Pech Oliver, May Andrea, Günter Erwin, Gossner Liebwin, Ell Christian
Department of Internal Medicine II, HSK Wiesbaden, Teaching Hospital of the University of Mainz, Wiesbaden, Germany.
Am J Gastroenterol. 2006 Oct;101(10):2223-9. doi: 10.1111/j.1572-0241.2006.00718.x.
Computed tomography (CT) and endoscopic ultrasound (EUS) are part of the regular staging protocol in esophageal cancer. The value of the two methods was assessed in patients with early cancer in Barrett's esophagus.
One hundred consecutive patients (median age 64 yr, interquartile range [IQR] 58-72) with suspected early cancer in Barrett's esophagus who were referred to our hospital for endoscopic therapy were prospectively included in a standardized staging program with upper gastrointestinal endoscopy, EUS (7.5 MHz in all cases plus 12.5 or 20 MHz for elevated and/or depressed lesions), CT of the chest and upper abdomen, and abdominal ultrasonography. The results were summarized in accordance with the TNM classification. On the basis of the lymph node findings on CT and/or EUS, the patients were assigned to three categories: C1, no suspicious lymph nodes; C2, paraesophageal lymph nodes < or =1 cm in size at the tumor level, lymph nodes > or =1 cm in size not at the tumor level in the mediastinum or celiac trunk; and C3, paraesophageal lymph nodes > 1 cm in size at the tumor level. The EUS and CT findings were checked every 6 months in patients who underwent endoscopic treatment. Surgical resection was scheduled in operable patients if staging showed a T category higher than T1 and/or the lymph node staging was assessed as C3. Patients with suspected submucosal infiltration underwent diagnostic endoscopic resection, and if submucosal involvement was confirmed were referred for surgery.
The median follow-up period was 25 months (IQR 19.5-30.0). The T category diagnosed with CT was < or = T1 in all patients. On EUS, the T category was classified as T1 in 92% of cases (N = 92) and as > T1 in 8% (N = 8, p < 0.05). Enlarged lymph nodes (C2 and C3) were detected in 45% of the patients. Significantly more C2 lymph nodes were diagnosed with EUS than CT (28 vs 19, p < 0.05). Lymph nodes at the level with the highest suspicion, C3, were detected using CT in only three of nine cases. Sensitivity of CT for N staging was not acceptable compared with EUS (38%vs 75%). No extranodal metastases were found on CT.
In suspected early cancer in Barrett's esophagus, EUS is superior to CT for T staging and N staging. As CT had no influence on the TNM classification in any of these patients, it may be possible to dispense with this method as a staging procedure in patients with cancer in Barrett's esophagus. By contrast, EUS is required in order to differentiate between patients with cancer in Barrett's esophagus in whom endoscopic therapy is suitable and those in whom surgical treatment is required.
计算机断层扫描（CT）和内镜超声（EUS）是食管癌常规分期方案的一部分。对巴雷特食管早期癌患者评估了这两种方法的价值。
连续100例怀疑患有巴雷特食管早期癌并转诊至我院接受内镜治疗的患者前瞻性纳入标准化分期程序，包括上消化道内镜检查、EUS（所有病例均采用7.5MHz，对于隆起和/或凹陷性病变加用12.5或20MHz）、胸部和上腹部CT以及腹部超声检查。结果按照TNM分类进行总结。根据CT和/或EUS上的淋巴结表现，将患者分为三类：C1，无可疑淋巴结；C2，肿瘤水平处食管旁淋巴结直径≤1cm，纵隔或腹腔干中不在肿瘤水平处的淋巴结直径≥1cm；C3，肿瘤水平处食管旁淋巴结直径＞1cm。接受内镜治疗的患者每6个月检查一次EUS和CT结果。如果分期显示T类别高于T1和/或淋巴结分期评估为C3，则为可手术患者安排手术切除。怀疑有黏膜下浸润的患者接受诊断性内镜切除，如果确认有黏膜下受累则转诊进行手术。
中位随访期为25个月（四分位间距19.5 - 30.0）。所有患者CT诊断的T类别均≤T1。在EUS上，92%的病例（N = 92）T类别分类为T1，8%（N = 8，p＜0.05）分类为＞T1。45%的患者检测到肿大淋巴结（C2和C3）。EUS诊断出的C2淋巴结显著多于CT（28例对19例，p＜0.05）。在9例C3级高度可疑水平的淋巴结中，仅3例通过CT检测到。与EUS相比，CT对N分期的敏感性不可接受（38%对75%）。CT未发现淋巴结外转移。
在怀疑巴雷特食管早期癌中，EUS在T分期和N分期方面优于CT。由于CT对这些患者的TNM分类均无影响，在巴雷特食管癌症患者中可能可以不用这种方法作为分期程序。相比之下，为了区分适合内镜治疗的巴雷特食管癌症患者和需要手术治疗的患者，EUS是必需的。
