Hu Yi, Fu Jian-Hua, Rong Tie-Hua, Xu Guo-Liang, Li Xiao-Dong, Zhang Peng-Yuan, Yang Hong, Zhu Zhi-Hua, Zhang Shi-Yi
State Key Laboratory of Oncology in Southern China, Guangzhou, Guangdong, 510060, PR China.
Ai Zheng. 2005 Nov;24(11):1358-62.
BACKGROUND & OBJECTIVE: Preoperative clinical staging is the key to choose ideal therapy plan for esophageal cancer. Endoscopic ultrasonography (EUS), an accuracy diagnostic technique for TN staging of esophageal cancer, is used commonly in foreign countries, but seldom in China. This study was to evaluate the application of EUS to preoperative clinical staging of esophageal cancer.
A total of 72 patients were examined preoperatively with EUS, and staged according to UICC (1997) TNM staging system. The EUS findings were compared with surgical pathologic findings.
The accuracy rates of T staging and N staging by EUS were 80.6% (58/72) and 88.9% (64/72), respectively. The accuracy rates of T staging were 50.0% (2/4) for T0, 75.0% (3/4) for T1, 70.6% (12/17) for T2, 90.0% (36/40) for T3, and 71.4% (5/7) for T4; those of N staging were 92.3% (36/39) for N0 and 84.8% (28/33) for N1, of which the accuracy rates of diagnosing mediastinum and abdomen lymph node metastases were 90.0% and 64.5%. The staging results by EUS were significantly accordant with those by surgical pathology: T staging, association coefficient = 0.687, P < 0.001; N staging, association coefficient = 0.878, P < 0.001. Twenty-two cases were staged incorrectly, including 14 cases of T staging, of which 8 cases were due to not distinguishing T2 and T3 correctly, and 8 cases of N staging, of which 5 cases were due to not distinguishing lymphadenitis and metastatic lymph nodes correctly.
The accuracy rate of EUS is high for preoperative staging of esophageal carcinoma, especially for T3 and mediastinum lymph node. Distinguishing T2 and T3, lymphadenitis and metastatic lymph nodes correctly and diagnosing abdomen lymph node metastasis can improve the diagnosis accuracy rate of EUS.
术前临床分期是选择食管癌理想治疗方案的关键。超声内镜（EUS）是一种用于食管癌TN分期的准确诊断技术，在国外应用普遍，但在我国较少使用。本研究旨在评估EUS在食管癌术前临床分期中的应用。
对72例患者术前行EUS检查，并根据UICC（1997）TNM分期系统进行分期。将EUS检查结果与手术病理结果进行比较。
EUS对T分期和N分期的准确率分别为80.6%（58/72）和88.9%（64/72）。T分期的准确率为：T0期50.0%（2/4），T1期75.0%（3/4），T2期70.6%（12/17），T3期90.0%（36/40），T4期71.4%（5/7）；N分期的准确率为：N0期92.3%（36/39），N1期84.8%（28/33），其中诊断纵隔和腹部淋巴结转移的准确率分别为90.0%和64.5%。EUS分期结果与手术病理分期结果显著一致：T分期，关联系数=0.687，P<0.001；N分期，关联系数=0.878，P<0.001。22例分期错误，其中T分期错误14例，8例是由于未正确区分T2和T3；N分期错误8例，5例是由于未正确区分淋巴结炎和转移淋巴结。
EUS对食管癌术前分期的准确率较高，尤其是对T3期和纵隔淋巴结。正确区分T2和T3、淋巴结炎和转移淋巴结以及诊断腹部淋巴结转移可提高EUS的诊断准确率。
