Mennigen Rudolf, Tuebergen Dirk, Koehler Gabriele, Sauerland Cristina, Senninger Norbert, Bruewer Matthias
Department of General Surgery, University of Münster, Münster, Germany.
J Gastrointest Surg. 2008 Feb;12(2):256-62. doi: 10.1007/s11605-007-0300-2. Epub 2007 Sep 6.
Using an endoscopic ultrasound (EUS) miniprobe, even highly stenotic esophageal cancers precluding the passage of a conventional probe can be examined without prior dilatation.
To assess: (1) staging accuracy of conventional EUS probe and miniprobe, (2) variables influencing staging accuracy, (3) endoscopic features predicting tumor stage.
Ninety-seven consecutive patients with esophageal cancer undergoing complete surgical resection were included. Preoperative EUS was performed using a conventional probe in nonstenotic tumors and a miniprobe in stenotic tumors. Accuracy of EUS for T and N stages was compared to pathohistological staging.
Overall EUS staging accuracy was 73.2% for T stage and 74.2% for N stage. It was similar for the miniprobe used in stenotic tumors vs the conventional probe used in nonstenotic tumors. Based on EUS, 84.5% of the patients would have been assigned to the appropriate therapy protocol (primary surgery vs neoadjuvant therapy). Endoscopic tumor features had no influence on staging accuracy. Tumor length >5 cm predicted advanced T and nodal positive stages.
The miniprobe allows adequate EUS staging of stenotic esophageal tumors precluding the passage of a conventional probe. Therefore, dilatation therapy of stenotic cancers to conduct conventional EUS should be avoided.
使用超声内镜（EUS）微型探头，即使是高度狭窄的食管癌，在无需事先扩张的情况下也可对常规探头无法通过的病变进行检查。
评估：（1）常规EUS探头和微型探头的分期准确性；（2）影响分期准确性的变量；（3）预测肿瘤分期的内镜特征。
纳入97例连续接受完整手术切除的食管癌患者。对无狭窄的肿瘤术前使用常规探头进行EUS检查，对狭窄肿瘤使用微型探头。将EUS对T和N分期的准确性与病理组织学分期进行比较。
EUS总体T分期准确性为73.2%，N分期准确性为74.2%。狭窄肿瘤使用的微型探头与无狭窄肿瘤使用的常规探头的分期准确性相似。基于EUS，84.5%的患者可被分配至合适的治疗方案（一期手术对比新辅助治疗）。内镜下肿瘤特征对分期准确性无影响。肿瘤长度>5 cm提示T分期较晚且有区域淋巴结转移。
微型探头可对常规探头无法通过的狭窄食管癌进行充分的EUS分期。因此，应避免对狭窄癌进行扩张治疗以实施常规EUS检查。
