| Background and ObjectiveThe adenocarcinoma of the cardia(ACC) is a relatively common digestive tract tumor,belong to a special type of gastric cancer.Since the mid-70s of the 20th century, the incidence of the terminal esophageal cancer and ACC was increasing year by year in many parts of the world and countries. Due to special anatomical location and pathological changes, its pathogenesis is still unclear.ACC can be asymptomatic in the early stage, many ACC were found in the later. The clinical manifestations are dysphagia, retrosternal burning pain. Under the naked eye, ulcer-type lesions and growth of invasive intramural pathology are mainly .Most ACC are adenocarcinoma and medium - poorly differentiated.In the past ,to inspect ACC relying on X-ray Barium Contrast Radiation( BCR), gastroscopy and so on.The merits are it can directly show the location and surface morphology of lesions, endoscopy forceps can take mass biopsy tissues under direct vision, but both are unable to observe the depth of tumor invasion and violation of the situation around the organs.At present, Computed Tomography (CT) and Magnetic Resonance Imaging(MRI) as a essential means of inspection of the preoperative diagnosis of ACC, through scanning the tumor to observe the violations of the surrounding tissue and the metastatic lymph nodes, it has an important value to the clinical diagnosis .Endoscopic Ultrasonography (EUS) can clearly show the five-storey structure of the digestive tract wall, EUS is the most reliable invasive inspection to determine the depth of tumor infiltration. but because of its invasiveness and the complexity operation of the apparatus and the high requirements for the operator's specification,and have limited value on violations of the surrounding organs ,so it hasn't generalized using. With the continuous advancement of the ultrasonic apparatus and technology, TUS for advanced cardiac were continually improved the diagnostic accuracy with the convenience of non-invasive, repeatable inspection, etc,and by observing the mass with the surrounding organs and lymph nodes of the violations.It make up other deficiencies, and provide valuable information for clinical diagnosis and treatment. In the past,though there have some reports about the diagnosis of carcinoma of cardia by TUS and made meaningful progress ,but relevant studies at home and abroad are rare.At the basis of previous research ,this topic is study on the advanced carcinoma of cardia's mass length, violations of esophageal length, the depth of invasion, as well as violations of the surrounding lymph nodes .To investiget the value of preoperative application with TUS for advanced carcinoma of cardia.Materials and methodsFrom July 2006 to December 2007 , checked the 45 hospitalized patients with ACC ,using routine preoperative transabdominal ultrasonography in our hospital . To observe the length of cardia mass, wall thickness of the lesions, wether or not have infringement of serosal layer, the length of the violations of esophageal and the status of the lymph node metastasis, and the general situation of the tumor specimens under naked eyes. To make the biopsy specimens turn to pathological section and to observe the corresponding information, record and organize data, to observe the ultrasound and pathology results, analyzed by using statistical analysis software.Results(1)There was no significant difference in the measurements of the mass length, thickness of the lesion department, violations on the length of the lower esophageal pathology of carcinoma of cardia between TUS and pathological results(P>0.05).And there are some relevant between the wall thickness of the lesions and wether or not have infringement of serosal layer(r=0.471,P=0.001).(2)Using TUS to judge whether or not violate the serosal layer of gastric wall lesions department in ACC patients,the sensitivity was 88.2% and specificity was 81.8%, 86.7% rate of right.(3)Using TUS to determine the lymph node metastases in the first station ,the sensitivity was 72% and specificity was 80%, diagnostic accuracy was 76%. At the first station of the number of metastatic lymph nodes compared groups matching between the results of ultrasonic and pathological ,the correlation was good (r = 0.794, P <0.001).(4) Because of the lack of sample , the second station have a relatively small number of metastatic lymph nodes in this group cases, ultrasound and pathology have bad comparability. But the results of the TUS were coincide with the pathological on the judgement of the second station of positive and negative lymph nodes in this group of cases .If it continous to increase the sample size, wether or not one can be more in line with the results, it depends on the further study.Conclusions(1)Using TUS can make an accurate judgment with the mass length and the length of the lower esophageal violations,it also has important reference value to the surgical therapeutic schedule.(2)Using TUS to judge the infiltration of the ACC, as well as the extent of lymph node metastasis around the mass ,there are more accurate judgments, sensitivity and specificity were high too.(3)TUS can provide more reliable information for preoperative staging of clinical diagnosis, it also can make up the insufficient of the X-ray and gastroscopy .TUS have the convenience of non-invasive, repeatable inspection ,etc. The TUS is expected to gradually become a routine examination, and in combination with other auxiliary inspection, it can more effectively guide clinical diagnosis and treatment. |
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