Ter Borg F, Bartelink M E, Bruil A B, Ledeboer M, van Driel L M J W, Guitink A, Faber J
Department of Gastroenterology and Hepatology, Deventer Hospital, Nico Bolkesteinlaan 75, 7416 SE, Deventer, The Netherlands.
Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands.
Tech Coloproctol. 2024 Dec 20;29(1):29. doi: 10.1007/s10151-024-03073-4.
Local resection of early rectal cancer is being increasingly used. With invasion of the muscularis propria layer of the rectal wall, the risk of lymph node metastasis becomes too high to consider this the optimal oncological treatment. Therefore, a diagnosis of muscular invasion is important before attempting local resection; however, endoscopic and magnetic resonance imaging (MRI) images have limitations, such as overstaging (26-31%). We investigated the potential of linear endoscopic ultrasound (L-EUS) in the diagnosis of muscularis propria invasion.
The study consisted of a development phase, in which linear (L)- EUS features, associated with muscular wall invasion were searched and tested, and a validation phase, during which 30 representative videos were assessed by the author F.t.B. and four experienced endosonographists without experience in rectal L-EUS.
The development cohort consisted of 91 patients (2019-2023). Overall, six EUS features were found to be significantly associated with muscular wall invasion: tornado sign, blob sign, massive connection, layer split, extramural deposit, and, most importantly impaired shiftability between the lesion and muscularis propria layer. During the development phase, these findings demonstrated excellent diagnostic features (sensitivity, 94.4%; specificity, 97.9%; and overstaging, 4%). In the validation phase, the sensitivity, specificity, and overstaging by F.t.B. were 88%, 85%, and 12%, respectively. Among the four inexperienced reviewers, the percentages were 65%-71%, 46%-54%, and 33%-39%, respectively. When considering the 27 videos that were considered easy or moderately difficult to assess, only 55% were correctly interpreted by the inexperienced reviewers.
Linear endoscopic ultrasonography may be a valuable tool for the assessment of ingrowth into the muscularis propria in supposedly early rectal cancer, especially using its dynamic potential to assess fixation to the muscular wall by moving the lesion. However, training will be required to achieve satisfactory results.
早期直肠癌的局部切除术应用越来越广泛。当肿瘤侵犯直肠壁固有肌层时，淋巴结转移风险过高，因此不能将局部切除术视为最佳的肿瘤治疗方法。所以，在尝试局部切除术前，对肌层浸润进行诊断很重要；然而，内镜检查和磁共振成像（MRI）图像存在局限性，比如分期过度（26%-31%）。我们研究了线性内镜超声（L-EUS）在诊断固有肌层浸润方面的潜力。
本研究包括一个探索阶段，在此阶段寻找并测试与肌壁浸润相关的线性（L）-EUS特征；以及一个验证阶段，在此期间由作者F.t.B.和另外四位没有直肠L-EUS经验的经验丰富的超声内镜医师对30个代表性视频进行评估。
探索队列包括91例患者（2019年至2023年）。总体而言，发现六个EUS特征与肌壁浸润显著相关：龙卷风征、斑点征、大量连接、层次分裂、壁外沉积物，最重要的是病变与固有肌层之间的移动性受损。在探索阶段，这些发现显示出出色的诊断特征（敏感性为94.4%；特异性为97.9%；分期过度为4%）。在验证阶段，F.t.B.的敏感性、特异性和分期过度分别为88%、85%和12%。在四位没有经验的评估者中，这些百分比分别为65%-71%、46%-54%和33%-39%。当考虑27个被认为评估难度为容易或中等的视频时，没有经验的评估者仅正确解读了55%。
线性内镜超声可能是评估疑似早期直肠癌固有肌层浸润的一种有价值的工具，特别是利用其动态潜力通过移动病变来评估与肌壁的固定情况。然而，需要进行培训才能取得满意的结果。
