I degrees Department of Surgery, Regional Hospital, 31100 Treviso, Italy.
Dis Colon Rectum. 2009 Nov;52(11):1837-43. doi: 10.1007/DCR.0b013e3181b16ce9.
The aims of this prospective study were 1) to evaluate the accuracy of high-resolution three-dimensional endorectal ultrasonography in distinguishing slight from massive submucosal invasion of early rectal tumors, and 2) to determine the technology's role in treatment selection.
A total of 142 consecutive patients with clinically possible pT1 rectal cancers underwent three-dimensional endorectal ultrasonography. Slight or massive irregularity of the hyperechoic submucosal layer was considered to characterize uT1-slight or uT1-massive tumors. Treatment was selected on the basis of ultrasonographic findings: endoscopic resection or full-thickness transanal local excision was selected for uT1-slight lesions, and radical resection was selected for uT1-massive tumors. Ultrasonographic staging was compared with histopathologic staging.
One hundred twenty-six patients were included in the final analyses. Three-dimensional endorectal ultrasonography staged 77 lesions as uT0, 25 as uT1-slight, 20 as uT1-massive, and 4 as uT2. Histologically, adenomas were found in 75 patients and tumor invasion was found in 44 lesions (24 pT1-slight, 16 pT1-massive, 4 pT2). The overall kappa for the concordance between ultrasonographic and histopathologic stagings was 0.81 (95% confidence interval, 0.72-0.89). No invasive carcinomas remained undetected. The depth of invasion was correctly determined in 87.2% of both pT1-slight and pT1-massive lesions. Considering the complete series of 126 patients, the accuracy of this modality in selecting appropriate management was 95.2% (kappa, 0.84; 95% confidence interval, 0.71-0.96). Adequate surgery was performed in 87.5% of pT1 tumors.
Three-dimensional endorectal ultrasonography is useful for assessing the depth of submucosal invasion in early rectal cancer and for selecting therapeutic options.
本前瞻性研究的目的是 1）评估高分辨率三维直肠内超声在区分早期直肠肿瘤黏膜下轻微浸润和广泛浸润中的准确性，以及 2）确定该技术在治疗选择中的作用。
共对 142 例临床可能为 pT1 直肠癌的患者进行了三维直肠内超声检查。高回声黏膜下层的轻微或广泛不规则被认为是 uT1-轻微或 uT1-广泛肿瘤的特征。根据超声检查结果选择治疗方法：内镜下切除或全层经肛门局部切除适用于 uT1-轻微病变，而广泛病变则选择根治性切除。超声分期与组织病理学分期进行比较。
126 例患者纳入最终分析。三维直肠内超声将 77 处病变分期为 uT0，25 处为 uT1-轻微，20 处为 uT1-广泛，4 处为 uT2。组织学上，75 例患者为腺瘤，44 处病变为肿瘤浸润（24 处 pT1-轻微，16 处 pT1-广泛，4 处 pT2）。超声和组织病理学分期之间的总体一致性kappa 值为 0.81（95%置信区间，0.72-0.89）。没有浸润性癌漏诊。pT1-轻微和 pT1-广泛病变的浸润深度均正确确定，准确率为 87.2%。考虑到 126 例患者的完整系列，该方法在选择适当治疗方法方面的准确性为 95.2%（kappa 值，0.84；95%置信区间，0.71-0.96）。87.5%的 pT1 肿瘤采用了适当的手术。
三维直肠内超声有助于评估早期直肠肿瘤黏膜下浸润的深度，并有助于选择治疗方案。
