摘要
AIM： To evaluate the value of endoscopic ultrasono- graphy （EUS） in the preoperative TNM staging of gastric cancer. METHODS ： Forty-one patients with gastric cancer （12 early stage and 29 advanced stage） proved by esophagogastroduodenoscopy and biopsies preoperatively evaluated with EUS according to TNM （1997） classification of International Union Contrele Cancer （UICC）. Pentax EG-3630U/Hitachi EUB-525 echo endoscope with real-time ultrasound imaging linear scanning transducers （7.5 and 5.0 MHz） and Doppler information was used in the current study. EUS staging procedures for tumor depth of invasion （T stage） were performed according to the widely accepted five-layer structure of the gastric wall. All patients underwent surgery. Diagnostic accuracy of EUS for TNM staging of gastric cancer was determined by comparing preoperative EUS with subsequent postoperative histopathologic findings. RESULTS： The overall diagnostic accuracy of EUS in preoperative determination of cancer depth of invasion was 68.3% （41/28） and 83.3% （12/10）, 60% （20/12）, 100% （5/5）, 25% （4/1） for T1, T2, T3, and T4, respectively. The rates for overstaging and understaging were 24.4% （41110）, and 7.3% （4113）, respectively. EUS tended to overstage T criteria, and main reasons for overstaging were thickening of the gastric wall due to perifocal inflammatory change, and absence of serosal layer in certain areas of the stomach. The diagnostic accuracy of metastatic lymph node involvement or N staging of EUS was 100% （17/17） for NO and 41.7% （24/10） for N＋, respectively, and 66% （41127） overall.Misdiagnosing of the metastatic lymph nodes was related to the difficulty of distinguishing inflammatory lymph nodes from malignant lymph nodes, which imitate similar echo features. Predominant location and distribution of tumors in the stomach were in the antrum （20 patients）, and the lesser curvature （17 patients）, respectively. Three cases were found as surgically unresectable （T4 N＋）, and included as being correctly diagnosed by EUS. CONCLUSION： EUS is a useful diagnostic method for preoperative staging of gastric cancer for T and N criteria. However, EUS evaluation of malignant lymph nodes is still unsatisfactory.
瞄准：在胃的癌症的外科手术前的 TNM 阶段评估内视镜的 ultrasonography (EUS ) 的价值。方法：有胃的癌症(12 早阶段和 29 晚期) 的 41 个病人由外科手术前地根据国际联合 Contrele 癌症(UICC ) 的 TNM (1997 ) 分类与 EUS 评估的 esophagogastroduodenoscopy 和活体检视证明了。有即时超声成像的 Pentax EG-3630U/Hitachi EUB-525 回响内诊镜线性扫描变换器(7.5 和 5.0 MHz ) 和 Doppler 信息在当前的学习被使用。为侵略(T 阶段) 的肿瘤深度的 EUS 阶段过程根据胃的墙的广泛地接受的五层的结构被执行。所有病人经历了外科。为胃的癌症的 TNM 阶段的 EUS 的诊断精确性被把外科手术前的 EUS 与随后的手术后的组织病理学说的调查结果作比较决定。结果：在侵略的癌症深度的外科手术前的决心的 EUS 的全面诊断精确性是 68.3%(41/28 ) 并且 83.3%(12/10 ) ， 60%(20/12 ) ， 100%(5/5 ) ， 25%(4/1 ) 为 T1， T2， T3，和 T4 分别地。为 overs 标注并且 unders 标注的率是 24.4%(41/10 ) ，并且 7.3%(41/3 ) 分别地。EUS 趋于到在阶段 T 标准，和 main 上，为标注的 overs 的原因由于仙子胃的墙正在变厚在胃的某些区域的 serosal 层的焦点的煽动性的变化，和缺席。变形淋巴节点参与的诊断精确性或 EUS 的 N 阶段为 N0 是 100%(17/17 ) 并且 41.7%(24/10 ) 为 N+ ，分别地并且 66%(41/27 ) 外套。变形淋巴结误诊与把煽动性的淋巴节点与恶意的淋巴节点区分开来的困难有关，它模仿类似的回响特征。在胃的肿瘤的占优势的地点和分发在窦(20 个病人) ，并且更小的弯曲(17 个病人) 分别地。三个盒子是被发现通过手术 unresectable (T4 N+) ，并且当是正确地由 EUS 诊断了，包括了。结论：EUS 是为为 T 和 N 标准的胃的癌症的外科手术前的阶段的一个有用诊断方法。然而，恶意的淋巴节点的 EUS 评估仍然是不能令人满意的。
