Hurlstone D P, Brown S, Cross S S, Shorthouse A J, Sanders D S
Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield, UK.
Gut. 2005 Nov;54(11):1585-9. doi: 10.1136/gut.2005.069849. Epub 2005 Jun 17.
Successful endoscopic management of early colorectal cancer using endoscopic mucosal resection requires the mandatory prediction of invasive depth and lymph node metastasis. Previous data using the Nagata crypt types Vn(B)/(C) as clinical indicators of T2/N+ disease have shown low specificity (50%) with a tendency to over stage lesions. New mini probe ultrasound "through the scope" imaging permits staging of lesions proximal to the rectum using direct endoscopic visualisation.
To compare the staging accuracy of the Nagata crypt type V with mini probe high frequency 20 MHz endoscopic ultrasound.
Sixty two patients with a Paris type II flat cancer were imaged using magnification colonoscopy followed by 20/12.5 MHz ultrasound in a "back to back" design. Crystal violet staining (0.05%) at 100x magnification permitted Nagata crypt criteria to be defined. Submucosal deep invasion (sm3+) was defined at ultrasound by the presence or absence of a disrupted third sonographic layer. Predicted T0/1:N0 lesions were resected using endoscopic mucosal resection with the remaining referred for surgery. Ultrasound and magnification staging were then compared with the resected histopathological specimens.
One patient was excluded from the study due to poor bowel preparation. Fifty two lesions from 52 patients therefore met inclusion criteria (12 sm1/13 sm2/27 sm3+). Ultrasound (20 MHz) was significantly more accurate for invasive depth staging compared with Nagata stage (p<0.0001) (overall accuracy 93% and 59%, respectively). The sensitivity for lymph node metastasis detection using ultrasound and magnification was 80% and 31%, respectively (p<0.001). The negative predictive value of ultrasound for invasive depth was better than that observed using magnification (88%/47%, respectively). The prevalence of nodal disease overall was 19% (10/52), with 80% (8/10) node positive lesions occurring in the sm3+ lesion group.
High frequency 20 MHz ultrasound is superior to magnification alone when differentiating T1/2 disease with a high positive predictive value for sm3 differentiation. Sm3+ invasion was associated with nodal metastasis.
使用内镜黏膜切除术成功地对早期结直肠癌进行内镜治疗需要对浸润深度和淋巴结转移进行必要的预测。以往将永田隐窝类型Vn(B)/(C)作为T2/N+疾病临床指标的数据显示，其特异性较低（50%），且有对病变过度分期的倾向。新型微型探头超声“经内镜”成像可通过直接内镜可视化对直肠近端病变进行分期。
比较永田隐窝类型V与微型探头20兆赫高频内镜超声的分期准确性。
对62例巴黎II型扁平癌患者进行放大结肠镜检查成像，然后采用“背对背”设计进行20/12.5兆赫超声检查。在100倍放大倍数下用0.05%的结晶紫染色来确定永田隐窝标准。超声检查时，根据第三超声层是否中断来定义黏膜下深层浸润（sm3+）。对预测为T0/1:N0的病变采用内镜黏膜切除术切除，其余患者转诊进行手术。然后将超声和放大内镜分期与切除的组织病理学标本进行比较。
1例患者因肠道准备不佳被排除在研究之外。因此，52例患者的52个病变符合纳入标准（12个sm1/13个sm2/27个sm3+）。与永田分期相比，超声（20兆赫）对浸润深度分期的准确性明显更高（p<0.0001）（总体准确性分别为93%和59%）。超声和放大内镜检测淋巴结转移的敏感性分别为80%和31%（p<0.001）。超声对浸润深度的阴性预测值优于放大内镜（分别为88%/47%）。总体淋巴结疾病患病率为19%（10/52），80%（8/10）的淋巴结阳性病变发生在sm3+病变组。
在鉴别T1/2疾病时，20兆赫高频超声优于单纯放大内镜，对sm3鉴别具有较高的阳性预测值。sm3+浸润与淋巴结转移相关。
