Koch J, Halvorsen R A, Levenson S D, Cello J P
Division of Gastroenterology, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, 1001 Potrero Avenue, San Francisco, California 94110, USA.
J Clin Ultrasound. 2001 Mar-Apr;29(3):117-24. doi: 10.1002/1097-0096(200103/04)29:3<117::aid-jcu1010>3.0.co;2-1.
Endoscopic sonography (EUS) is an important imaging modality for evaluating benign and malignant luminal gastrointestinal-tract abnormalities. The objectives of this study were to evaluate the feasibility of catheter-based EUS (C-EUS) during standard upper and lower endoscopy in patients with malignancies and other abnormalities of the gastrointestinal-tract lumen, to assess the image quality obtained with the 12.5-MHz catheter-based ultrasound transducer, and to prospectively compare the interpretations of C-EUS images with those of the standard EUS (S-EUS) images.
One hundred thirty-seven consecutive patients referred for EUS were evaluated with C-EUS followed by S-EUS. The patients were assigned to 1 of 2 groups: group A, patients with intramural masses or intestinal wall thickening, with biopsies negative for malignancy; and group B, patients with esophageal, gastric, duodenal, or rectal cancer referred for staging. The results of C-EUS and S-EUS were compared for each group.
C-EUS was completed in 134 patients: 81 patients with 83 lesions in group A and 53 patients in group B. For group A, C-EUS image interpretation concurred with that of S-EUS in 74 (89%) of 83 lesions. For group B, C-EUS concurred with S-EUS for tumor depth (T) and nodal (N) classifications in 19 cases (36%) and 26 cases (49%), respectively. The depth of invasion was underestimated by C-EUS in all 34 cases in which the T classifications by C-EUS and S-EUS were discordant. In 1 of 6 patients with stenotic cancer that was nontraversable by S-EUS, C-EUS identified lymphadenopathy (incorrectly classified as N0 by S-EUS).
C-EUS was easily performed, and the C-EUS images were comparable to the S-EUS images in assessing mucosal and intramural lesions. The limited depth of penetration of the catheter-based transducer resulted in understaging the extent of tumor invasion and underestimating the nodal spread.
超声内镜检查（EUS）是评估胃肠道管腔内良性和恶性病变的重要成像方式。本研究的目的是评估在患有胃肠道管腔恶性肿瘤和其他异常的患者进行标准上消化道和下消化道内镜检查期间基于导管的EUS（C-EUS）的可行性，评估使用12.5MHz基于导管的超声换能器获得的图像质量，并前瞻性地比较C-EUS图像与标准EUS（S-EUS）图像的解读。
对连续137例接受EUS检查的患者先进行C-EUS检查，随后进行S-EUS检查。患者被分为2组中的1组：A组，有壁内肿块或肠壁增厚且活检恶性为阴性的患者；B组，因分期而转诊的食管癌、胃癌、十二指肠癌或直肠癌患者。比较每组C-EUS和S-EUS的结果。
134例患者完成了C-EUS检查：A组81例患者有83处病变，B组53例患者。对于A组，83处病变中的74处（89%）C-EUS图像解读与S-EUS一致。对于B组，C-EUS与S-EUS在肿瘤深度（T）和淋巴结（N）分类上分别有19例（36%）和26例（49%）一致。在C-EUS和S-EUS的T分类不一致的所有34例病例中，C-EUS均低估了浸润深度。在6例S-EUS无法通过的狭窄癌患者中，有1例C-EUS发现了淋巴结病变（S-EUS错误分类为N0）。
C-EUS操作简便，在评估黏膜和壁内病变方面，C-EUS图像与S-EUS图像相当。基于导管的换能器穿透深度有限，导致对肿瘤浸润范围分期不足，对淋巴结扩散估计过低。
