Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-0054, Japan.
Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Yahaba, 028-3695, Japan.
Cancer Imaging. 2021 Dec 7;21(1):66. doi: 10.1186/s40644-021-00437-z.
The indication for endoscopic resection for submucosally invasive colorectal cancer (T1-CRC) depends on the preoperative diagnosis of invasion depth. The aim of this investigation was to evaluate the association between barium enema examination (BE) profile views and depth of submucosal (SM) invasion in CRCs.
We reviewed the radiographic and endoscopic findings of 145 T1-CRCs diagnosed from 2008 to 2019. We measured the widths of horizontal and vertical rigidity under a BE profile view corresponding to CRC and compared the values with SM invasion depth. Horizontal rigidity was defined as the horizontal length and vertical rigidity as the vertical width of the barium defect corresponding to each target lesion. The most appropriate cut-off values for predicting SM invasion ≥1.8 mm were calculated by receiver operating characteristic curve analysis.
Values of horizontal rigidity (r = 0.626, P < 0.05) and vertical rigidity (r = 0.482, P < 0.05) correlated significantly with SM invasion depth. The most appropriate cut-off values for the prediction of SM invasion depth ≥ 1.8 mm were 4.5 mm for horizontal rigidity, with an accuracy of 80.7%; and 0.7 mm for vertical rigidity, with an accuracy of 77.9%. The prevalence of lympho-vascular invasion was significantly different when those cut-off values were applied (43.2% vs. 17.5% for horizontal rigidity, P < 0.005).
In T1-CRC, values of horizontal and vertical rigidities under a BE profile view were correlated with SM invasion depth. While the accuracy of the rigidities for the prediction of SM invasion depth ≥ 1.8 mm was not high, horizontal rigidity may be predictive of lympho-vascular invasion, thus aiding in therapeutic decision-making.
内镜下黏膜切除术（ESD）治疗黏膜下浸润性结直肠癌（T1-CRC）的适应证取决于术前对浸润深度的诊断。本研究旨在评估钡剂灌肠检查（BE）侧位像与 CRC 黏膜下（SM）浸润深度之间的关系。
我们回顾了 2008 年至 2019 年间诊断为 T1-CRC 的 145 例患者的放射学和内镜检查结果。我们测量了 BE 侧位像中对应 CRC 的水平和垂直刚性的宽度，并将这些值与 SM 浸润深度进行了比较。水平刚性定义为水平长度，垂直刚性定义为每个靶病变对应的钡剂缺损的垂直宽度。通过受试者工作特征曲线分析计算预测 SM 浸润深度≥1.8mm 的最佳截断值。
水平刚性（r=0.626，P<0.05）和垂直刚性（r=0.482，P<0.05）与 SM 浸润深度显著相关。预测 SM 浸润深度≥1.8mm 的最佳截断值分别为水平刚性 4.5mm，准确率为 80.7%；垂直刚性 0.7mm，准确率为 77.9%。当应用这些截断值时，淋巴血管侵犯的发生率存在显著差异（水平刚性为 43.2% vs. 17.5%，P<0.005）。
在 T1-CRC 中，BE 侧位像的水平和垂直刚性值与 SM 浸润深度相关。虽然刚性值预测 SM 浸润深度≥1.8mm 的准确性不高，但水平刚性可能有助于预测淋巴血管侵犯，从而辅助治疗决策。
