Hünerbein M, Totkas S, Moesta K T, Ulmer C, Handke T, Schlag P M
Department of Surgery and Surgical Oncology, Charité, Humbolt University, Robert-Rössle Hospitql, Berlin, Germany.
Surgery. 2001 Feb;129(2):164-9. doi: 10.1067/msy.2001.110428.
The value of endorectal ultrasound (EUS) in the diagnosis of recurrent rectal cancer is limited by the inability to differentiate between malignant and benign lesions. We have prospectively investigated the role of EUS with transrectal ultrasound-guided biopsy in the postoperative follow-up of rectal cancer.
Since 1995, patients who had undergone a sphincter-saving operation for rectal cancer (n = 312) were followed-up by a standard program including rectal palpation, carcinoembryonic antigen monitoring, computed tomography, and EUS. Transrectal EUS-guided biopsy of perirectal lesions was performed in 68 patients with perirectal lesions by using a rigid endoprobe with a 10 MHZ multiplane transducer and special targeting device.
Overall local recurrence was observed in 36 patients. Intraluminal recurrence was diagnosed by proctoscopy in 12 patients. Transrectal EUS-guided biopsy showed pelvic recurrence in 22 of 68 patients with perirectal lesions. Biopsy specimens with benign histology were obtained from 41 patients, and the procedure failed in 5 cases (accuracy, 92%). There was a strong agreement between transrectal biopsy results and the final diagnosis (kappa = 0.84), the sensitivity and specificity being 91% and 93%, respectively. In contrast, clinical examination (kappa = 0.27), computed tomography (kappa = 0.47), or EUS (kappa = 0.42) showed only a moderate level of agreement with the histopathologic diagnosis, mainly because of the limited specificity of all 3 methods (65% vs 46% vs 57%). EUS-guided biopsy was significantly more accurate than computed tomography and EUS (P <.01). The biopsy results had a considerable impact on the management in 18 of 68 patients (26%).
Transrectal EUS-guided biopsy is a safe and efficient method for tissue sampling of perirectal lesions. This minimally invasive and inexpensive technique improves the accuracy of endorectal ultrasound in the diagnosis of recurrent rectal cancer.
直肠内超声（EUS）在复发性直肠癌诊断中的价值受到无法区分恶性和良性病变的限制。我们前瞻性地研究了EUS联合经直肠超声引导活检在直肠癌术后随访中的作用。
自1995年以来，对312例行直肠癌保肛手术的患者采用包括直肠指诊、癌胚抗原监测、计算机断层扫描和EUS在内的标准方案进行随访。对68例有直肠周围病变的患者，使用带有10MHz多平面探头和特殊靶向装置的硬性内镜进行经直肠EUS引导下直肠周围病变活检。
36例患者出现总体局部复发。12例患者经直肠镜检查诊断为腔内复发。经直肠EUS引导活检显示，68例有直肠周围病变的患者中有22例存在盆腔复发。41例患者获得了组织学良性的活检标本，5例活检失败（准确率92%）。经直肠活检结果与最终诊断之间有很强的一致性（kappa = 0.84），敏感性和特异性分别为91%和93%。相比之下，临床检查（kappa = 0.27）、计算机断层扫描（kappa = 0.47）或EUS（kappa = 0.42）与组织病理学诊断的一致性仅为中等水平，主要是因为这三种方法的特异性均有限（分别为65%、46%和57%）。EUS引导活检明显比计算机断层扫描和EUS更准确（P <.01）。活检结果对68例患者中的18例（26%）的治疗管理产生了重大影响。
经直肠EUS引导活检是一种安全有效的直肠周围病变组织采样方法。这种微创且廉价的技术提高了直肠内超声在复发性直肠癌诊断中的准确性。
