超声内镜诊断结直肠黏膜下肿瘤准确性的影响因素分析

Influencing factors for the diagnostic accuracy of endoscopic ultrasonography for colorectal submucosal tumors

摘要:

探讨超声内镜检查术（endoscopic ultrasonography，EUS）诊断结直肠黏膜下肿瘤（submucosal tumors，SMT）准确性的影响因素。方法 回顾性分析2015年12月至2023年10月期间在南方医科大学深圳医院经EUS诊断，并通过内镜下手术、EUS‑FNA或外科手术获得病理诊断的330处结直肠SMT病变（来自323例患者）的临床资料。计算EUS诊断不同类型结直肠SMT的准确率，采用单因素和多因素logistic回归分析EUS诊断结直肠SMT准确性的影响因素。结果 EUS对结直肠SMT总的诊断准确率为73.6%（243/330）。本研究涉及19种SMT，神经内分泌肿瘤占51.2%（169/330），脂肪瘤占15.5%（51/330），其余17种病变占比均小于6%。其中，黏膜慢性炎症、结直肠神经鞘瘤、黄色肉芽肿性炎、毛细血管瘤、结肠黄斑瘤、淋巴腺复合体和血管平滑肌脂肪瘤7种病变诊断准确率为0%；颗粒细胞瘤、平滑肌瘤、直肠扁桃体、肠道血吸虫病、纤维组织增生、胃肠间质瘤和淋巴管瘤7种病变诊断准确率<30%；囊肿、肠道子宫内膜异位症、神经内分泌肿瘤、脂肪瘤和肠气囊肿病5种病变诊断准确率>60%。多因素logistic回归分析发现，病变位置（左半结肠比直肠：OR=0.06，95%CI：0.02~0.17，P<0.001；右半结肠比直肠：OR=0.04，95%CI：0.01~0.13，P<0.001；回肠末端比直肠：OR=0.09，95%CI：0.02~0.42，P=0.002）、回声性质（无回声比低回声：OR=6.26，95%CI：1.31~29.97，P=0.022；高回声比低回声：OR=13.39，95%CI：4.16~43.09，P<0.001）和超声层次（第4层比第3层：OR=0.22，95%CI：0.06~0.81，P=0.023）是EUS诊断结直肠SMT准确性的独立影响因素。结论 神经内分泌肿瘤和脂肪瘤是结直肠中最常见的SMT，少见及罕见SMT的EUS诊断准确性较低。病变位置、回声性质和超声层次显著影响EUS对结直肠SMT的诊断准确性。

Abstract:

Objective To identify the factors influencing the diagnostic accuracy of endoscopic ultrasonography (EUS) for colorectal submucosal tumors (SMT). Methods A retrospective analysis was conducted on 330 colorectal SMT lesions (from 323 patients) diagnosed by EUS at Shenzhen Hospital of Southern Medical University from December 2015 to October 2023. Pathological diagnosis were confirmed through endoscopic resection, EUS-guided fine needle aspiration (EUS-FNA) or surgical resection. Diagnostic accuracy was calculated for each type of colorectal SMT. Univariate and multivariate logistic regression analysis were performed to identify factors affecting EUS diagnostic accuracy. Results The overall diagnostic accuracy of EUS for colorectal SMT was 73.6% (243/330). Among 19 SMT subtypes enrolled, neuroendocrine neoplasms (51.2%, 169/330) and lipomas (15.5%, 51/330) were most prevalent, while 17 rare subtypes each accounted for <6%. Seven rare SMT (mucosal chronic inflammation, colorectal schwannoma, xanthogranulomatous inflammation, capillary hemangioma, colonic xanthoma, lymphadenoid complex, and angiomyolipoma) showed 0% diagnostic accuracy. Seven other subtypes (granular cell tumor, leiomyoma, rectal tonsil, intestinal schistosomiasis, fibrous tissue hyperplasia, gastrointestinal stromal tumor, and lymphangioma) showed accuracy <30%, whereas five subtypes (cyst, bowel endometriosis, neuroendocrine neoplasm, lipoma, and pneumatosis cystoides intestinalis) achieved >60% accuracy. Multivariate logistic regression analysis confirmed that the lesion location (left colon VS rectum: OR=0.06, 95%CI: 0.02-0.17, P<0.001; right colon VS rectum: OR=0.04, 95%CI: 0.01-0.13, P<0.001; ileocecal valve VS rectum: OR=0.09, 95%CI: 0.02-0.42, P=0.002); echogenicity (anechoic VS hypoechoic: OR=6.26, 95%CI: 1.31-29.97, P=0.022; hyperechoic VS hypoechoic: OR=13.39, 95%CI: 4.16-43.09, P<0.001) and ultrasonic layer (layer 4 VS layer 3: OR=0.22, 95%CI: 0.06-0.81, P=0.023) were independent influencing factors of EUS diagnostic accuracy for colorectal SMT. Conclusion Neuroendocrine neoplasms and lipomas represent the most common colorectal SMT, whereas rare and uncommon SMT exhibit low EUS diagnostic accuracy. Lesion location, echogenicity, and ultrasonic layer significantly influence EUS diagnostic accuracy for colorectal SMT.