的准确率相当，两种检查方法在胃癌术前N分期中各有优缺点，联合两种检查方法可相互弥补不足，增加胃癌术前N分期判断准确率，对手术治疗方案的制定有指导意义。

关键词: 超声检查, 造影剂, 内窥镜检查, 胃肿瘤, 淋巴转移
Objective

To evaluate the accuracy of double contrast-enhanced ultrasonography (DCUS) and endoscopic ultrasonography (EUS) in the preoperative N staging of gastric cancer.

Methods

Between June 2015 and September 2016, a total of 65 consecutive patients who were diagnosed with histologically confirmed gastric carcinoma and underwent surgery in the 2nd Affiliated Hospital of Wenzhou Medical University were enrolled into this study. DCUS and EUS were performed in all patients to estimate lymph node metastasis (N stage) within 5 days before surgery. The findings of the histopathologic examination of resected specimens were considered as gold standard and were retrospectively compared with the results of DCUS and EUS. The sensitivity, specificity and Youden index of DCUS and EUS were calculated. The difference of diagnostic performance between DCUS and EUS was assessed by chi-square test.

Results

There were 25 N- patients and 40 N+ patients confirmed by pathology. Of all 25 N- cases, 18 cases were diagnosed correctly by DCUS and 20 cases were diagnosed correctly by EUS; Of all 40 N+ cases, 32 cases were diagnosed correctly by DCUS and 31 cases were diagnosed correctly by EUS. The sensitivity, specificity and Youden index of DCUS were 80.0%, 72.0% and 0.52 respectively. The sensitivity, specificity and Youden index of EUS were 77.5%, 80.0% and 0.58 respectively. The overall accuracy of DCUS and EUS in N-staging were 76.9% (50/65) and 78.5% (51/65). There was no significant difference between two methods (χ2=0.044, P=0.833).

Conclusions

There was no significant difference between DCUS and EUS in overall N-staging of gastric cancers. Either of these two methods had its advantages and disadvantages. When the two methods were combined, the accuracy of preoperative N-staging of gastric cancers could be improved and this improvement may influence treatment algorithms.

Key words: Ultrasonography, Contrast media, Endoscopy, Stomach neoplasms, Lymphatic metastasis
图1 胃癌转移淋巴结超声双重造影图。胃周见多发肿大淋巴结回声（箭头所示），显著增强的实质内有局灶性低或无灌注区
图2~3 胃癌转移淋巴结超声内镜图。图1、2均可见胃壁外呈椭圆形低回声并有明确边界的淋巴结 （箭头所示）
表1 超声双重造影、超声内镜评估胃癌术前区域淋巴转移（N分期）与术后病理结果对照（例）
方法 术后病理结果 合计
N（＋） N（-）
超声双重造影 ? ? ?
N（＋） 32 7 39
N（-） 8 18 26
超声内镜 ? ? ?
N（＋） 31 5 36
N（-） 9 25 29
[1]
Jemal A, Bray F, Center MM, et al. Global cancer statistics [J]. CA Cancer J Clin, 2011, 61(2):69-90.
[2]
Shen L, Shan YS, Hu HM, et al. Management of gastric cancer in Asia: resource-stratified guidelines [J]. Lancet Oncol, 2013, 14(12):e535-e547.
[3]
徐飚，王建明. 胃癌流行病学研究 [J]. 中华肿瘤防治杂志, 2006, 13(1):1-7.
[4]
秦新裕. 努力提高我国胃癌诊治水平 [J]. 中华胃肠外科杂志, 2010, 13(1):9-12.
[5]
Huenerbein M, Dohmoto M, Rau B, et al. Endosonography and endosonography-guided biopsy of upper-GI-tract tumors using a curved-array echoendoscope [J]. Surg Endosc, 1996, 10(12):1205-1209.
[6]
李诺，温艳惠，郭海梅. 超声内镜对胃癌术前TN分期准确性的Meta分析 [J]. 现代肿瘤学, 2012, 20(1):110-114.
[7]
Rubaltelli L, Khadivi Y, Tregnaghi A, et al. Evaluation of lymph node perfusion using continuous mode harmonic ultrasonography with a second generation contrast agent [J]. J Ultrasound Med, 2004, 23:829-836.
[8]
洪玉蓉，刘学明，张闻, 等. 超声造影在浅表淋巴结疾病鉴别诊断中的应用研究 [J]. 中华超声影像学杂志, 2006, 15(11):849-852.
[9]
Willis S, Troung S, Gribnitz S, et al. Endoscopic ultrasonography in the preoperative staging of gastric cancer [J]. Surg Endosc, 2000, 14(10):951-954.
[10]
金俊蕊，邓靖宇，梁寒. 胃癌淋巴结分期的临床变革及分期方法的研究进展 [J]. 中国肿瘤临床杂志, 2016, 43(15):683-689.
[11]
王志兵，朱建兵，沈钧康, 等. 胃癌64排螺旋CT征象与病理TN分期相关性分析 [J]. 中国临床研究, 2016, 29(12):1710-1713.
[12]
王倩，周华玲，张东东, 等. 超声双重造影对胃癌术前分期的诊断意义 [J/CD]. 中华危重症医学杂志(电子版), 2015, 8(2):100-103.
[13]
耿焱，王爱民，熊英, 等. 超声内镜检查在胃癌术前分期中的临床价值 [J/CD]. 中华胃肠内镜电子杂志, 2015, 2(1):18-22.
[14]
曹春辉，黄品同，郑毅雄, 等. 超声双重造影在胃癌术前诊断和临床分期的初步应用研究 [J/CD]. 消化肿瘤杂志(电子版), 2011, 3(4):229-232.
[15]
洪勇强，战微微，杨继东, 等. 超声双重造影在进展期胃癌诊断及疗效评估中的研究 [J]. 中华全科医学, 2015, 13(1):97-99.
[16]
余秀华，施红，张宏, 等. 超声双重造影及三维成像在良恶性胃溃疡鉴别诊断中的应用价值 [J/CD]. 中华医学超声杂志(电子版), 2015, 12(7):519-525.
[17]
张宏宇，黄丽萍，刘大铭, 等. 胃癌的超声造影参数与微血管密度的相关性 [J]. 中国医学影像技术, 2015, 31(6):867-871.
[18]
Jenssen C, Alvarez-Sánchez MV, Napoléon B, et al．Diagnostic endoscopic ultrasonography: assessment of safety and prevention of complications [J]. World J Gastroenterol, 2012, 18(34):4659-4676.
[19]
王瑞杰，冯野. 胃癌术前分期检查方法及进展 [J]. 中国实验诊断学, 2017, 21(2):355-357.
[20]
严超，朱正纲，燕敏. 内镜超声检查和多层螺旋CT检查对胃癌淋巴结转移状况的评估价 [J]. 中华外科杂志, 2005, 43(3):174-176.
[21]
金震东，李兆申. 消化超声内镜学 [M]. 2版. 北京: 科学出版社, 2011: 285-300.
[22]
Potrc S, Skalicky M, Ivanecz A, et al. Does endoscopic ultrasound staging already allow individual treatment regimens in gastric cancer [J]. Wien Klin Wochenschr, 2006, 118(2):48-51.
[23]
Korst RJ, Altorki NK. Imaging for esophageal tumors [J]. Thorac Surg Clin, 2004, 14(1):61-69.
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