Holdsworth P J, Johnston D, Chalmers A G, Chennells P, Dixon M F, Finan P J, Primrose J N, Quirke P
University Department of Surgery, General Infirmary, Leeds, UK.
Br J Surg. 1988 Oct;75(10):1019-22. doi: 10.1002/bjs.1800751022.
Pre-operative staging of rectal cancer might define patients with disease confined to the rectal wall without lymph node metastases, in whom local excision might be appropriate, or patients with extrarectal spread, who might benefit from pre-operative radiotherapy. With these objectives, 36 consecutive patients with rectal cancer were studied by endoluminal ultrasound: 17 of them also underwent computed tomography (CT) of the pelvis. The results were correlated with the findings at operation and subsequent pathological examination. Endoluminal ultrasound correctly predicted invasion of the tumour through the rectal wall in 86 per cent of patients, with a sensitivity of 96 per cent and specificity of 50 per cent, but correctly identified lymph node metastases in only 61 per cent of patients (sensitivity 57 per cent; specificity 64 per cent). CT correctly predicted invasion through the rectal wall in 94 per cent of cases, with a sensitivity of 100 per cent and specificity of 67 per cent and correctly identified lymph node metastases in 70 per cent of patients (sensitivity 25 per cent; specificity 85 per cent). These findings indicate that both endoluminal ultrasound and CT may be helpful in selecting patients for pre-operative radiotherapy. Neither technique, however, can reliably identify lymph node metastases and therefore cannot be used to select patients who would be suitable for local excision.
直肠癌的术前分期可明确疾病局限于直肠壁且无淋巴结转移的患者（这类患者可能适合局部切除），或有直肠外扩散的患者（这类患者可能从术前放疗中获益）。基于这些目的，对36例连续性直肠癌患者进行了腔内超声检查：其中17例还接受了盆腔计算机断层扫描（CT）。将检查结果与手术及后续病理检查结果进行了对比。腔内超声在86%的患者中正确预测了肿瘤穿透直肠壁，敏感性为96%，特异性为50%，但仅在61%的患者中正确识别出淋巴结转移（敏感性57%；特异性64%）。CT在94%的病例中正确预测了穿透直肠壁的情况，敏感性为100%，特异性为67%，在70%的患者中正确识别出淋巴结转移（敏感性25%；特异性85%）。这些结果表明，腔内超声和CT在选择术前放疗的患者时可能都有帮助。然而，这两种技术都不能可靠地识别淋巴结转移，因此不能用于选择适合局部切除的患者。
