Restivo Angelo, Zorcolo Luigi, Marongiu Luigi, Scintu Francesco, Casula Giuseppe
Department of Surgical Sciences, Colorectal Unit, University of Cagliari, Cagliari, Italy.
Dig Surg. 2015;32(2):129-34. doi: 10.1159/000375537. Epub 2015 Mar 10.
Endorectal ultrasound (ERUS) is considered reliable in staging rectal cancer, but recently some critics have questioned its accuracy. The aim of this study was to evaluate how often an ERUS-based decision leads to an appropriate treatment.
Two hundred and twenty patients with rectal cancer staged with ERUS who underwent a surgical resection or a local excision without neoadjuvant therapy from 1997 to 2012 were included. According to ERUS, patients were divided into three groups of indication: (a) local excision (Tis-1 N0), (b) direct surgery (T2 N0), (c) preoperative chemoradiation (T3-4 or N+). Accuracy was explored by the correlation established with the final pathology.
Accuracy for T and N staging was 65 and 64%, respectively. Indication to local excision and to chemoradiation was correct in 97 and 88% of patients staged by ERUS. Accuracy of indication to direct surgery was poor (37%), and 21% of patients were overtreated in this group.
ERUS seems not able to fulfill all the needs of ideal tailored therapeutic strategies. T2 diagnosis needs to be confirmed by an excisional biopsy before a final decision is made because overstaging of early tumors may occur in a not-so-negligible proportion of patients.
直肠内超声（ERUS）在直肠癌分期中被认为是可靠的，但最近一些批评者对其准确性提出了质疑。本研究的目的是评估基于ERUS的决策导致适当治疗的频率。
纳入1997年至2012年期间220例经ERUS分期且未接受新辅助治疗而行手术切除或局部切除的直肠癌患者。根据ERUS，将患者分为三组适应证：（a）局部切除（Tis-1 N0），（b）直接手术（T2 N0），（c）术前放化疗（T3-4或N+）。通过与最终病理结果建立的相关性来探讨准确性。
T分期和N分期的准确性分别为65%和64%。ERUS分期患者中，局部切除和放化疗适应证的正确比例分别为97%和88%。直接手术适应证的准确性较差（37%），该组中有21%的患者接受了过度治疗。
ERUS似乎无法满足理想的个体化治疗策略的所有需求。在做出最终决定之前，T2诊断需要通过切除活检来确认，因为在不可忽视比例的患者中可能会出现早期肿瘤分期过度的情况。
