| Objective: Gastric stromal tumor(GST)has a potential malignant tendency.The pathological diagnosis of lesions with different risk levels has different treatment strategies.Early diagnosis and early surgical treatment play a decisive role in improving the prognosis of patients.The purpose of this paper is to discuss endoscopic ultrasonography(EUS)and multislice computed tomography(MSCT)value to the diagnosis of GST and dangerous degree of predictive value.And the evaluation of EUS and MSCT to guide GST surgical treatment.Methods: According to the inclusion and exclusion criteria,110 patients in the Department of Gastroenterology and gastrointestinal surgery of the First Affiliated Hospital of Inner Mongolia Medical University from December 2015 to December 2020 were screened.All patients were improved with EUS and MSCT before operation,and the postoperative pathological diagnosis was GST.The clinical data of the patients were analyzed retrospectively.The coincidence between the qualitative diagnosis of GST by EUS and MSCT before operation and the pathological diagnosis after operation was analyzed.Analyze the image characteristics and related parameters of patients in low-risk group and medium and high-risk group under EUS and MSCT,and judge the diagnostic value of EUS and MSCT for GST with different risk levels.Finally,the operation and postoperative follow-up data of patients were collected to evaluate the guiding significance of EUS and MSCT in the operation of gastric stromal tumor.Results: 1.General data of patients showed that there were 62 males and 48 females in the110 GST patients,with an average age of 57.1±9.74 years old,and an average tumor diameter of 2.76±1.55 cm.The lesion sites were 75.5% of gastric body,19.1% of gastric fundus and5.45% of gastric antrum.There were no significant differences in gender,age and lesion site between the low-risk group and the medium-high risk group(P > 0.05),and the tumor diameter of the medium-high risk group was significantly larger than that of the low-risk group(P<0.05);2.The diagnostic coincidence rates of EUS,MSCT and EUS combined with MSCT were 81.8%,70.0% and 90.0%(P<0.05),respectively,pairwise comparison among the three groups showed that the EUS group was higher than the MSCT group,and the combined group was slightly higher than the EUS group,with no statistical significance(P>0.05).The combined group was significantly higher than MSCT group(P < 0.05);3.EUS imaging showed that the tumor diameter,the ratio of cystic lesions,the ratio of surface ulcers,the ratio of liquefaction necrosis,the ratio of irregular boundary and the ratio of uneven echo in the medium-high risk group were significantly higher than those in the low-risk group(P<0.05),and the diameter was an independent risk factor for higher risk of GST.EUS diagnosis of GST with a diameter of 2.9cm was more likely to suggest moderate to high risk GST,with sensitivity of 75.80% and specificity of 88.6%;4.MSCT imaging showed that the tumor diameter,uneven density,blurred boundary,uneven enhancement,intratumor vascular shadow and extra-luminal growth ratio in the medium-high risk group were higher than those in the low-risk group,and the differences were statistically significant(P<0.05).Further analysis showed that the tumor diameter and uneven enhancement were independent risk factors with higher risk degree of GST.When the diameter of GST was 2.9cm,MSCT was more likely to suggest moderate to high risk GST,with sensitivity of 75.8% and specificity of 86.8%.3.EUS imaging showed that the tumor diameter,the ratio of cystic lesions,the ratio of surface ulcers,the ratio of liquefaction necrosis,the ratio of irregular boundary and the ratio of uneven echo in the medium-high risk group were significantly higher than those in the low-risk group(P<0.05),and the diameter was an independent risk factor for higher risk of GST.EUS diagnosis of GST with a diameter of 2.95 cm was more likely to suggest moderate to high risk GST,with sensitivity of 75.80% and specificity of 88.6%;5.Compared with EUS alone or MSCT,EUS combined with MSCT had the highest sensitivity(80.6%)and accuracy(82.4%),and specificity(83.8%)was similar to that of MSCT alone,with no statistical significance(P>0.05);6.There was no significant difference in the overall incidence of postoperative complications between endoscopic treatment group and laparoscopic treatment group(P >0.05),but the average postoperative hospital stay(5.6±2.2d)in endoscopic treatment group was significantly shorter than that in laparoscopic treatment group(7.6±2.5d)(P<0.05);Conclusion: 1.EUS and MSCT have high diagnostic value for gastric stromal tumor.The combination of EUS and MSCT can improve the diagnostic rate of gastric stromal tumor and better predict the risk degree of GST;2.The diameter,surface ulcer,irregular boundary,cystic degeneration,liquefaction necrosis and uneven echo of GST under EUS were closely related to the risk degree(P<0.05).The diameter of tumor was an independent risk factor of GST with medium and high risk degree;3.Under MSCT,the diameter,uneven density,blurred boundary,uneven enhancement,intratumor vascular shadow and extravitary growth of GST were closely correlated with the risk degree(P < 0.05).Tumor diameter and uneven enhancement were independent risk factors of medium and high risk GST;4.EUS and MSCT can effectively guide the selection of surgical treatment modalities for GST,and endoscopic surgery is safe and effective in the short term. |
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