Lightdale C J
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York.
Endoscopy. 1992 May;24 Suppl 1:297-303. doi: 10.1055/s-2007-1010487.
The accumulating data show that endoscopic ultrasonography (EUS) is highly compatible with the UICC/AJCC staging classification for esophageal and gastric cancer, based on the TNM system expressing anatomical extent of disease. The great strength of EUS in staging these cancers is its ability to image the gut wall and adjacent structures in unique detail. EUS is more accurate than computed tomography in staging the depth of primary tumor invasion (T) and regional lymph node metastases (N). High frequency EUS is not useful in staging for distant metastases (M) due to limited depth of the field. EUS also has limitations in reliably distinguishing between neoplastic and inflammatory tissue. Thus, the major use of EUS is in staging rather than in diagnosis. However, initial reports indicate that EUS may be helpful in the detection of malignancy in Barrett's esophagus, in diagnosing post-operative recurrent cancer, and in evaluating the response to non-operative therapy. EUS appears to represent an important advance in the staging and follow-up of patients with esophageal and gastric cancer. Instruments and techniques will continue to evolve, but the next level of research should be designed to show that the improved staging provided by EUS has clinical utility and can affect patient outcome.
越来越多的数据表明，基于表达疾病解剖范围的TNM系统，内镜超声检查（EUS）与国际抗癌联盟（UICC）/美国癌症联合委员会（AJCC）的食管癌和胃癌分期分类高度相符。EUS在这些癌症分期方面的巨大优势在于其能够以独特的细节对肠壁及相邻结构进行成像。在对原发性肿瘤浸润深度（T）和区域淋巴结转移（N）进行分期时，EUS比计算机断层扫描更准确。由于视野深度有限，高频EUS在远处转移（M）分期中并无用处。EUS在可靠区分肿瘤组织和炎症组织方面也存在局限性。因此，EUS的主要用途在于分期而非诊断。然而，初步报告表明，EUS可能有助于检测巴雷特食管中的恶性肿瘤、诊断术后复发性癌症以及评估非手术治疗的反应。EUS似乎代表了食管癌和胃癌患者分期及随访方面的一项重要进展。仪器和技术将不断发展，但下一阶段的研究应旨在表明EUS提供的改进分期具有临床实用性并能影响患者的预后。
