Matsumoto Takayuki, Hizawa Kazuoki, Esaki Motohiro, Kurahara Koichi, Mizuno Mitsuru, Hirakawa Katsuya, Yao Takashi, Iida Mitsuo
Department of Endoscopic Diagnostics & Therapeutics, Kyushu University Hospital, Fukuoka, Japan.
Gastrointest Endosc. 2002 Sep;56(3):354-60. doi: 10.1016/s0016-5107(02)70038-2.
Prediction of invasion depth and lymph node metastasis is mandatory when local treatment is considered for small colorectal cancer. The aim of this study was to compare the accuracy of EUS with a catheter probe (probe-EUS) and magnifying colonoscopy for prediction of invasion depth and lymph node metastasis for small colorectal cancer.
Small colorectal cancers were imaged by both probe-EUS and magnifying colonoscopy. Invasion depth by probe-EUS was determined by the presence or absence of distortion of the third sonographic layer. Findings by magnifying colonoscopy were divided into regular, distorted, and amorphous patterns. Histopathologically, depth of invasion was classified as intramucosa/slight or deep invasion. Findings by probe-EUS and magnifying colonoscopy were compared with respect to deep invasion and lymph node metastasis.
There were 22 small colorectal cancers with intramucosa/slight invasion and 28 with deep invasion. Four of 30 cancers had associated lymph node metastasis. Accuracy for depth of invasion was 91.8% for probe-EUS and 63.3% in magnifying colonoscopy, the difference being statistically significant (p = 0.0013). Negative predictive value of probe-EUS for deep invasion was higher than that for magnifying colonoscopy (respectively, 90.9% vs. 54.1%) in the population studied (prevalence deep invasion 56%). The accuracy for lymph node metastasis was 24.1% for probe-EUS and 72.4% for magnifying colonoscopy, the difference being statistically significant (p < 0.001). Positive predictive value for lymph node metastasis was higher when the amorphous pattern was noted by magnifying colonoscopy compared with the positive predictive value for deep invasion by probe-EUS (respectively, 33.3% vs. 8.7%) in the population studied (prevalence lymph node metastasis 13.3%).
Probe-EUS is superior to magnifying colonoscopy for determination of invasion depth in small colorectal cancer. Magnifying colonoscopy may be predictive of lymph node metastasis, thereby suggesting that the procedures provide complementary information with respect to the decision for local versus surgical therapy.
在考虑对小的结直肠癌进行局部治疗时，预测浸润深度和淋巴结转移是必不可少的。本研究的目的是比较使用导管探头的超声内镜检查（探头式超声内镜检查，probe-EUS）和放大结肠镜检查在预测小的结直肠癌浸润深度和淋巴结转移方面的准确性。
对小的结直肠癌同时进行探头式超声内镜检查和放大结肠镜检查成像。探头式超声内镜检查的浸润深度根据第三超声层是否存在变形来确定。放大结肠镜检查的结果分为规则型、变形型和无定形型。在组织病理学上，浸润深度分为黏膜内/轻度或深度浸润。将探头式超声内镜检查和放大结肠镜检查的结果在深度浸润和淋巴结转移方面进行比较。
有22例小的结直肠癌为黏膜内/轻度浸润，28例为深度浸润。30例癌症中有4例伴有淋巴结转移。探头式超声内镜检查对浸润深度的准确率为91.8%，放大结肠镜检查为63.3%；差异具有统计学意义（p = 0.0013）。在所研究的人群中（深度浸润患病率为56%），探头式超声内镜检查对深度浸润的阴性预测值高于放大结肠镜检查（分别为90.9%对54.1%）。探头式超声内镜检查对淋巴结转移的准确率为24.1%，放大结肠镜检查为72.4%；差异具有统计学意义（p < 0.001）。在所研究的人群中（淋巴结转移患病率为13.3%），当放大结肠镜检查发现无定形型时，其对淋巴结转移的阳性预测值高于探头式超声内镜检查对深度浸润的阳性预测值（分别为33.3%对8.7%）。
在确定小的结直肠癌浸润深度方面，探头式超声内镜检查优于放大结肠镜检查。放大结肠镜检查可能对淋巴结转移具有预测性，从而表明这两种检查方法在决定局部治疗还是手术治疗方面可提供互补信息。
