Kolev Nikola Y, Tonev Anton Y, Ignatov Valentin L, Zlatarov Aleksander K, Bojkov Vasil M, Kirilova Tanya D, Encheva Elitsa, Ivanov Krasimir
1 Clinic of surgery, St. Marina University Hospital, Medical University of Varna, Varna, Bulgaria.
Int Surg. 2014 Mar-Apr;99(2):106-11. doi: 10.9738/INTSURG-D-13-00227.1.
In the last 20 years, endorectal ultrasound (ERUS) has been one of the main diagnostic methods for locoregional staging of rectal cancer. ERUS is accurate modality for evaluating local invasion of rectal carcinoma into the rectal wall layers (T category). Adding the three-dimensional modality (3-D) increases the capabilities of this diagnostic tool in rectal cancer patients. We review the literature and report our experience in preoperative 3-D ERUS in rectal cancer staging. In the group of 71 patients, the staging of preoperative 3-D endorectal ultrasonography was compared with the postoperative morphologic examination. Three-dimensional ERUS preoperative staging was confirmed with morphologic evaluation in 66 out of 71 cases (92.9%). The detection sensitivities of rectal cancer with 3-D ERUS were as follows: T1, 92.8%; T2, 93.1%; T3, 91.6%; and T4, 100.0%; with specificity values of T1, 98.2%; T2, 95.4%; T3, 97.8%; and T4, 98.5%. Three-dimensional ERUS correctly categorized patients with T1, 97.1%; T2, 94.3%; T3, 95.7%; and T4, 98.5%. The percentage of total overstaged cases was 2.75% and that of understaged cases was 6.87%. The metastatic status of the lymph nodes was determined with a sensitivity of 79.1% (19 of 24), specificity of 91.4% (43 of 47), and diagnostic accuracy of 87.3% (62 of 71). In our experience, 3-D ERUS has the potential to become the diagnostic modality of choice for the preoperative staging of rectal cancer.
在过去20年里，直肠内超声检查（ERUS）一直是直肠癌局部区域分期的主要诊断方法之一。ERUS是评估直肠癌向直肠壁各层局部浸润情况（T分期）的准确方式。增加三维模式（3-D）可提高该诊断工具对直肠癌患者的诊断能力。我们回顾了相关文献并报告了我们在直肠癌分期中应用术前三维ERUS的经验。在71例患者组中，将术前三维直肠内超声检查的分期与术后形态学检查进行了比较。71例中有66例（92.9%）术前三维ERUS分期经形态学评估得到证实。三维ERUS对直肠癌的检测敏感度如下：T1期为92.8%；T2期为93.1%；T3期为91.6%；T4期为100.0%；特异度值分别为：T1期98.2%；T2期95.4%；T3期97.8%；T4期98.5%。三维ERUS对T1期患者的正确分类率为97.1%；T2期为94.3%；T3期为95.7%；T4期为98.5%。分期过高的病例占比为2.75%，分期过低的病例占比为6.87%。确定淋巴结转移状态的敏感度为79.1%（24例中的19例），特异度为91.4%（47例中的43例），诊断准确率为87.3%（71例中的62例）。根据我们的经验，三维ERUS有潜力成为直肠癌术前分期的首选诊断方式。
