Patel Rikesh Kumar, Sayers Adele Elizabeth, Kumar Prashanth, Khulusi Sam, Razack Abdul, Hunter Iain Andrew
Academic Surgical Unit, Castle Hill Hospital, Cottingham, United Kingdom.
Academic Surgical Unit, Castle Hill Hospital, Cottingham, United Kingdom.
Clin Colorectal Cancer. 2014 Dec;13(4):245-50. doi: 10.1016/j.clcc.2014.09.002. Epub 2014 Sep 21.
In early rectal cancer, ERUS has a vital role in determining radical or local excision based on identification of T-stage. Transanal endoscopic microsurgery (TEMs) has a reduced morbidity and mortality compared with radical surgery. Correct identification of lesions that can be managed with TEMs is therefore imperative. Our aim was to assess the accuracy of ERUS in identifying mucosal/submucosal lesions and thus their suitability for TEMs.
A retrospective analysis of a prospectively maintained database of patients who underwent ERUS was carried out over an initial 25-month period at a tertiary colorectal center. Our main outcome measures were T-stage measured using ERUS or magnetic resonance imaging (MRI) (indicating suitability for local excision, ie, ≤ T1) with correlation with that of the subsequent surgical specimen and improvement in accuracy over time. After data analysis and review, the study was repeated over the subsequent 12 months to establish whether there was a learning curve with the use of ERUS.
Over the initial period, 52 patients who met the inclusion criteria underwent ERUS. T-staging was accurate in 73.1% (38/52) with identification of ≤ T1 lesions having a sensitivity of 70.8% and a specificity 100%. The accuracy, sensitivity, and specificity of MRI was similar to that of ERUS (72.7%, 70.0%, and 100% respectively). Over the subsequent period, 23 patients underwent ERUS with T-staging accuracy improving to 78.3% (18/23) (P = .777).
In our experience, ERUS is a useful adjunct to clinical assessment and pelvic MRI in determining suitability for local excision. Its 100% specificity in determining that a lesion is limited to the mucosa or submucosa aids in the assessment of lesions that are being considered for submucosal resection. Over the time periods assessed, improvement in T-staging accuracy was demonstrated, which might be due to the presence of a learning curve.
在早期直肠癌中，超声内镜检查（ERUS）在基于T分期的判定以确定行根治性手术还是局部切除方面起着至关重要的作用。与根治性手术相比，经肛门内镜显微手术（TEMs）的发病率和死亡率更低。因此，正确识别适合TEMs治疗的病变至关重要。我们的目的是评估ERUS在识别黏膜/黏膜下病变以及判断其是否适合TEMs治疗方面的准确性。
在一家三级结直肠中心，对一个前瞻性维护的接受ERUS检查患者数据库进行了为期25个月的回顾性分析。我们的主要观察指标是使用ERUS或磁共振成像（MRI）测量的T分期（表明适合局部切除，即≤T1），并与后续手术标本的T分期进行相关性分析，以及随着时间推移准确性的提高情况。经过数据分析与审查后，在随后的12个月里重复该研究，以确定使用ERUS是否存在学习曲线。
在最初阶段，52例符合纳入标准的患者接受了ERUS检查。T分期的准确率为73.1%（38/52），识别≤T1病变的敏感性为70.8%，特异性为100%。MRI的准确率、敏感性和特异性与ERUS相似（分别为72.7%、70.0%和100%）。在随后阶段，23例患者接受了ERUS检查，T分期准确率提高到78.3%（18/23）（P = 0.777）。
根据我们的经验，在确定是否适合局部切除方面，ERUS是临床评估和盆腔MRI的有用辅助手段。其在判定病变局限于黏膜或黏膜下层方面具有100%的特异性，有助于评估考虑行黏膜下切除的病变。在所评估的时间段内，T分期准确性有所提高，这可能是由于存在学习曲线。
