Department of Gastroenterology, Hospital Vitkovice, Ostrava-Vitkovice, Czech Republic.
Surg Endosc. 2011 Oct;25(10):3393-9. doi: 10.1007/s00464-011-1737-7. Epub 2011 May 18.
This prospective study aimed to evaluate the impact of high-frequency ultrasound probe sonography (HFUPS) staging on the management of patients with superficial colorectal neoplasia (SCN) as determined by the endoscopic characteristics of lesions.
Consecutive patients referred for endoscopic treatment of nonpedunculated SCN were enrolled in this study. A lesion was considered high risk if a depressed area or invasive pit pattern was present. The gold standard for final staging included histology from endoscopic or surgical resection. The impact on treatment was defined as any modification of the therapeutic algorithm based on the result of the HFUPS examination compared with that based on endoscopy alone.
In this study, 48 lesions in 48 patients were evaluated. Of these, 28 (58%) were considered high risk, and the remaining 20 (42%) were regarded as low risk. A total of seven lesions (15%) that could not be examined with HFUPS and another non-neoplastic lesion were excluded from final analysis. For the remaining 40 lesions, the overall accuracy of the HFUPS examination to predict the correct T-stage was 90% (95% confidence interval [CI], 77-96%). The HFUPS examination had a positive impact on the treatment of 0 low-risk and 11 high-risk (42%) lesions.
The impact of HFUPS on the treatment of SCN depends on their endoscopic characteristics. It is negligible for low-risk SCNs, and these lesions can be treated on the basis of their endoscopic appearance alone. Nevertheless, compared with endoscopy alone, HFUPS changed the subsequent therapeutic approach in a positive way for up to 42% of high-risk lesions, including those with a depressed component and an invasive pit pattern. These endoscopic features can therefore be recommended as the entry criteria for an HFUPS examination.
本前瞻性研究旨在评估高频超声探头超声（HFUPS）分期对内镜下病变特征确定的浅表结直肠肿瘤（SCN）患者管理的影响。
本研究纳入了连续就诊行内镜治疗的非息肉状 SCN 患者。若存在凹陷区域或侵袭性陷窝模式，则认为病变为高危。最终分期的金标准包括内镜或手术切除的组织学。根据 HFUPS 检查结果与仅根据内镜检查结果的治疗算法的任何修改来定义对治疗的影响。
本研究共评估了 48 例 48 个病灶，其中 28 个（58%）被认为是高危的，其余 20 个（42%）被认为是低危的。共有 7 个病灶（15%）因无法进行 HFUPS 检查和另一个非肿瘤性病变而被排除在最终分析之外。对于剩余的 40 个病灶，HFUPS 检查预测正确 T 分期的总体准确性为 90%（95%置信区间 [CI]，77-96%）。HFUPS 检查对 0 个低危和 11 个高危（42%）病灶的治疗有积极影响。
HFUPS 对 SCN 治疗的影响取决于其内镜特征。对于低危 SCN，HFUPS 的影响可以忽略不计，这些病变可以仅根据其内镜表现进行治疗。然而，与单纯内镜检查相比，HFUPS 改变了高达 42%高危病变的后续治疗方法，包括那些有凹陷成分和侵袭性陷窝模式的病变。因此，可以将这些内镜特征推荐作为进行 HFUPS 检查的纳入标准。
