| Objective: To analyze the imaging characteristics and diagnostic results of gastric neuroendocrine neoplasms(G-NENs)under ultrasound endoscope(EUS)and enhanced computed tomography(CT),to explore the diagnostic value of EUS and enhanced CT for G-NENs.Methods: The clinicopathological and imaging features of patients with G-NENs confirmed by histopathological biopsy admitted to the Second Hospital of Lanzhou University from January 2012 to July 2022 were retrospectively collected.Gastrointestinal stromal tumor(GIST)was selected as the control group,and the clinical and imaging features of patients with G-NENs and GIST were compared.According to different pathological grades,G-NENs can be divided into the gastric neuroendocrine tumor(G-NET)and gastric neuroendocrine carcinoma(G-NEC)/mixed neuroendocrine-non-neuroendocrine neoplasms(Mi NENs),the clinical and imaging characteristics of patients with G-NET and G-NEC/Mi NENs were compared.The differential imaging features between the two groups(P < 0.05)were included in Binary Logistic Analysis to determine the independent identification factors of G-NENs and GIST,G-NET,and G-NEC/Mi NENs.Using histopathological results as the diagnostic gold standard,comparing the consistency rate of T-stage and N-stage diagnosis of G-NENs lesions by EUS,enhanced CT and histopathology,and the detection rate and accuracy of G-NENs lesions were analyzed.Results:1.Patient characteristics:(1)After the screening,a total of 145 G-NENs patients were included in the study,including 42 patients who underwent EUS examination,139 patients who underwent enhanced CT examination,and 36 patients who underwent both;A total of 130 GIST patients were included in the control group,including 87 patients who underwent EUS examination,117 patients who underwent enhanced CT examination,and 74 patients who underwent both.(2)The average age of onset of GNENs and GIST patients was(58.02 ± 9.68)years old and(55.07 ± 11.59)years old,respectively.The incidence of male patients in the G-NENs group was significantly higher than that in the GIST group(76.5% vs 46.9%).Non-specific symptoms such as abdominal pain,bloating,dysphagia,and black stools were the main symptoms in both groups,but dysphagia was more likely to occur in G-NENs patients,while the incidence of black stools and acid reflux were higher in GIST patients(P < 0.05).(3)The average age of onset of G-NET and G-NEC/Mi NENs patients was(53.40 ± 10.11)years old and(60.64 ± 8.39)years old,respectively.The incidence of male patients in the GNEC/Mi NENs group was significantly higher than that in the G-NET group(91.5% vs50.0%).In terms of clinical manifestations,G-NET is more easily detected by physical examination,and the incidence of abdominal pain and dysphagia in G-NEC/Mi NENs patients was significantly higher than that in G-NET patients(P < 0.05).2.EUS imaging features:(1)The median lesion size of G-NENs was 12.0(7.4,17.0)mm,and most lesions were single(56.1%),non-smooth(85.4%),regular(56.1%),lesions with clear boundary(51.2%),uneven(73.2%),low-echo(90.2%)lesions originating from mucosal lamina propria(46.3%)or submucosal layer(31.7%),the incidence rates of ulcer,calcification,and cystic lesions were 41.5%,17.1%,and 46.3%,respectively.The median lesion size of GIST was 26.3(16.7,36.8)mm,GIST mainly showed single(92.0%),smooth(65.5%),regular(73.6%),clear border(88.5%),lowecho(98.9%)lesions originating from muscle proper(88.5%),and non-uniform(52.9%)internal echoes,the incidence rates of ulcer,calcification and cystic lesions were 19.5%,8.4%,and 25.3%,respectively.(2)Comparison between G-NENs and GIST showed that the lesion site,size,number,appearance,shape,boundary,level of origin,echo intensity,uniformity,ulcer,and cystic lesions were effective differentiating factors(P< 0.05).(3)Compared with G-NET,the lesion size of G-NEC/Mi NENs was larger(21.0mm vs 10.2 mm),the morphology was more irregular(87.5% vs 34.4%),and the origin was deeper.Whereas,there were no significant differences in the number of lesions,appearance,boundary,echo level,echo uniformity,the incidence of ulcer,calcification,and cystic lesions between the two groups(P > 0.05).3.Enhanced CT imaging features: G-NENs easily developed in the upper 1/3 of the stomach(38.8%),and the median lesion size was 20.08(14.45,31.85)mm.Most of the lesions showed irregular shape(69.4%),unclear boundary(51.2%),uniform density(69.4%),and moderate(41.3%)or severe enhancement(50.4%).The incidence of ulcer,calcification,and tumor vascular shadow was 51.2%,8.3%,and 48.8%,respectively.GIST easily developed in the middle 1/3 of the stomach(43.6%),and the median lesion size is 37.20(25.50,55.10)mm.It mostly presents with a regular shape(88.9%),clear boundary(80.3%),uniform density(52.1%),and mainly nodular and elevated lesions(95.7%)with moderate enhancement(68.4%).The incidence of ulcer,calcification,and tumor vascular shadow was 33.3%,10.3%,and 37.6%,respectively.(2)Comparison between G-NENs and GIST showed that the location,size,shape,boundary,density,degree of enhancement,ulceration,and growth type of lesions were effective indicators for distinguishing G-NENs from GIST.Multivariate Logistic analysis showed that lesion size,enhancement mode,ulcer,and lesion growth type were independent distinguishing factors between G-NENs and GIST(P < 0.05).(3)Compared to G-NET,G-NEC/Mi NENs lesions were larger in diameter(29.19 mm vs13.90mm),have a higher proportion of irregular in shape(78.3% vs 39.3%),unclear in boundary(56.5% vs 32.1%),and more non-uniform in density(73.9% vs 53.6%),moderate and severe enhancement(93.5% vs 85.7%),ulcer(56.5% vs 32.1%),tumor vascular shadow(54.3% vs 28.6%),lymph node metastasis(87.0% vs 25.0%),and larger T stage of the lesion.They were more likely to show diffuse thickening of the gastric wall(82.6% vs 39.3%),but there was no significant difference in the incidence of calcification and distant metastasis between the two groups(P > 0.05).Multivariate Logistic analysis showed that lesion size,tumor vascular shadow,and tumor T stage were independent distinguishing factors between G-NET and G-NEC/Mi NENs.4.The consistency rates of preoperative EUS,enhanced CT and postoperative pathological examination were 96.7% and 70.2% for the T stage,90.0% and 87.6% for the N stage.The detection rate of G-NENs lesions was 97.6% and 87.1%,and the accuracy rate was 33.3% and 2.9%,respectively.Comparison between groups showed that the diagnostic agreement rate of preoperative and postoperative pathological T stages and lesion detection rate by EUS were higher than those in enhanced CT(P <0.05),but there was no statistical significance in the diagnostic agreement rate between preoperative and postoperative pathological N stages and lesion detection rate by EUS(P > 0.05).Conclusions: The clinicopathological and imaging features of G-NENs and GIST,G-NET,and G-NEC/Mi NENs were different,and tumor size and enhancement pattern were effective indicators for identification between groups.The diagnostic accuracy of G-NENs and the evaluation value of preoperative T staging by EUS were stronger than those by enhanced CT,but there was no significant difference between the two groups in the lesion detection rate of G-NENs and the evaluation of preoperative N staging. |
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