縱軸超聲內(nèi)鏡、小頭超聲內(nèi)鏡及白光內(nèi)鏡對早期胃癌黏膜下浸潤預(yù)測價值的探討

縱軸超聲內(nèi)鏡、小頭超聲內(nèi)鏡及白光內(nèi)鏡對早期胃癌黏膜下浸潤預(yù)測價值的探討摘要：目的：探討縱軸超聲內(nèi)鏡、小頭超聲內(nèi)鏡及白光內(nèi)鏡對早期胃癌黏膜下浸潤預(yù)測價值。方法：以2008年1月至2013年12月經(jīng)手術(shù)治療的356例早期胃癌為研究對象，分別采用縱軸超聲內(nèi)鏡、小頭超聲內(nèi)鏡及白光內(nèi)鏡進(jìn)行前瞻性觀察。結(jié)果：在本研究中，縱軸超聲內(nèi)鏡與小頭超聲內(nèi)鏡明顯優(yōu)于白光內(nèi)鏡對早期胃癌黏膜下浸潤預(yù)測。其中，縱軸超聲內(nèi)鏡的準(zhǔn)確性并不高于小頭超聲內(nèi)鏡，但在評估胃癌侵襲深度、特別是黏膜下浸潤的情況下，縱軸超聲內(nèi)鏡的準(zhǔn)確性更高。結(jié)論：縱軸超聲內(nèi)鏡和小頭超聲內(nèi)鏡應(yīng)作為早期胃癌黏膜下浸潤預(yù)測的重要工具。在病理學(xué)上明確黏膜下浸潤的情況下，應(yīng)考慮采用術(shù)前超聲內(nèi)鏡進(jìn)行評估。

關(guān)鍵詞：縱軸超聲內(nèi)鏡，小頭超聲內(nèi)鏡，白光內(nèi)鏡，早期胃癌，黏膜下浸潤

Introduction:本研究旨在研究縱軸超聲內(nèi)鏡、小頭超聲內(nèi)鏡及白光內(nèi)鏡對早期胃癌黏膜下浸潤的預(yù)測價值。方法：選擇2008年1月至2013年12月廣州市第一人民醫(yī)院經(jīng)手術(shù)治療的356例早期胃癌，分別采用縱軸超聲內(nèi)鏡、小頭超聲內(nèi)鏡及白光內(nèi)鏡進(jìn)行前瞻性觀察。結(jié)果：在本研究中，縱軸超聲內(nèi)鏡與小頭超聲內(nèi)鏡明顯優(yōu)于白光內(nèi)鏡對早期胃癌黏膜下浸潤的預(yù)測。結(jié)論：縱軸超聲內(nèi)鏡和小頭超聲內(nèi)鏡應(yīng)作為早期胃癌黏膜下浸潤預(yù)測的重要工具。

Abstract:Objective:Toinvestigatethepredictivevalueoflinearendoscopicultrasound(L-EUS),radialendoscopicultrasound(R-EUS)andwhitelightendoscopy(WLE)inpredictingsubmucosalinvasionofearlygastriccancer.Methods:Atotalof356patientswithearlygastriccancerwhounderwentsurgicaltreatmentatGuangzhouFirstPeople’sHospitalfromJanuary2008toDecember2013wereprospectivelyobservedwithL-EUS,R-EUSandWLE.Results:L-EUSandR-EUSweresignificantlybetterthanWLEinpredictingsubmucosalinvasionofearlygastriccancer.L-EUSwasnotsuperiortoR-EUSintermsofaccuracy,butitwasbetterinidentifyingthedepthofinvasion,especiallysubmucosalinvasion.Conclusion:L-EUSandR-EUSshouldbeconsideredasimportanttoolsinpredictingsubmucosalinvasionofearlygastriccancer.Preoperativeultrasoundevaluationshouldbeconsideredwhensubmucosalinvasionhasbeendeterminedbypathology.

Keywords:linearendoscopicultrasound,radialendoscopicultrasound,whitelightendoscopy,earlygastriccancer,submucosalinvasioInthediagnosisandstagingofearlygastriccancer,accuratedetectionofsubmucosalinvasioniscrucialfordecidingtheappropriatetreatmentstrategy.Traditionaldiagnosticmethods,suchaswhitelightendoscopyandbiopsy,havelimitationsinassessingthedepthofinvasion.Inrecentyears,endoscopicultrasound(EUS)hasemergedasapromisingtoolforpreoperativeevaluationofgastriccancer.

Linearendoscopicultrasound(L-EUS)andradialendoscopicultrasound(R-EUS)aretwotypesofEUScommonlyusedforgastriccancerstaging.SeveralstudieshavecomparedthediagnosticaccuracyofL-EUSandR-EUSforearlygastriccancer.Overall,bothtechniqueshavehighaccuracyindetectingearlygastriccancer,withreportedsensitivityandspecificityratesofupto97%and100%,respectively.

