Shimoyama S, Imamura K, Takeshita Y, Tatsutomi Y, Yoshikawa A, Fujishiro M, Yahagi N
Department of Gastrointestinal Surgery, University of Tokyo, 7-3-1, Hongo, Tokyo 113-8655, Japan.
Surg Endosc. 2006 Mar;20(3):434-8. doi: 10.1007/s00464-005-0144-3. Epub 2006 Jan 25.
There are few published data on the discrimination ability of endoscopic ultrasonography (EUS) among each subdivision of T1 cancer, and overdiagnosis is an unsolved problem that eventually causes overtreatment. The purpose of this study was to verify whether our treatment strategy incorporating EUS realizes a tailored patient management of T1 esophageal cancer.
This study comprised 20 esophageal cancer patients undergoing 12- to 20-MHz miniprobes for T staging and a 7.5-MHz dedicated echoendoscope for N staging. Initial therapy constituted endoscopic submucosal dissection (ESD) for endosonographically node-negative, mucosal, or slight submucosal cancers and a primary esophagectomy with three-field lymphadenectomy for deeper cancers. If the ESD specimen revealed no cancer involvement of the muscularis mucosa, the patients entered a follow-up program; otherwise, they were advised to undergo a subsequent esophagectomy and three-field lymphadenectomy.
Perfect discrimination accuracy was achieved among T1, T2, and T3 cancers. Whether cancer depth was up to the slight submucosal layer or deeper was correctly differentiated in 12 of 14 T1 cancers (86%). EUS categorized all patients correctly into candidates for either ESD or surgery. The pathological cancer depth of the resected specimens revealed that no patients experienced unnecessary overtreatment.
A higher frequency miniprobe is useful for the detailed evaluation of cancer depth, contributing to decision making for treatment options of T1 esophageal cancer. A miniprobe and echoendoscope in combination with ESD provide an appropriately tailored management plan on an individual basis, avoiding unnecessary treatment or indicating radical surgery.
关于内镜超声检查（EUS）在T1期癌症各亚分类中的鉴别能力，已发表的数据较少，而过度诊断是一个尚未解决的问题，最终会导致过度治疗。本研究的目的是验证我们纳入EUS的治疗策略是否能实现对T1期食管癌患者的个体化管理。
本研究纳入了20例食管癌患者，他们接受了用于T分期的12至20MHz微型探头和用于N分期的7.5MHz专用超声内镜检查。初始治疗包括对内镜超声检查显示无淋巴结转移、黏膜或轻度黏膜下癌的患者进行内镜黏膜下剥离术（ESD），以及对较深癌症患者进行原发性食管切除术并清扫三野淋巴结。如果ESD标本显示肌层黏膜无癌浸润，患者进入随访程序；否则，建议他们接受后续的食管切除术并清扫三野淋巴结。
在T1、T2和T3期癌症之间实现了完美的鉴别准确性。在14例T1期癌症中，有12例（86%）正确区分了癌症深度是达到轻度黏膜下层还是更深。EUS将所有患者正确分类为ESD或手术的候选者。切除标本的病理癌症深度显示，没有患者接受不必要的过度治疗。
更高频率的微型探头有助于详细评估癌症深度，有助于T1期食管癌治疗方案的决策。微型探头和超声内镜与ESD相结合，可在个体基础上提供适当的个体化管理计划，避免不必要的治疗或提示根治性手术。
