摘要
目的探讨超声内镜诊断联合CT诊断不同大小食管黏膜下肿物的效能。方法回顾性选择2018年6月至2022年12月常州市中医医院收治的205例食管黏膜下肿物患者,其中男性137例,女性68例;年龄21~67岁,平均年龄43.78岁;病灶处于食管上段78例,中段67例,下段60例;病灶直径0.3~4.0 cm,平均直径1.02 cm。所有患者术前行超声内镜、CT检查,术后行病理学检查,比较CT诊断、超声内镜诊断及二者联合诊断对食管黏膜下肿物的检查结果与病理诊断结果的一致性。绘制受试者工作特性(ROC)曲线,以曲线下面积(AUC)评估诊断价值。结果病理诊断结果显示,184例为良性肿瘤,21例为恶性肿瘤。CT诊断良性171例,恶性34例;CT影像恶性肿瘤强化不均匀、边界模糊、密度欠均匀。超声内镜诊断良性178例,恶性27例;超声内镜恶性间质瘤可见混合低回声团块,起源于黏膜肌层或固有肌层,边界模糊,内镜下表现为较大的黏膜下隆起,表面可伴凹陷及溃疡形成。CT诊断总符合率为84.88%,超声内镜诊断总符合率为91.22%;二者联合诊断对食管黏膜下肿物良恶性的总符合率为97.07%,与病理诊断一致性良好(Kappa值=0.859,P<0.05)。直径<1 cm、1~2 cm食管黏膜下肿物,CT诊断与病理诊断一致性不存在或较差(Kappa值=0.361,P<0.05),而超声内镜诊断与病理诊断一致性均一般(Kappa值=0.541、0.673,P<0.05),但二者联合诊断与病理诊断一致性均较好(Kappa值=0.761、0.783,P<0.05);直径>2 cm食管黏膜下肿物,CT诊断、超声内镜诊断、二者联合诊断与病理诊断一致性较好(Kappa值=0.762、0.798、0.867,P<0.05)。ROC曲线结果显示,CT诊断、超声内镜诊断及二者联合诊断食管癌黏膜下肿物的灵敏度分别为88.04%、93.48%、97.83%,特异度分别为57.14%、71.43%、90.48%,AUC值分别为0.726、0.825、0.942(P<0.05),且二者联合的AUC值更高(P<0.05)。结论超声内镜诊断、CT诊断在不同大小食管黏膜下肿物中�
Objective To investigate the efficacy of endoscopic ultrasonography combined with CT in the diagnosis of esophageal submucosal tumors with different sizes.Methods From June 2018 to December 2022,a total of 205 patients with esophageal submucosal masses were enrolled,which included 137 males and 68 females,aged 21-67 years old with mean age of 43.78 years old.The lesions were located at upper esophagus in 78 cases,mid dle esophagus in 67 and lower esophagus in 60.The lesion diameter was 0.3-4.0 cm with mean diameter of 1.02 cm.All of them performed preoperative endoscopic ultrasonography,CT examination,and postoperative pathological examination.The consistency of CT diagnosis,endoscopic ultrasonography diagnosis and combined diagnosis of esophageal submucosal masses with pathological diagnosis results was compared,The receiver operating characteristic(ROC)curve was drawn and the area under curve(AUC)was used to evaluate the diagnostic value.Results The pathological diagnosis showed that 184 cases were benign tumors and 21 were malignant tumors.The diagnosed results of CT indicated 171 cases of benign and 34 of malignant.The CT images of malignant tumors showed uneven enhancement,blurred boundary,and uneven density.In addition,178 cases of benign and 27 of malignant was diagnosed by endoscopic ultrasonography.The endoscopic ultrasonography showed mixed low-echo mass in malignant stromal tumors,which originated from muscularis mucosa or muscularis propria,with blurred boundaries,and presented as large submucosal uplift,surface with depression and ulcer formation.The total coincidence rate of CT diagnosis was 84.88%,and the total coincidence rate of endoscopic ultrasonography was 91.22%.The total coincidence rate of combined diagnosis of benign and malignant esophageal submucosal tumors was 97.07%,which showed better coincidence with pathological diagnosis(Kappa=0.859,P<0.05).There was no or poor consistency between CT diagnosis and pathological diagnosis in esophageal submucosal tumors with lesion diameter<1 cm and
作者
卜玲玲
王晶
叶小峰
陈晨
BU Ling-ling;WANG Jing;YE Xiao-feng;CHEN Chen(Department of Spleen and Stomach Diseases,Affiliated Hospital of Nanjing University of Traditional Chinese Medicine,Changzhou 213000,Jiangsu,China)
出处
《生物医学工程与临床》
CAS
2023年第6期735-740,共6页
Biomedical Engineering and Clinical Medicine
基金
江苏省研究生科研与实践创新计划项目(SJCX18_0069)。
关键词
CT
超声内镜
肿瘤大小
食管黏膜下肿物
诊断价值
CT
endoscopic ultrasound
tumor sizes
esophageal submucosal masses
diagnostic value
