Giovannini M, Bories E, Pesenti C, Moutardier V, Lelong B, Delpéro J R
Endoscopy Unit, Paoli-Calmettes Institute, Marseilles, France.
Endoscopy. 2006 Apr;38(4):339-43. doi: 10.1055/s-2005-870412.
This paper describes experience in the staging of rectal cancer using a new software program for three-dimensional endoscopic ultrasonography (EUS) that works without electromagnetic sensors and can be used even with electronic radial or linear rectal probes.
From May 2003 to March 2004, 35 three-dimensional endorectal ultrasound (ERUS) examinations were carried out using this program. The indication for ERUS was local staging of rectal cancer in all cases. The three-dimensional software imaging program forms part of a new ultrasound scanning system (Hitachi 6500 or 8000) and allows reconstruction of the two-dimensional EUS images in six different scans.
Thirty-five rectal cancers were assessed using two-dimensional and three-dimensional EUS. Using two-dimensional imaging, it was not possible to assess precisely the degree of involvement of the mesorectum (more or less than 50%). No differences were evident with three-dimensional EUS for superficial tumors (T1 and T2N0), but in six of 15 patients classified as having T3N0 lesions, three-dimensional EUS revealed malignant lymph nodes, a finding that was confirmed surgically in five of the six cases. Three-dimensional EUS also made it possible to assess the degree of infiltration of the mesorectum precisely in all cases, demonstrating complete invasion of the mesorectum in eight cases. These findings were confirmed in all cases by the surgical data. Two-dimensional EUS correctly assessed 25 of the 35 rectal tumors (71.4%) in relation to the T and N classifications, and three-dimensional EUS increased this figure to 31 correct evaluations out of 35 (88.6%).
Three-dimensional ERUS is easy to carry out using this new software program. There is no need for an external sensor mounted at the tip of the probe, and manipulation of the rectal probe is facilitated. Three-dimensional ERUS can be carried out using linear and radial electronic probes with the same ultrasound equipment. Three-dimensional ERUS allows more precise staging of lesions and better definition of the mesorectal margins, and this has a direct impact on therapeutic decision-making in patients with rectal cancer.
本文介绍了使用一种新型三维内镜超声（EUS）软件程序对直肠癌进行分期的经验，该程序无需电磁传感器，甚至可与电子径向或线性直肠探头配合使用。
2003年5月至2004年3月，使用该程序进行了35例三维直肠内超声（ERUS）检查。所有病例中ERUS的适应证均为直肠癌的局部分期。该三维软件成像程序是一种新型超声扫描系统（日立6500或8000）的一部分，可在六种不同扫描中重建二维EUS图像。
使用二维和三维EUS对35例直肠癌进行了评估。使用二维成像时，无法精确评估直肠系膜的受累程度（超过或少于50%）。对于浅表肿瘤（T1和T2N0），三维EUS与二维EUS相比无明显差异，但在15例被分类为T3N0病变的患者中，有6例三维EUS显示出恶性淋巴结，其中6例中有5例经手术证实。三维EUS还能够在所有病例中精确评估直肠系膜的浸润程度，显示8例直肠系膜完全受侵。所有病例的这些发现均通过手术数据得到证实。二维EUS在T和N分类方面正确评估了35例直肠肿瘤中的25例（71.4%），三维EUS将这一数字提高到35例中有31例正确评估（88.6%）。
使用这种新软件程序进行三维ERUS操作简便。无需在探头尖端安装外部传感器，便于直肠探头的操作。三维ERUS可使用相同的超声设备通过线性和径向电子探头进行。三维ERUS能够对病变进行更精确的分期，并更好地界定直肠系膜边缘，这对直肠癌患者的治疗决策有直接影响。
