Reddy Nischita K, Markowitz Avi B, Abbruzzese James L, Bhutani Manoop S
The University of Texas Medical Branch, Galveston, TX, USA.
J Clin Gastroenterol. 2008 Sep;42(8):892-6. doi: 10.1097/MCG.0b013e3180cab11a.
Since its advent, endoscopic ultrasonography (EUS) has emerged as an invaluable tool in the diagnosis and management of gastrointestinal and adjacent cancers. Yet, it remains unclear how non-gastroenterologists who manage these malignancies use EUS in their practices.
A link to a self-administered questionnaire, hosted on our university website, was emailed to 650 practicing medical, radiation, and surgical oncologists in the United States.
Data were analyzed from 100 responses. When available, the overall utilization of EUS for staging nonsmall cell lung cancer (NSCLC) was significantly low (19.0%), although available. When EUS was unavailable, majority of the patients with pancreatobiliary cancer (79%; P<0.01) were not referred for staging, unlike those with esophageal (57.9%) and rectal cancer (73.7%) were. EUS availability did not impact its use in staging gastric cancer. Majority of the respondents thought EUS made an impact in managing patients with rectal (89.5%), esophageal (84.5%), and pancreatobiliary cancers (58.5%) but not gastric (54.7%) or NSCLC (61.5%). In staging NSCLC, endoscopic ultrasound-guided fine-needle aspirate (35.7%) and mediastinoscopy (34.7%) were noted as the most accurate for tissue sampling of lymph nodes in levels 5, 7, and 8. EUS was deemed better than computerized tomography or magnetic resonance imaging by 42% in detecting small pancreatic tumors. Majority have not referred patients for EUS-guided celiac plexus neurolysis for palliation of pain in unresectable pancreatic cancer.
These data highlight the utilization of EUS that did not necessarily follow established guidelines. Further research is essential to evaluate obstacles to utilization of endoscopic ultrasound-guided fine-needle aspirate.
自问世以来，内镜超声检查（EUS）已成为胃肠道及相邻部位癌症诊断和管理中一项极为重要的工具。然而，目前尚不清楚负责管理这些恶性肿瘤的非胃肠病学医生在其临床实践中如何使用EUS。
通过电子邮件向美国650名执业医学、放射和外科肿瘤学家发送了一份托管在我们大学网站上的自填式问卷链接。
对100份回复的数据进行了分析。在可获得EUS的情况下，用于非小细胞肺癌（NSCLC）分期的EUS总体利用率显著较低（19.0%）。当无法获得EUS时，与食管癌（57.9%）和直肠癌（73.7%）患者不同，大多数胰腺癌患者（79%；P<0.01）未被转诊进行分期。EUS的可获得性并未影响其在胃癌分期中的使用。大多数受访者认为EUS对直肠癌（89.5%）、食管癌（84.5%）和胰腺癌（58.5%）患者的管理有影响，但对胃癌（54.7%）或NSCLC（61.5%）患者的管理没有影响。在NSCLC分期中，内镜超声引导下细针穿刺抽吸（35.7%）和纵隔镜检查（34.7%）被认为是对5、7和8区淋巴结进行组织采样最准确的方法。42%的人认为EUS在检测小胰腺肿瘤方面优于计算机断层扫描或磁共振成像。大多数人未将患者转诊进行EUS引导下的腹腔神经丛神经溶解术以缓解不可切除胰腺癌的疼痛。
这些数据突出了EUS的使用情况，其未必遵循既定指南。进一步研究对于评估内镜超声引导下细针穿刺抽吸的使用障碍至关重要。
