A comparative study of endoscopic ultrasonography and pathology for upper gastrointestinal submucosal lesions / 中华消化内镜杂志

ABSTRACT

Objective To evaluate the valuse of endoscopic ultrasonography ( EUS ) for upper gastrointestinal submucosal lesions and the role of Photoshop in differentiating leiomyoma and stromal tumors. Methods Data of 656 patients with upper gastrointestinal submucosal lesions evaluated by EUS and receiving endoscopic submucosal dissection ( ESD ) from April 2010 to March 2015 were collected and retrospectively analyzed. The goldern standard for lesions size and origin was the intraoperative diagnosis of ESD, and that of the type of lesions ( leiomyoma, stromal tumor, ectopic pancreas, lipoma, etc.) was pathological and immunohistochemical finding. The consistency of diagnosis of the EUS was evaluated. In addition, Photoshop was used to differentiate diagnosis of leiomyoma and stromal tumors which were confirmed by pathology and immunohistochemistry. Results The consistency in diagnosing the size and lesion origins was 92?56%(560/605) and 88?43%(535/605)between EUS and ESD intraoperative result. The consistency in pathological types of EUS was 79?34%(480/605). Photoshop was used to analyze the EUS images of 177 stromal tumor and 241 leiomyoma. The gray value of stromal tumor was significantly higher than that of leiomyoma(59?97 VS 39?39, t=43?27, P<0?05).The echo of stromal tumor was higher. The standard deviation of gray value of leiomyoma were significantly lower than that of the stromal tumor ( 4?81 VS 5?42, t = 2?83, P < 0?05 ) , indicating the echo uniformity of leiomyoma was better. Conclusion EUS shows high accuracy rate for upper gastrointestinal submucosal lesions, providing more accurate basis for endoscopic therapy. EUS combined with Photoshop is helpful for differentiating stromal tumor from leiomyoma.