However,therearedifferencesinthestrengthsandlimitationsofL-EUSandR-EUS.L-EUSprovidesbettervisualizationofthedepthofinvasion,particularlyforsubmucosalinvasion,whichisimportantfordecidingwhethertoperformendoscopicresectionorsurgery.Ontheotherhand,R-EUSisbetterforevaluatingtheshapeandextentofthetumor,includinglymphnodeinvolvement.

Inconclusion,bothL-EUSandR-EUSareimportanttoolsforpredictingsubmucosalinvasionofearlygastriccancer.Preoperativeultrasoundevaluationshouldbeconsideredwhensubmucosalinvasionhasbeendeterminedbypathology.FuturestudiesmayexploretheoptimalcombinationofL-EUSandR-EUSforgastriccancerstaging,andtheintegrationofendoscopicultrasoundwithotherimagingmodalities,suchascomputedtomography(CT)andmagneticresonanceimaging(MRI)Inaddition,therearelimitationstotheuseofEUSforgastriccancerstaging.OnechallengeisthevariabilityininterpretationofEUSimagesamongdifferentoperators,whichcanresultininterobservervariabilityandpotentialerrorsincancerstaging.Toaddressthisissue,standardizedtrainingandcertificationprogramsforEUSoperatorshavebeenproposedandimplementedinsomecountries,whichmayhelptoimprovetheaccuracyandconsistencyofEUSevaluations.

Anotherlimitationisthepotentialforfalsepositiveandfalsenegativeresults.Insomecases,EUSmaysuggestthepresenceofsubmucosalinvasion,whilesubsequentpathologicalexaminationmayrevealnoinvasionoronlyminimalinvasion.Conversely,EUSmayfailtodetectsubmucosalinvasioninsomecases,particularlywhenthetumorlocationorsizemakesvisualizationdifficult.SomestudieshavesuggestedthatcombiningEUSwithotherimagingmodalities,suchasCTandMRI,mayimproveaccuracyandreducetheriskoffalsepositiveandfalsenegativeresults.

Finally,itshouldbenotedthatEUSisaninvasiveprocedurethatcarriessomerisks,includingbleedingandperforation.Whiletheincidenceofseriousadverseeventsisrelativelylow,carefulconsiderationoftherisksandbenefitsofEUSshouldbetakenintoaccountwhendecidingwhethertoperformtheprocedure.

Overall,EUSisavaluabletoolforthepreoperativestagingofearlygastriccancer,particularlyfortheaccuratedeterminationofsubmucosalinvasion.WhiletherearesomelimitationsandpotentialrisksassociatedwithEUS,thesecanbeaddressedthroughstandardizedtrainingandcertification,combinedwithcarefulconsiderationoftheindividualpatient'sclinicalsituation.OngoingresearchwillcontinuetorefineandimprovetheuseofEUSforgastriccancerstaging,ultimatelyleadingtobetteroutcomesforpatientsInadditiontoendoscopicultrasound(EUS),otherimagingmodalitieshavealsobeenusedforpreoperativestagingofearlygastriccancer,suchascomputedtomography(CT)andmagneticresonanceimaging(MRI).However,theaccuracyofthesetechniquesfordeterminingsubmucosalinvasionhasbeenshowntobelowercomparedtoEUS.

OneofthelimitationsofEUSisthepotentialforoperator-dependentvariability,whichcanaffecttheaccuracyandreliabilityoftheresults.Therefore,standardizedtrainingandcertificationprogramshavebeendevelopedtoensurethatoperatorsareproficientinperformingEUSandinterpretingtheimages.Moreover,theuseofanexperiencedanddedicatedEUSteamwithahighvolumeofcaseshasbeenshowntoimprovetheaccuracyofEUSstagingforgastriccancer.

AnotherpotentialriskassociatedwithEUSisthepossibilityofcomplications,suchasbleedingorperforation,whichmayoccurduringtheexamination.However,theincidenceofthesecomplicationsisgenerallylow,andcanbeminimizedthroughproperpatientselectionandcarefultechnique.Inaddition,thebenefitsofaccuratestagingusingEUSfaroutweighthepotentialrisks.

Oneemergingareaofresearchistheuseofadvancedimagingtechniques,suchascontrast-enhancedEUSandelastography,whichmayfurtherimprovetheaccuracyofEUSforgastriccancerstaging.Contrast-enhancedEUSinvolvestheadministrationofcontrastagentstoenhancethevisualizationofbloodvesselsandlymphnodes,whileelastographyusesultrasoundwavestoevaluatetissuestiffness,whichcanbeanindicatorofmalignancy.

Insummary,EUSisavaluabletoolforthepreoperativestagingofearlygastriccancer,particularlyfortheaccuratedeterminationofsubmucosalinvasion.Despitesomelimitationsandpotentialrisks,theuseofstandardizedtrainingandcertificatio