Senagore A, Milsom J W, Senagore P, Mazier W P, Scholten D J, Zydbel P
Department of Surgical Research, Ferguson Clinic, Grand Rapids, Michigan 49503.
J Surg Res. 1988 May;44(5):522-6. doi: 10.1016/0022-4804(88)90157-6.
The purpose of this study was to compare the accuracy of preoperative staging of experimental rectal tumors by digital rectal exam, intrarectal ultrasound (IRUS), and CT scanning with pathologic exam. Rectal tumor masses were induced in 10 mongrel dogs by submucosal injection of 2-3 cc of Freund's complete adjuvant. One week later, the animals underwent digital rectal exam, IRUS, and pelvic CT scans. Pelvic exenteration specimens were submitted for pathologic evaluation. Evaluations and interpretations were done in blinded fashion by independent examiners. The rectal "tumor" was detected in 9 of 10 digital exams, 10 of 10 IRUS exams, and 1 of 10 CT scans. Correct Duke's staging occurred in 70% of digital exams, 90% of IRUS exams, and 10% of CT exams compared to pathological staging. Lymph nodes were detected on pathologic exam in all animals (8.7/animal, range 3-16), on IRUS in all animals (6.4/animal, range 5-13), and in none of the digital or CT examinations. IRUS was significantly more accurate in detecting (P less than 0.0001) and locally staging tumors (P less than 0.0001), and in detecting and localizing lymphadenopathy compared to CT scan. Intrarectal ultrasound is a simple, highly accurate device for assessing depth of wall penetration of rectal tumors and in detecting pararectal lymph nodes and should be considered the preoperative staging procedure of choice for rectal cancer.
本研究的目的是比较直肠指检、直肠内超声（IRUS）和CT扫描对实验性直肠肿瘤进行术前分期的准确性，并与病理检查结果进行对比。通过向10只杂种犬的黏膜下注射2 - 3毫升弗氏完全佐剂诱导直肠肿瘤块形成。一周后，对这些动物进行直肠指检、IRUS检查和盆腔CT扫描。将盆腔脏器清除标本送去做病理评估。评估和解读由独立的检查人员以盲法进行。在10次直肠指检中有9次检测到直肠“肿瘤”，10次IRUS检查均检测到，而10次CT扫描中只有1次检测到。与病理分期相比，正确的杜克分期在直肠指检中占70%，在IRUS检查中占90%，在CT检查中占10%。所有动物的病理检查均发现有淋巴结（平均每只动物8.7个，范围3 - 16个），IRUS检查也均发现有淋巴结（平均每只动物6.4个，范围5 - 13个），而直肠指检和CT检查均未发现。与CT扫描相比，IRUS在检测肿瘤（P < 0.0001）、对肿瘤进行局部分期（P < 0.0001）以及检测和定位淋巴结病方面显著更准确。直肠内超声是一种简单、高度准确的设备，可用于评估直肠肿瘤的壁层浸润深度以及检测直肠旁淋巴结，应被视为直肠癌术前分期的首选检查方法。
