术前放化疗后经直肠超声与 CT 和 MRI 对局部进展期直肠癌的准确性比较。
Accuracy of transrectal ultrasound after preoperative radiochemotherapy compared to computed tomography and magnetic resonance in locally advanced rectal cancer.
机构信息
Surgical Department, University of Siena, Siena, Italy.
出版信息
Int J Colorectal Dis. 2012 Jul;27(7):967-73. doi: 10.1007/s00384-012-1419-5. Epub 2012 Feb 3.
INTRODUCTION
The aim of the present study was to compare the restaging results obtained by transrectal ultrasound (TRUS), computed tomography (CT), and magnetic resonance imaging (MRI) performed after preoperative chemoradiation with pathologic staging of the operative specimen.
METHODS
From January 2008 to December 2009, all the consecutive patients with locally advanced rectal cancer that underwent neoadjuvant therapy at our department were evaluated. The results of diagnostic examinations and the definitive pathological examination were considered and compared.
RESULTS
Thirty-seven patients were included in the study (27 males, 73%), mean age was 65.5 years (range 45–82 years). In all the patients TRUS and CT and in 20 patients MRI were performed before and after the treatment. Concerning the depth of invasion after treatment TRUS agreed with histopathology in 25/37 patients (67.5%), CT agreed in 22/ 37 cases (59.5%), and MRI in 12/20 cases (60%). Considering only neoplasia with stage T3, TRUS agreed in 23/24 cases (96%), CT in 19 cases (79%), and MRI in 10/12 cases (83.5%). Considering the tumors that did not exceed the rectal wall (T0, T1, and T2), TRUS agreed with histology in 2/13 cases (15.5%),CTin 3/13 cases (23%), andMRI 2/8 cases (25%). Concerning the presence of positive lymph nodes TRUS agreed with histology in 28/37 cases (75.5%), while CT agreed in 21/37 cases (56.5%) and MRI in 11/20 cases (55%). The concordance between the techniques was found to be low.
CONCLUSIONS
Transrectal ultrasonography resulted as the most accurate method to determine neoplastic wall infiltration and lymph node involvement even after radiochemotherapy. In most cases, considering the poor correlation between the diagnostic procedures and the disagreement of the results, a restaging performed only with TRUS could be proposed, limiting the use of the other imaging methods to selected cases.
介绍
本研究旨在比较经术前放化疗后行直肠超声（TRUS）、计算机断层扫描（CT）和磁共振成像（MRI）与手术标本病理分期的再分期结果。
方法
2008 年 1 月至 2009 年 12 月，所有在我院接受新辅助治疗的局部晚期直肠癌连续患者均接受评估。对诊断检查和明确的病理检查结果进行了考虑和比较。
结果
37 例患者入组（27 例男性，73%），平均年龄 65.5 岁（45-82 岁）。所有患者均在治疗前后行 TRUS 和 CT 检查，20 例患者行 MRI 检查。治疗后肿瘤侵犯深度方面，TRUS 与组织病理学结果相符 25/37 例（67.5%），CT 相符 22/37 例（59.5%），MRI 相符 12/20 例（60%）。仅考虑 T3 期肿瘤，TRUS 与组织学结果相符 24/24 例（96%），CT 相符 19 例（79%），MRI 相符 10/12 例（83.5%）。对于未超出直肠壁的肿瘤（T0、T1 和 T2），TRUS 与组织学结果相符 13/13 例（15.5%），CT 相符 3/13 例（23%），MRI 相符 2/8 例（25%）。对于阳性淋巴结，TRUS 与组织学结果相符 37/37 例（75.5%），CT 相符 21/37 例（56.5%），MRI 相符 11/20 例（55%）。各技术之间的一致性较低。
结论
经直肠超声是确定肿瘤壁浸润和淋巴结受累的最准确方法，即使在放化疗后也是如此。在大多数情况下，由于诊断程序之间的相关性差和结果不一致，仅行 TRUS 再分期可能是可行的，限制了其他影像学方法在选定病例中的应用。
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