Kobayashi Kiyonori, Kawagishi Kana, Ooka Shouhei, Yokoyama Kaoru, Sada Miwa, Koizumi Wasaburo
Kiyonori Kobayashi, Research and Development Center for New Medical Frontiers, Kitasato University, School of Medicine, Sagamihara, Kanagawa 252-0380, Japan.
World J Gastroenterol. 2015 Mar 7;21(9):2693-9. doi: 10.3748/wjg.v21.i9.2693.
To evaluate the clinical usefulness of endoscopic ultrasonography (EUS) for the diagnosis of the invasion depth of ulcerative colitis-associated tumors.
The study group comprised 13 patients with 16 ulcerative colitis (UC)-associated tumors for which the depth of invasion was preoperatively estimated by EUS. The lesions were then resected endoscopically or by surgical colectomy and were examined histopathologically. The mean age of the subjects was 48.2 ± 17.1 years, and the mean duration of UC was 15.8 ± 8.3 years. Two lesions were treated by endoscopic resection and the other 14 lesions by surgical colectomy. The depth of invasion of UC-associated tumors was estimated by EUS using an ultrasonic probe and was evaluated on the basis of the deepest layer with narrowing or rupture of the colonic wall.
The diagnosis of UC-associated tumors by EUS was carcinoma for 13 lesions and dysplasia for 3 lesions. The invasion depth of the carcinomas was intramucosal for 8 lesions, submucosal for 2, the muscularis propria for 2, and subserosal for 1. Eleven (69%) of the 16 lesions arose in the rectum. The macroscopic appearance was the laterally spreading tumor-non-granular type for 4 lesions, sessile type for 4, laterally spreading tumor-granular type for 3, semi-pedunculated type (Isp) for 2, type 1 for 2, and type 3 for 1. The depth of invasion was correctly estimated by EUS for 15 lesions (94%) but was misdiagnosed as intramucosal for 1 carcinoma with high-grade submucosal invasion. The 2 lesions treated by endoscopic resection were intramucosal carcinoma and dysplasia, and both were diagnosed as intramucosal lesions by EUS.
EUS provides a good estimation of the invasion depth of UC-associated tumors and may thus facilitate the selection of treatment.
评估内镜超声检查（EUS）在诊断溃疡性结肠炎相关肿瘤浸润深度方面的临床实用性。
研究组包括13例患有16个溃疡性结肠炎（UC）相关肿瘤的患者，术前通过EUS估计肿瘤浸润深度。然后通过内镜切除或手术结肠切除术切除病变，并进行组织病理学检查。受试者的平均年龄为48.2±17.1岁，UC的平均病程为15.8±8.3年。2个病变通过内镜切除治疗，其他14个病变通过手术结肠切除术治疗。使用超声探头通过EUS估计UC相关肿瘤的浸润深度，并根据结肠壁狭窄或破裂的最深层进行评估。
EUS诊断为UC相关肿瘤的病变中，13个为癌，3个为发育异常。癌的浸润深度为黏膜内8个病变，黏膜下2个，固有肌层2个，浆膜下1个。16个病变中有11个（69%）发生在直肠。宏观表现为侧向扩散肿瘤非颗粒型4个病变，无蒂型4个，侧向扩散肿瘤颗粒型3个，半有蒂型（Isp）2个，1型2个，3型1个。EUS正确估计了15个病变（94%）的浸润深度，但1例高级别黏膜下浸润癌被误诊为黏膜内癌。通过内镜切除治疗的2个病变为黏膜内癌和发育异常，两者均被EUS诊断为黏膜内病变。
EUS能较好地估计UC相关肿瘤的浸润深度，从而有助于治疗方案的选择。
