Research On The Value Of Microprobe Endoscopic Ultrasonography In The Diagnosis Of Gastrointestinal Neuroendocrine Tumors And Assessment Of The Depth Of The Lesions

Objective:To investigate the value of miniprobe endoscopic ultrasonography in the diagnosis of gastrointestinal neuroendocrine tumors(GI-NENS)and the evaluation of their depth of involvement,and to analyze the related factors affecting the diagnostic accuracy of miniprobe endoscopic ultrasonography(m EUS).Methods:We retrospectively collected patients who were referred to the First Affiliated Hospital of Nanchang University from January 2007 to October 2021 and were proposed to be diagnosed with neuroendocrine tumors after undergoing gastroenteroscopy,and in view of the limitations of gastroenteroscopy,we did not include patients with small intestinal neuroendocrine tumors in this study,while excluding cases in which no microprobe endosonography was done,pathological diagnosis was unknown,data were incomplete,and duplicate cases.For each patient,the clinical characteristics,conventional endoscopic data,and miniprobe endoscopic ultrasonography data of lesions were statistically compared,and the consistency between the diagnostic results of miniprobe endoscopic ultrasonography and the pathological diagnostic results were compared,and the accuracy of miniprobe endoscopic ultrasonography for the diagnosis of lesion depth was further analyzed.Statistical analysis of data through SPSS 24.0 software,the statistical method used chi square test,and used logistics regression analysis and other related factors affecting their diagnosis,P < 0.05 statistically significant.Results:Study cases after the enrollment screening,480 patients were finally included as study subjects,and the diagnostic results of miniprobe endoscopic ultrasonography diagnosis of gastrointestinal neuroendocrine tumors with the same pathological diagnosis were 386 cases(80.4%),of which the most common was rectal neuroendocrine tumors,accounting for 78.5%(303/386),followed by duodenum,stomach,colon and esophagus in that order;Tumours with a tumour size of 10-20mm(61.4%)and G1 grade were frequent(96.6%);The tumors were mostly located in the submucosa(94.3%).There were a total of 91 lesions that were incorrectly diagnosed by miniprobe endoscopic ultrasonography in this study,among which 12 gastrointestinal neuroendocrine tumors were misdiagnosed as other lesions but were pathologically confirmed as gastrointestinal neuroendocrine tumors,and another 79 were considered gastrointestinal neuroendocrine tumors by miniprobe endoscopic ultrasonography but were pathologically confirmed as lesions of non-gastrointestinal neuroendocrine tumors(15 polypoid lesions,14 inflammatory lesions,and 9 ectopic pancreas,etc.).The overall diagnostic accuracy of miniprobe endoscopic ultrasonography was 81.0%(389/480),sensitivity 97.0%(386/398),specificity 3.7%(3/82),positive predictive value 83.0(386/465),negative predictive value 20%(3/15).However,for the lesion depth assessment of gastrointestinal neuroendocrine tumors,the diagnostic accuracy of miniprobe endoscopic ultrasonography was 87.3%(337/386),in which the diagnostic accuracy for gastrointestinal neuroendocrine tumors involving the submucosa was 86.0%(332/386),sensitivity was 95.4%(332/348),specificity was 15.8%(6/38),positive predictive value and negative predictive value were 91.2%(332/364)and 27.3%(16/22),respectively.Multivariate logistic regression analysis indicated that tumor size and homogeneity of echogenicity were independent correlates of lesion depth diagnosed by miniprobe endoscopic ultrasonography,and the diagnostic accuracy of lesion depth of gastrointestinal neuroendocrine tumors was high in tumor size 10-20mm(OR 2.878,95% CI 1.411-5.870;P=0.004)and homogeneous echogenicity(OR 0.250,95% CI 0.096-0.655;P=0.005).Conclusion:Miniprobe endoscopic ultrasonography has a better diagnostic accuracy in the diagnosis of gastrointestinal neuroendocrine tumors,and it has a high diagnostic accuracy for the deep diagnosis of tumors with a tumor size of 10-20 mm,which contributes to the choice of treatment options.However,the overall specificity of miniprobe endoscopic ultrasonography is poor,and it is sometimes difficult to differentiate from other gastrointestinal lesions,in addition,because of the limited ability of miniprobe endoscopic ultrasonography penetration and the poor diagnostic ability for lymphatic vascular metastasis,it needs to combine other imaging examination or ultrasound endoscopic guided biopsy to improve the ability of miniprobe endoscopic ultrasonography diagnosis and evaluation.