超声内镜评分对消化道良恶性病变的诊断价值-第三军医大学学报.DOCVIP

DOI:10.16016/j.1000a25404.201411029 论 著 超声内镜评分对消化道及壁外压迫性病变良恶性的诊断价值 刘孟麟，陈伟庆 （400010 重庆，重庆医科大学附属第二医院消化内科） [摘要] 目的 建立基于乳腺影像报告和数据系统（Breast imaging reporting and data system，BI-RADS）的EUS-BIRADS评分体系并评价其对消化道黏膜层、黏膜下及壁外压迫性病变良恶性的诊断价值。方法 回顾性分析我院2006年6月至2012年12月经病理学诊断明确的消化道及壁外病变509例。参照BI-RADS超声诊断标准建立EUS-BIRADS评分体系，依据EUS-BIRADS评分体系在未知病理诊断情况下为每1组超声内镜图像评分，并将评分结果与病理结果比对。ROC曲线分析示AUG=0.947，取EUS评6.5分时为临界值（对应Youden指数最高值），＞6分的病例倾向于恶性病变，分值≤6分者倾向于非恶性病变。利用Pearsonχ2检验、McNemarχ2检验、敏感度、特异度、阳性预测值、阴性预测值、Youden指数、诊断符合率、Kappa值等评估EUS-BIRADS评分体系的诊断价值。结果 EUS-BIRADS评分对于黏膜层、黏膜下及壁外病变的良恶性评定的敏感度、特异度、阳性预测值、阴性预测值、Youden指数、诊断符合率、Kappa值分别为85.1%、92.9%、71.2%、96.8%、0.7795、91.6%、0.7234。Pearsonχ2检验（χ2值=269.573，P＜0.001）示EUS-BIRADS评分结果与病理检验结果不独立，其列联系数 R=0.728示两者正相关，但McNemarχ2检验（P值：0.014）示EUS-BIRADS评分体系与病理学诊断之间存在有差异。结论 基于BI-RADS标准建立的EUS-BIRADS评分体系对消化道及壁外病变的良恶性的预判与病理诊断之间有较好一致性，可以辅助临床医师预判病变性质以利于进一步检查。 [关键词] 超声内镜；乳腺影像报告和数据系统；消化道；良恶性 [中图法分类号] R445.9 [文献标志码] A Diagnostic Value of the EUS-BIRADS Scoring System for Assessing Malignant Risk of Lesions in Digestive Tract and Outer Wall Oppression Liu Menglin，Chen Weiqing (Department of Gastroenterology, the Second Affiliated Hospital, Chongqing Medical University) [Abstract] Objective This study was aimed to establish a new EUS scoring system which was based on the BI-RADS standard, and evaluate its diagnosis value for identifying the benign and malignant lesions in gastrointestinal mucosa or submucosa or outside wall oppression. Methods To establish the EUS-BIRADS scoring system with reference to BI-RADS ultrasound diagnostic criteria. 509 cases with pathological diagnosis of gastrointestinal mucosa or submucosa or outside wall oppression from June 2006 to December 2012 were analyzed retrospectively. We scored for each group of EUS images by reference to EUS-BIRADS scoring system without pathological diagnosis, and then compared scoring with pathological results