Huh Jung Wook, Park Yoon Ah, Jung Eun Joo, Lee Kang Young, Sohn Seung-Kook
Department of Surgery, Yongdong Severance Hospital, Yonsei University Health System, Seoul, Korea.
J Am Coll Surg. 2008 Jul;207(1):7-12. doi: 10.1016/j.jamcollsurg.2008.01.002. Epub 2008 Apr 14.
Preoperative restaging of irradiated rectal cancer is essential for the planning of optimal therapy. The aim of this study was to compare the accuracy of endorectal ultrasonography (ERUS) and CT in restaging rectal cancer after preoperative chemoradiation and to evaluate the factors affecting the accuracy of ERUS.
Eighty-three patients with initial, locally advanced rectal cancer were prospectively evaluated by ERUS (n=60) and CT (n=80) after preoperative chemoradiation and just before surgery. All patients then underwent subsequent surgical resection and complete pathologic staging.
In restaging the depth of invasion, the overall accuracy was 38.3% (23 of 60) by ERUS and 46.3% (37 of 80) by CT. Overstaging was more common than understaging with both imaging modalities. Accuracy for restaging lymph node metastasis was 72.6% (37 of 51) by ERUS and 70.4% (50 of 71) by CT. The predictive value of node-negative cases by ERUS was somewhat lower than that of CT (81.1% versus 85.4%, respectively). Complete pathology-proved remission was not correctly predicted in any of the 11 patients by any imaging modalities. Pathologic T and N staging correlated with the staging accuracy of ERUS (p=0.028 and p=0.001, respectively).
ERUS and CT may allow good prediction of node-negative rectal cancers, although they are inaccurate modalities for predicting treatment response on the rectal wall. New methods of interpretation and diagnostic criteria for ERUS and CT are essential for increasing the accuracy of cancer prediction in at-risk patients.
放疗后直肠癌的术前再分期对于优化治疗方案的制定至关重要。本研究旨在比较直肠内超声（ERUS）和CT在术前放化疗后直肠癌再分期中的准确性，并评估影响ERUS准确性的因素。
83例初诊为局部晚期直肠癌的患者在术前放化疗后且手术前接受了ERUS（n = 60）和CT（n = 80）的前瞻性评估。所有患者随后均接受了手术切除及完整的病理分期。
在再分期肿瘤浸润深度方面，ERUS的总体准确率为38.3%（60例中的23例），CT为46.3%（80例中的37例）。两种成像方式下，分期过高比分期过低更常见。ERUS对淋巴结转移再分期的准确率为72.6%（51例中的37例），CT为70.4%（71例中的50例）。ERUS对淋巴结阴性病例的预测价值略低于CT（分别为81.1%和85.4%）。11例患者中，任何一种成像方式均未正确预测出经病理证实的完全缓解。病理T和N分期与ERUS的分期准确率相关（分别为p = 0.028和p = 0.001）。
ERUS和CT对淋巴结阴性直肠癌可能有较好的预测能力，尽管它们在预测直肠壁治疗反应方面并不准确。对于提高高危患者癌症预测的准确性而言，ERUS和CT新的解读方法及诊断标准至关重要。
