Napoleon B, Pujol B, Berger F, Valette P J, Gerard J P, Souquet J C
Department of Digestive Diseases, Hôpital Edouard Herriot, Lyon, France.
Br J Surg. 1991 Jul;78(7):785-8. doi: 10.1002/bjs.1800780707.
Endosonography is the best available method for the pretherapeutic staging of rectal cancer. The present prospective study was to determine the influence of previous radiotherapy, widely used in the management of this tumour, on the accuracy of endosonography. A complete endosonographic examination was performed just before surgery in 40 patients with rectal cancer. Endosonographic and pathological staging were compared in group A, 21 patients without previous radiotherapy, and group B, 19 patients with preoperative radiotherapy. While the endosonographic accuracy for lymph node involvement was similar in the two groups (85 per cent compared with 84 per cent), wall invasion was correctly ascertained in 86 per cent in group A but in only 47 per cent in group B (P less than 0.05). After irradiation, the thickening of the rectal wall and the poor visualization of the hyperechoic layers hampered interpretation. Post-radiotherapy inflammation and/or fibrosis probably explained the echographic changes. Radiotherapy therefore altered endosonographic staging of rectal cancer. New interpretation criteria are needed for evaluation and follow-up of rectal cancer treated by radiotherapy.
腔内超声检查是直肠癌治疗前分期的最佳可用方法。本前瞻性研究旨在确定广泛用于该肿瘤治疗的既往放疗对腔内超声检查准确性的影响。对40例直肠癌患者在手术前进行了完整的腔内超声检查。将21例未接受过放疗的A组患者和19例接受过术前放疗的B组患者的腔内超声检查结果与病理分期进行比较。两组中淋巴结受累的腔内超声检查准确性相似（分别为85%和84%），但A组中86%的患者正确确定了肠壁侵犯情况，而B组中仅为47%（P<0.05）。放疗后，直肠壁增厚及高回声层显示不清妨碍了判断。放疗后炎症和/或纤维化可能解释了超声图像的变化。因此，放疗改变了直肠癌的腔内超声分期。对于接受放疗的直肠癌患者的评估和随访，需要新的解读标准。
