超声内镜对直肠神经内分泌肿瘤的诊断价值及影响因素研究

Diagnostic value and influencing factors of endoscopic ultrasonography for rectal neuroendocrine neoplasms

摘要:

目的 研究超声内镜检查（endoscopic ultrasonography，EUS）对直肠神经内分泌肿瘤（rectal neuroendocrine neoplasms，R⁃NENs）的诊断价值及其影响因素。方法 回顾性选取2016年3月至2023年6月于青岛大学附属医院经白光内镜疑诊为R⁃NENs、行内镜诊治或外科手术并获得病理诊断的患者资料进行病例对照研究，统计临床资料、EUS特征以及病理结果，将EUS所示结果与病理结果相比较，得出EUS对R⁃NENs诊断的准确性，采用二元logistic回归模型分析影响准确性的因素。结果 共纳入患者317例，EUS诊断R⁃NENs的敏感度为98.03%（249/254），特异度为34.92%（22/63），阳性预测值为85.86%（249/290），阴性预测值为81.48%（22/27），准确率为85.49%（271/317），约登指数为0.33。肿瘤超声长径≤5 mm（P=0.002，OR=2.892，95%CI：1.464~5.713）、肿瘤表面无扩张血管（P=0.019，OR=2.613，95%CI：1.170~5.837）、肿瘤表面色泽正常（P=0.001，OR=3.460，95%CI：1.645~7.279）和红色（P=0.048，OR=7.242，95%CI：1.015~51.680）是影响EUS诊断R⁃NENs准确性的独立危险因素。EUS诊断R⁃NENs累及深度的准确率为76.77%（195/254）。肿瘤回声不均质（P<0.001，OR=4.008，95%CI：1.980~8.113）、肿瘤表面有凹陷（P=0.035，OR=2.664，95%CI：1.073~6.615）是影响EUS诊断R⁃NENs累及深度准确性的独立危险因素。结论 R⁃NENs的内镜表现和超声特点与诊断的准确性密切相关。肿瘤超声长径、肿瘤表面有无扩张血管及肿瘤表面色泽影响EUS诊断的准确性，肿瘤回声异质性、肿瘤表面是否凹陷影响EUS诊断累及深度的准确性。因此EUS对R⁃NENs的诊断具有很好的临床应用价值。

Abstract:

Objective To investigate the diagnostic value and influencing factors of endoscopic ultrasonography (EUS) for detecting rectal neuroendocrine neoplasms (R-NENs). Methods A retrospective case-control study was performed on data of patients with suspected R-NENs by white light endoscopy who underwent endoscopic diagnosis and treatment or surgical operation and obtained pathological diagnosis at the Affiliated Hospital of Qingdao University from March 2016 to June 2023. Clinical data, EUS characteristics and pathological results were statistically analyzed, and the diagnostic accuracy of EUS for R-NENs were obtained by comparing the EUS results with the pathological results. Influencing factors affecting accuracy were analyzed by using the binary logistic regression model. Results A total of 317 patients were included. The sensitivity, the specificity, the positive predictive value and the negative predictive value of EUS in diagnosing R-NENs were 98.03% (249/254), 34.92% (22/63), 85.86% (249/290) and 81.48% (22/27) respectively. The accuracy was 85.49% (271/317) and the Jorden index was 0.33. Tumor size ≤5 mm (P=0.002, OR=2.892, 95%CI: 1.464-5.713), absence of surface vascular dilation (P=0.019, OR=2.613, 95%CI: 1.170-5.837), normal tumor coloration (P=0.001, OR=3.460, 95%CI: 1.645-7.279) and erythematous surface appearance (P=0.048, OR=7.242, 95%CI: 1.015-51.680) were independent risk factors affecting the accuracy of R-NENs diagnosis by EUS. Depth assessment accuracy of EUS was 76.77% (195/254), with echo heterogeneity (P<0.001, OR=4.008, 95%CI: 1.980-8.113) and surface depression (P=0.035, OR=2.664, 95%CI: 1.073-6.615) emerging as significant factors affecting invasion depth evaluation. Conclusion EUS demonstrates substantial clinical utility for R-NENs assessment, with diagnostic performance being significantly associated with tumor morphology and sonographic features. Macroscopic characteristics including tumor size, vascular patterns, and chromatic features influence diagnostic accuracy, while echo-textural heterogeneity and surface depression affect invasion depth precision. These findings underscore the clinical relevance of comprehensive EUS evaluation in R-NENs management.