超声内镜在贲门部平滑肌瘤和胃肠道间质瘤鉴别诊断中的意义

Significance of Ultrasound Endoscopy in the Differential Diagnosis of Cardiac Leiomyomas and Gastrointestinal Stromal Tumors

摘要: 背景和目的：贲门处上皮下肿物(SLE)主要为平滑肌瘤和胃肠道间质瘤(GIST)，两者临床预后截然不同，前者为良性肿物，可进行随访观察，后者具有潜在恶性，需要内镜下切除。贲门处病变术后具有并发胃食管反流和狭窄的风险，因此该部位的术前评估更应谨慎以避免不必要的损害。超声内镜(EUS)对SLE的术前诊断具有重要价值，本研究的目的是分析贲门部SLE的超声内镜下特征与病理结果的对应关系，以达到术前鉴别诊断平滑肌瘤和GIST，为病患提供个体化诊疗意见(切除或随访)的目的。材料和方法：本研究纳入了2017年1月至2021年11月于青岛大学附属医院住院行内镜下贲门肿物切除术且术后病理示平滑肌瘤和GIST的患者。定量资料使用t检验进行分析，分类变量使用fisher确切概率法进行分析比较差异。P < 0.05认为差异有统计学意义。结果：本研究共纳入6例GIST和30例平滑肌瘤，对肿物的基线资料、肿物的大小、形态、起源层次、生长模式、内部回声、内镜下血流信号影和弹性成像进行分析，肿物形态(P = 0.024)及超声内镜下内部回声(P = 0.003)差异具有统计学意义。对形态及内部回声进行综合分析，内部回声对平滑肌瘤和GIST的鉴别诊断价值更高。结论：超声内镜检查可对贲门部平滑肌瘤及GIST进行鉴别诊断，肿物形态为广基形及内部低回声，尤其是低回声，提示平滑肌瘤可能性大。超声内镜检查是贲门肿物的术前鉴别诊断的一种有效、安全、可靠的方法。

Abstract: Background & Purpose: The main subepithelial leisons (SEL) at the cardia are leiomyomas and gas-trointestinal stromal tumors (GIST), both of which have a different clinical prognosis, with the for-mer being benign and allowed to be followed up, and the latter being potentially malignant and re-quiring endoscopic resection. Because of the risk of postoperative gastroesophageal reflux and ste-nosis at the cardia, preoperative evaluation of this area should be more cautious to avoid unneces-sary damage. Ultrasound endoscopy (EUS) is valuable for the preoperative diagnosis of SLE. This study aimed to analyze the relationship between the characteristics under EUS and pathological findings of SLE in the cardia, to achieve the preoperative differential diagnosis of leiomyomas and GIST, and to provide patients with individualized treatment advice (resection or follow-up). Materi-als and Methods: We included patients hospitalized in the Affiliated Hospital of Qingdao University from January 2017 to November 2021 for endoscopic resection of the cardiac mass with postopera-tive pathology showing leiomyomas and GIST. Quantitative data were analyzed using the t-test, and categorical variables were analyzed using the Fisher exact probability method to compare differ-ences. P < 0.05 was considered statistically significant. Results: There were 6 cases of GIST and 30 cases of leiomyomas included in this study. We analyzed the baseline data, size, morphology, level of origin, growth pattern, internal echogenicity, endoscopic blood flow signal image, and flexibility imaging, the differences in the shape of the mass (P = 0.024) and ultrasonographic endoscopic in-ternal echogenicity (P = 0.003) were statistically significant. A comprehensive assessment of shape and internal echogenicity showed that internal echogenicity had a higher value in the differential diagnosis of leiomyomas and GIST. Conclusion: Ultrasound endoscopy can be performed to differen-tiate between leiomyomas and GIST in the cardia. Broad-based shape and internal hypoechogenici-ty, especially hypoechogenicity, suggest a high probability of leiomyomas. Ultrasound endoscopy may provide an effective, safe, and reliable method for the preoperative differential diagnosis of cardiac masses.