背景:尽管常规内窥镜(CE)和内窥镜超声检查(EUS)的组合对于预测早期胃癌(EGC)的深度很有用,EUS对粘膜下(SM)浸润性癌的诊断价值尚未得到充分研究.
方法:我们于2017年5月至2021年1月进行了一项多中心前瞻性研究,以评估结合CE和EUS的诊断策略的有效性,并阐明EUS对疑似SM入侵的EGC的附加价值。在每种情况下,诊断首先是使用CE,其次是EUS,最后用组合算法确认。
结果:共纳入来自10个机构的180例EGC患者,其中175项进行了分析。组织病理学深度为M,72、16、64和23个病变中的SM1、SM2和≥MP,分别。治疗包括内镜黏膜下剥离术92例,手术83例。CE的M-SM1或SM2-MP分类的总体诊断准确率为58.3%,EUS的75.7%,CE和EUS的组合为78.9%;后两者显着高于单独的CE(P<0.001)。CE,EUS,108个分化型病变的组合准确率为51.9%,77.4%,79.6%,后两者均显著高于单独CE(P<0.001)。在CE-SM2低置信度病变中观察到EUS的显着累加效应,但在CE-M-SM1病变或CE-SM2高置信度病变中未观察到。在九项行政长官调查结果中,不规则表面,粘膜下肿瘤样升高,和非延伸体征是pSM2-MP的显著独立标志物。误诊为EUS病变。
结论:EUS为分化型和CE-SM2低置信度EGC诊断侵袭深度提供了额外价值。
背景:UMIN000025862.
Although the combination of conventional endoscopy (CE) and endoscopic ultrasonography (EUS) is useful for predicting the depth of early gastric cancer (EGC), the diagnostic value of EUS for submucosal (SM) invasive cancer has not been fully investigated.
We conducted a multicenter prospective study from May 2017 to January 2021 to evaluate the validity of a diagnostic strategy combining CE and EUS and to clarify the additional value of EUS for EGC suspected of SM invasion. In each case, the diagnosis was first made using CE, followed by EUS, and finally confirmed using a combination algorithm.
A total of 180 patients with EGC were enrolled from 10 institutions, of which 175 were analyzed. The histopathological depths were M, SM1, SM2, and ≥ MP in 72, 16, 64, and 23 lesions, respectively. Treatment included 92 endoscopic submucosal dissection cases and 83 surgical cases. The overall diagnostic accuracy classified by M-SM1 or SM2-MP was 58.3% for CE, 75.7% for EUS, and 78.9% for the combination of CE and EUS; the latter two were significantly higher than that of CE alone (P < 0.001). The CE, EUS, and combination accuracy rates in 108 differentiated-type lesions were 51.9%, 77.4%, and 79.6%, respectively; the latter two were significantly higher than CE alone (P < 0.001). A significant additive effect of EUS was observed in CE-SM2 low-confidence lesions but not in CE-M-SM1 lesions or in CE-SM2 high-confidence lesions. Among the nine CE findings, irregular surface, submucosal tumor-like elevation, and non-extension signs were significant independent markers of pSM2-MP. Poorly delineated EUS lesions were misdiagnosed.
EUS provides additional value for differentiated-type and CE-SM2 low-confidence EGCs in diagnosing invasion depth.
UMIN000025862.