| Objective To investigate the clinical significance of ultrasound endoscopy combined with elastic imaging in preoperative TNM stage of gastric carcinoma.It provides a basis for choosing reasonable preoperative staging method for gastric cancer patients,and thus provides a reference basis for the choice of clinical treatment plan for gastric cancer.Methods Collecting stomach from June 2014 to December 2017,diagnosed by gastroscopy and pathological biopsy Carcinoma,145 patients with gastric cancer who were hospitalized at the affiliated hospital of Nantong University,excluded those who had not undergone surgery,had surgery in the outer hospital,and had pathological symptoms of chronic ulcers after surgery.A total of 115 patients with gastric cancer were clearly diagnosed after surgery.A total of 96 cases were examined with EUS combined elastography and CT.According to the eighth edition of the gastric cancer staging standard formulated by the U.S.Cancer Joint Committee,thepostoperative pathology is used as the gold standard,using sensitivity,specificity and accuracy,and positiveprediction values.The negative prediction and Kappa values were used to evaluate the value of EUS combined elastography in preoperative staging of gastriccancer,and the results were compared with the accuracy of CT preoperative staging.Results 1.The total accuracy of EUS in the T stage of gastric cancer is 55.2 %,and the T1-T4 phase accuracy is respectively 89.6 %,83.3 %,71.9 %,65.6 %,sensitivity and specificity were 50.0 % and97.5 %,23.1 % and 96.3 %,13.6 % and 89.2 %,92.9 % and 44.4 %,the positive and negative predictions were 80.0 % and 90.7 %,50.0 % and85.6 %,27.3 % and 77.6 %,56.5 % and 88.9 %,respectively.The Kappa value was 0.291 compared with the pathological results;The total accuracy of CT in stage T of gastric carcinoma was 38.5 %,the accuracy of T1-T4 was 77.1 %,69.8 %,67.7 %,and 62.5 %.Sensitivity and specificity were 75.0 % and 77.5 %,43.8 % and 75.0 %,27.3 % and79.7 %,28.6 % and 88.9 %,the positive and negative predictions were40.0 % and 93.9 %,25.9 % and 87.0 %,28.6 % and 78.7 %,66.7 % and61.5 %,respectively.The Kappa value was 0.201 compared with the pathological results;EUS has a statistically significant difference between the accuracy of T stage of gastric cancer and CT(P = 0.021);The total accuracy of EUS CT in the T stage of gastric cancer was 76.0 %,and that of T1-T4 was 97.9 %,89.6 %,83.3 %,and 81.3 %.Sensitivity and specificity were 87.5 % and 100 %,50.0 % and 97.5 %,50.0 % and93.2 %,95.2 % and 70.4 %,The positive and negative predictions were100 % and 97.6 %,80.0 % and 90.7 %,68.8 % and 86.3 %,71.4 % and95.0 %,respectively,and the Kappa value was 0.640 compared with the pathological results;The difference is statistically significant compared with the individual EUS for the accuracy of T stages(P = 0.002).2.The accuracy of EUS combined elastography in the N stage of gastric cancer was 75.0 %,sensitivity and specificitye excluding 71.9 %and 81.3 %,the positive and negative predictions were 88.5 % and59.1 %,respectively,and the Kappa value was 0.486 compared with the pathological results;the accuracy of CT in the N stage of gastric cancer was 53.1 %,the sensitivity and specificity were 50.0 % and 59.4 %,thepositive prediction value and the negative prediction value were 71.1 %and 37.3 %,respectively,and the Kappa value was 0.082 compared with the pathological results.Compared with CT,EUS combined elastography has a statistical difference(P value 0.002)in the N stage of gastric cancer.The accuracy of EUS combined elastic imaging and CT in the N stage of gastric cancer was 85.4 %,and the sensitivity and specificity were84.4 % and 87.5 %,the positive and negative predictions were 93.1 %and 73.7 %,respectively,compared with the pathological results attributive test Kappa value is 0.687;Compared with EUS combined elastography on N staging accuracy,the difference was not statistically significant(P = 0.070).3.The accuracy of EUS combined elastic imaging in the M stage of gastric cancer is 91.7 %.Sensitivity and specificity were 44.4 % and96.6 %,respectively,and positive and negative predictions were 57.1 %and 94.4 %,compared with the pathological results,the Kappa value was0.455;The accuracy of CT in the M stage of gastric cancer was 95.8 %,and the sensitivity and specificity were 66.7 % and 98.9 %,respectively.The positive and negative predictions were 85.7 % and96.6 %,respectively,and the Kappa value was 0.728 compared with the pathological results.The accuracy of EUS combined elastic imaging on M staging was not statistically different from that of CT(P value0.233).The accuracy of the M stage of gastric cancer with EUS combined elastic imaging and CT was 96.9 %,the sensitivity and specificity were66.7 % and 100 %,the positive prediction value and negative prediction value were 100 % and 96.7 %,respectively,and the Kappa value was compared with the pathological results.0.784;The accuracy of M staging with EUS in combination with EUS is not statistically significant Meaning(P = 0.120).Conclusions1.EUS's accuracy in T stage diagnosis of gastric cancer is superior to that of CT and EUS.CT examination improved the accuracy of the T staging,and there was a significant statistical difference betweenthe two.2.EUS combined elastography has a higher accuracy in N stage of gastric cancer,which is significantly higher than CT.EUS combined elastography combined with CT examination increases the accuracy of N stage,but there is no statistical difference compared with EUS combined elastography.3.EUS combined elastic imaging has a higher accuracy in the M stage of gastric cancer,and EUS combined elastic imaging combined with CT has slightly improved the accuracy of M stage,but there is no statistical difference with the former.4.Compared with the pathological results,the TNM stage of EUS combined elastography was slightly less consistent with the pathological stage,and the NM stage was moderately consistent with the pathological stage.5.CT examination can be used as a useful supplement to EUS combined elastography examination. |
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