| Objective1.To discuss the valuable of endoscopic ultrasonography in gastrointestinal submucosal diagnostic uplift.2.Through the analysis of the causes of misdiagnosis, further control of upper gastrint- estinal submucosal lesions of the ultrasonic characteristics and for the correct diagnosis of endoscopic ultrasound diagnosis.Meterials and methods1.The first part selected from January 2007 to January 2011 at the Jinan Military Ge- neral Hospital, the 1022 cases of Endoscopic Ultrasonography submucosal protunberant l- nesions in patients, male patients with 522 cases, 500 cases of female patients, aged 14 to 83 years old , average age of 52.1 .Retrospective analysis of the echo characteristics of su- bmucosal lesions of the disease spectrum, common lesions such as image features and lev- els.2.The second part of the selection in January 2007 to 2011 a period of Jinan Military General Hospital of EUS diagnosis of submucosal protuberant lesions, and received a total of 234 cases of pathology. 130 patients were male, 124 cases of female, aged 17 to 83 yea- rs old, mean age was 51.2 years. Retrospective analysis of endoscopic ultrasonography on the diagnosis rate of submucosal lesions, and analyse misjudgment reasons.Results1.Spectrum of disease: 1022 cases of submucosal lesions, EUS diagnosis of stromal tumor 419 cases, 296 cases of leiomyoma, malignant tumor in 35 cases, 95 cases of ectopic pancreas, the wall outside the oppression of 81 cases, inflammation in 38 cases, fat tumors in 26 cases, 15 cases of venous aneurysms, cysts in 12 cases, 7 cases of duodenal papilla vice. 2.Disease distribution: 1022 cases of submucosal lesions, 452 cases of esophageal or- igin, including the esophagus 119 cases, 218 cases of middle and lower section of 115 ca- ses; originated in the stomach 478 cases, of which 159 cases of fundus, antrum 177 cases, gastric body 123, the junction of the end of the body in 12 cases, 9 cases of gastric angle; originated in the duodenum and cardia are 57 cases and 35 cases. Ultrasonic level where 486 cases originated in the muscularis mucosa, submucosa 101 cases, 332 cases muscul- arispropria, foreign film in 22 cases.3.Acoustic features: stromal tumors appeared as hypoechoic; 143 cases originated in the muscularis mucosa, submucosa in 29 cases, 243 cases of muscularis propria, foreign fi- lm in 3 cases. Smooth muscle tumors appeared as hypoechoic; 196 cases originated in the mucosa, submucosa in 27 cases, 90 cases of muscularis propria, foreign film in 3 cases. 22 cases of malignant tumor are hypoechoic, hyperechoic in 3 cases, 10 cases of mixed echo; originated in the muscularis mucosa in 11 cases, 2 cases of the submucosa, muscularis pro- pria in 4 cases, 16 cases of foreign films. Ectopic pancreas are hypoechoic in 18 cases, hy- perechoic in 58 cases, 19 cases of mixed echo; 66 cases originated in the muscularis muco- sa, submucosa in 29 cases. Inflammation is hypoechoic in 15 cases, hyperechoic 23; ori- ginated in the muscularis mucosa in 28 cases, the submucosa in 10 cases. Lipomas are h- ypoechoic in 1 case, high echo 25; originated in the muscularis mucosa in 21 cases, four c- ases of the submucosa, muscularis propria in 1. 15 cases of venous aneurysm are low echo in 4 cases, hyperechoic in 2 cases, no echo 9; originated in the muscularis mucosa in 12 ca- ses, the submucosa in 3 cases. Showed a hypoechoic cyst in 1 case, no echo in 11 cases; 11 cases originated in the muscularis mucosa, submucosa, in 1 case. Wall outside the oppre- ssion of 28 cases of esophageal lesions, 50 cases of stomach, duodenum in 3 cases. Due to vascular compression in 6 cases, the wall outside the tumor in 9 cases, spleen in 21 cases, gallbladder, 25 cases of pancreatic cysts in 5 cases, no abnormality in 15 cases.4.Endoscopic ultrasound and pathology consistent rate: access to the pathological ca- ses of 254 cases, 207 cases ultrasound diagnosis and pathologic diagnosis consistent, the r- ate was 81.5%. Inflammation, the diagnosis of malignancy was 100% correct. Ectopic pan- creas, leiomyoma, lipoma, stromal tumor diagnostic accuracy is 81.0%, 88.1%, 83.3% and 47.6%. Pathological classification of dangerous invasion of stromal tumor of 16 cases, including 10 cases of low invasive, moderately invasive of 6 cases. Endoscopic ultrasonog- raphy for the diagnosis of 11 cases of invasive low, moderate, invasive of 5 cases, diagnos- is was 93.8% (k = 0.76). 5.Misdiagnosed reasons: There are not soaked in water or ultrasonic probes without contact with the mucosa by gas disturbances affect image quality; select the frequency of endoscopic ultrasonography probe is too high or too low, the impact of the diagnostic sens- itivity and specificity; gastrointestinal tract creep in a constant state of normal structure of the transient misdiagnosed as submucosal lesions.Conclusion1.Endoscopic ultrasound diagnosis of upper gastrointestinal submucosal lesions in order to uplift the most common stromal tumor.2.Uplift of upper gastrointestinal mucosal lesions in the lower part of the stomach is most common,and up to the antrum. Esophagus to esophageal disease is most common.O- rigin of the most common level of the muscularis mucosa, followed by the submucosa, mu- scularis propria and foreign film.3.Leiomyoma to the muscularis mucosa are the most common stromal tumor to the m- uscularis propria are the most common appeared as hypoechoic; fatty tumor found in up to the muscularis mucosa,is hyperechoic; ectopic pancreas more common in the muscularis mucosa, can be expressed high, low and mixed echo; cancer discovered more serosal inva- sion, mostly for low-echo and hybrid echo, internal echo uneven, lesions generally greater than 2cm, many accompanied by surface erosion; vein tumor and cyst mucosa muscle is most common, are no echo echo-based; wall outside the uplift of the most common lesions in the stomach, the low echo-based.4.Endoscopic ultrasonography of malignant stromal tumor invasion and tumor grade classification of risk compared to judge the results, with good consistency;5.Stromal tumors and leiomyomas similar to endoscopic ultrasound, needing the pathological to distinguish.6.The most misdiagnosed cases are in the esophagus and the antrum.Comparison of endoscopic ultrasonography and pathological diagnosis rate in line with the highest rate of inflammation and malignant tumors.7.Common causes of misdiagnosis is not for the ultrasound probe is immersed in wa- ter or by contact with the mucosa of gas interference, affect the image quality; select the fr- equency probe EUS inappropriate affect the diagnostic sensitivity and specificity and so o- n. |
PDF Full Text Request