超声内镜及图像分析技术在评估胃间质瘤危险度分级的临床价值

Clinical Value of Endoscopic Ultrasonography and Image Analysis Techniques in Assessing the Risk Grade of Gastric Stromal Tumors

摘要: 目的：探究超声内镜及图像分析技术在评估胃间质瘤危险度分级的临床价值。方法：收集2015年至2021年于青岛大学附属医院行手术或内镜下切除治疗的62例胃间质瘤患者。根据2008年NIH危险分级标准，将患者分为极低危组(n = 11例)、低危组(n = 29例)、中危组(n = 13例)、高危组(n = 9例)，分析各危险分层组胃间质瘤的超声内镜征象特点。应用Photoshop软件将超声内镜图像量化，以灰度平均值(回声强度)、灰度标准偏差(回声均匀度)表示，分析肿瘤直径、灰度平均值均值(Tmean)、灰度标准偏差平均值(TSD)在各危险分层组的差异，绘制受试者工作特征曲线(ROC)，评估三者评估胃间质瘤危险度分级的效能。结果：肿瘤内部液化、钙化、血流信号在GST危险度分组间差异有统计学意义(P < 0.05)。经二元logistic回归分析，肿瘤内部液化为GST危险度分级的独立危险因素(OR = 3.504, 95% CI = 1.087~11.299, P < 0.05)。GST的肿瘤直径、Tmean、TSD在不同危险分层间差异有统计学意义(P < 0.05)，极低危组、低危组、中危组的肿瘤直径、Tmean、TSD均小于高危组(P < 0.05)。以高危险分层为阳性结果绘制ROC曲线，当肿瘤直径 > 42.5 mm，Tmean > 17.3775，TSD > 8.0988，预测GST为高侵袭性风险的效能AUC值分别为0.872、0.769、0.885。结论：EUS对于术前评估GST的侵袭危险性具有较高的临床价值。肿瘤内部发生液化是评估GST危险分层的独立危险因素。肿瘤直径、图像分析技术(Tmean、TSD)作为区分GST高恶性潜能的重要指标，可更好地辅助EUS对GST的评估。

Abstract: Objective: To explore the clinical value of endoscopic ultrasonography and image analysis techniques in assessing the risk grade of gastric stromal tumors. Methods: A total of 62 patients with gastric stromal tumor who underwent surgery or endoscopic resection in the Affiliated Hospital of Qingdao University from 2015 to 2021 were collected. According to the 2008 NIH risk grading standard, the patients were divided into very low-risk group (n = 11), low-risk group (n = 29), intermediate-risk group (n = 13), and high-risk group (n = 9) to analyze the characteristics of endoscopic ultrasonography of gastric stromal tumors in each risk stratification group. The endoscopic ultrasound images were quantified by Photoshop software, expressed as gray mean (echo intensity), gray standard deviation (echo uniformity), and the differences of tumor diameter, gray mean mean (Tmean), and gray standard deviation mean (TSD) in each risk stratification group were analyzed, the receiver operating characteristic curve (ROC) was drawn, and the efficacy of the three to assess the risk classification of gastric stromal tumors was evaluated. Results: The liquefaction, calcification, and blood flow signals were significantly different among GST risk groups (P < 0.05). After binary logistic regression analysis, liquefaction was an independent risk factor to predicting the risk classification of GST (OR = 3.504, 95% CI = 1.087~11.299, P < 0.05). The tumor diameter, Tmean, and TSD of GST were significantly different among different risk stratifications (P < 0.05) and the tumor diameter, Tmean, and TSD in the very low-risk group, low-risk group, and intermediate-risk group were lower than those in the high-risk group (P < 0.05). The ROC curve was drawn with high risk stratification as the positive result. When tumor diameter > 42.5 mm, Tmean > 17.3775, TSD > 8.0988, the efficacy AUC values for predicting GST as high invasive risk were 0.872, 0.769, and 0.885, respectively. Conclusion: EUS has high clinical value for preoperative assessment of the invasive risk of GST. Liquefaction is an independent risk factor for assessing the risk stratification of GST. Tumor diameter and image analysis technology (Tmean, TSD), as important indicators to distinguish the high malignant potential of GST, can better assist EUS in the evaluation of GST.