| Objective:Considering low diagnosis rate of primary gastric lymphoma(PGL)under endoscope,this study aims to improve understanding of the endoscopic performance for PGL through analyzing the endoscopic and pathologic data of suspected PGL diagnosed by pathology and endoscope in multiple centers of Shandong,and to reduce the rate of misdiagnosis and missed diagnosis and increase preoperative diagnosis rate for PGL.Methods:The endoscopic and pathologic data of non-suspected PGL diagnosed by gastroscopy,suspected PGL diagnosed by endoscopy and gastric lymphoma or non-gastric lymphoma diagnosed by pathology were selected from 8 hospitals in Shandong(including Qilu Hospital of Shandong University,Linyi People's Hospital,Binzhou People's Hospital,the First People's Hospital of Zibo,Weihai Municipal Hospital,Heze Municiple Hospital,the First People's Hospital of Jining and Liaocheng People's Hospital)between June 2008 and March 2015 as subject for retrospective analysis.A total of 282 patients were included in this study including 112 patients without suspected PGL under endoscope(called endoscopic non-suspected group)and 70 patients with suspected PGL under endoscope or with confirmed PGL or non-PGL by pathology(called endoscopic suspected group).The endoscopic performance of PGL patients in each group was compared,and the correlations between different endoscopic characteristics and confirmed PGL were analyzed.Results:1.Among the included 282 patients,the main pathologic type of pathology confirmed patients was non-Hodgkin lymphoma,with diffuse large B-cell lymphoma accounting for about 50%;T-cell lymphoma was few;plasmacytic lymphoma and mantle-cell lymphoma were rare.2.Comparison between the endoscopic non-suspected group and the endoscopic suspected group revealed that the median age of onset was similar,and that endoscopic lesions showed malignant syndrome with hemorrhage of digestive tract was more inclined to the diagnosis of PGL.3.Comparison of endoscopic characteristics between the two groups demonstrated that single lesions occupied a dominant role,mainly seen in the gastric body and the gastric antrum.As for the patients with diffuse lesions or single lesions located in the gastric antrum or the gastric angle,the diagnosis rate for PGL by pathology increased.4.The endoscopic lesion types of the two groups basically include dulcer type,infiltrative type,mass type and large folds of mucous membrane type.Ulcer type was mainly detected in both non-suspected group and suspected group(58.9%vs.39.4%),which was followed by mass type(26.8%vs.24.1%).Data analysis showed that ulcer type lesions.especially giant ulcer,was more inclined to the diagnosis of PGL;while gastroscopic infiltrative type lesions and large folds of mucous membrane type lesions had a decreased diagnosis rate of PGL.5.The texture analysis results of endoscopic lesions revealed that hard ones increased the tendency of pathology diagnosed PGL.No differences were found in soft ones,tough ones or brittle ones.6.Patients with lymphoma of mucosa-associated lymphoid tissue(MALT)had a higher positive rate of Helicobacter Pylori(Hp)infection;while patients with diffuse large B-cell lymphoma had a lower Hp detection rate.Conclusion:The main pathologic type of PGL is B-cell type,and the diffuse large B-cell lymphoma is the most common.Age peak for the onset of PGL ranges from 40 to 49 years old.Most endoscopic lesions are single,mainly located at the gastric antrum and the gastric body;endoscopic lesions show four different morphologies including ulcer type,infiltrative type,mass type and large folds of mucous membrane type,and the ulcer type occupies a dominant role.In addition,MALT lymphoma is obviously correlated to Hp infection.Endoscopy has a low diagnosis rate for PGL,and improvement in its diagnosis rate is expected through multi-point,deep and repeated biopsy. |
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