Nottingham Digestive Diseases Centre and Biomedical Research Unit, Nottingham University Hospitals NHS Trust, Queens Medical Centre Campus, Nottingham NG7 2UH, UK.
Surg Endosc. 2010 May;24(5):1110-6. doi: 10.1007/s00464-009-0737-3. Epub 2009 Nov 14.
Endoscopic ultrasound (EUS) is useful for detecting depth of invasion and nodal involvement in patients with early Barrett's neoplasia (EBN), precluding endoscopic management. This study aimed to determine whether the lesion morphology of the EBN shown on high-resolution endoscopy predicts EUS and histologic tumor stage.
Retrospective series from two tertiary referral centers were studied. Patients with EBN referred for EUS evaluation before treatment were identified, and data were collected from endoscopies, a database, and case notes. All patients had high-resolution endoscopy followed by radial EUS.
This study included 50 patients (22 men) with a median age of 69 years (interquartile range, 60-79 years). Visible lesions in the Barrett's segment were described as Paris types 0-1 (n = 9), 0-IIb (n = 12), 0-IIa (n = 12), 0-IIa + IIc (n = 6), and 0-IIc (n = 5). Of the 50 patients, 46 (92%) had either EMR (n = 17), esophagectomy (n = 23), or both (n = 6). All 12 patients (100%) with Paris 0-IIb lesions had T0/T1 m staging on EUS confirmed with resection histology. The sensitivity for EUS T-staging for Paris classification was 71.4% for type 0-I, 100% for type 0-IIb, 83% for type 0-IIa, 66.7% for type 0-IIa + IIc, and 66.7% for type IIc. Overall, 8 (17%) of the 46 patients were understaged and 2 (4%) were overstaged. For detecting submucosal invasion, EUS had a sensitivity of 66%, a specificity of 93%, a negative predictive value of 85%, and a diagnostic accuracy of 84.4%.
Submucosal invasion is detected by EUS for 26% of patients with EBN. The value of EUS staging before resection for type 0-IIb early Barrett's cancer (flat lesions) is limited because 100% of these lesions are limited to the mucosa. For the management algorithm in this selected cohort, the use of EUS should be reconsidered.
内镜超声（EUS）对于检测早期 Barrett 肿瘤（EBN）患者的浸润深度和淋巴结受累情况非常有用，可以排除内镜治疗。本研究旨在确定 EBN 在高分辨率内镜下的病变形态是否可预测 EUS 和组织学肿瘤分期。
回顾性研究来自两个三级转诊中心的系列病例。确定了因 EUS 评估而转诊的 EBN 患者，并从内镜、数据库和病例记录中收集数据。所有患者均行高分辨率内镜检查和径向 EUS。
本研究纳入 50 例（22 例男性）患者，中位年龄 69 岁（四分位距 60-79 岁）。Barrett 段可见病变描述为巴黎分型 0-1 型（n = 9）、0-IIb 型（n = 12）、0-IIa 型（n = 12）、0-IIa + IIc 型（n = 6）和 0-IIc 型（n = 5）。50 例患者中，46 例（92%）接受了内镜黏膜切除术（n = 17）、食管切除术（n = 23）或两者联合治疗（n = 6）。12 例（100%）巴黎 0-IIb 型病变患者的 EUS T 分期为 T0/T1m，经手术病理证实。EUS 对巴黎分类 T 分期的敏感性分别为 0-I 型 71.4%、0-IIb 型 100%、0-IIa 型 83%、0-IIa + IIc 型 66.7%和 IIc 型 66.7%。总体而言，46 例患者中有 8 例（17%）分期过低，2 例（4%）分期过高。对于检测黏膜下浸润，EUS 的敏感性为 66%，特异性为 93%，阴性预测值为 85%，诊断准确性为 84.4%。
EUS 检测到 EBN 患者中有 26%存在黏膜下浸润。对于 0-IIb 型早期 Barrett 癌（平坦病变），术前 EUS 分期的价值有限，因为这些病变 100%局限于黏膜层。对于这个选择的队列的管理算法，应该重新考虑 EUS 的使用。
