Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan.
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan,
Digestion. 2021;102(5):701-713. doi: 10.1159/000511589. Epub 2020 Nov 18.
We aimed to compare the efficacy of endoscopic ultrasound elastography (EUS-EG) with that of magnifying chromoendoscopy (MCE) and endoscopic ultrasonography (EUS) for the diagnosis of the depth of invasion in colorectal neoplasms. This is an important clinical issue as the depth of invasion is associated with the risk of metastasis.
Consecutive patients with suspected superficial colorectal neoplasms, evaluated by MCE, EUS, and EUS-EG, for whom endoscopic submucosal dissection was considered, were enrolled in 2018 (derivation study) and in 2019-2020 (validation study). The primary clinical endpoint was the diagnostic yield differentiating intramucosal and shallow submucosal neoplasms from deep submucosal (dSM) and advanced colorectal cancers. In addition, inter- and intra-observer agreements of the elastic score of colorectal neoplasm (ES-CRN) were evaluated by 2 expert and 2 non-expert endoscopists.
Thirty-one (33 lesions) and 50 (55 lesions) patients were enrolled in the derivation and validation studies, respectively. Sensitivity, specificity, positive, and negative predictive values, and accuracy of assessment of the depth of submucosal or deeper invasion in the derivation and validation groups were as follows: EUS-EG, 100/88.2/86.7/100/93.3% and 77.8/86.1/73.7/88.6/83.3%; MCE, 66.7/94.4/90.9/77.3/81.8% and 84.2/91.4/84.2/91.4/88.9%; and EUS, 93.3/77.8/77.8/93.3/84.8% and 89.5/65.7/58.6/92.0/74.1%, respectively. For the 2 expert endoscopists, interobserver agreement for the ES-CRN (first and second assessments) in the derivation group was 0.84 and 0.78, respectively; these values were 0.73 and 0.49, respectively, for the 2 non-expert endoscopists.
DISCUSSION/CONCLUSION: All 3 modalities presented similar diagnostic yield. Inter- and intra-observer agreements of the ES-CRN were substantial, even for non-expert endoscopists. Therefore, EUS-EG may be a useful modality in determining the depth of invasion in colorectal neoplasms.
本研究旨在比较内镜超声弹性成像（EUS-EG）与放大色素内镜（MCE）和超声内镜（EUS）对结直肠肿瘤浸润深度的诊断效能。这是一个重要的临床问题，因为浸润深度与转移风险相关。
纳入 2018 年（推导研究）和 2019-2020 年（验证研究）期间因疑似浅层结直肠肿瘤而接受 MCE、EUS 和 EUS-EG 评估且适合内镜黏膜下剥离术的连续患者。主要临床终点是区分黏膜内和浅层黏膜下肿瘤与深层黏膜下（dSM）和进展期结直肠癌的诊断效果。此外，由 2 名专家和 2 名非专家内镜医生评估结直肠肿瘤弹性评分（ES-CRN）的组内和组间一致性。
推导研究和验证研究分别纳入 31 例（33 处病变）和 50 例（55 处病变）患者。在推导组和验证组中，EUS-EG 对黏膜下或更深层浸润深度的评估的敏感度、特异度、阳性预测值、阴性预测值和准确度分别为 100/88.2/86.7/100/93.3%和 77.8/86.1/73.7/88.6/83.3%；MCE 为 66.7/94.4/90.9/77.3/81.8%和 84.2/91.4/84.2/91.4/88.9%；EUS 为 93.3/77.8/77.8/93.3/84.8%和 89.5/65.7/58.6/92.0/74.1%。对于 2 名专家内镜医生，推导组 ES-CRN（首次和第二次评估）的组内一致性分别为 0.84 和 0.78；对于 2 名非专家内镜医生，相应的组内一致性分别为 0.73 和 0.49。
讨论/结论：所有 3 种方法的诊断效果相似。ES-CRN 的组内和组间一致性均较大，即使是非专家内镜医生也是如此。因此，EUS-EG 可能是一种有用的确定结直肠肿瘤浸润深度的方法。
