Barbaro B, Savastano M, Sallustio G
Instituto di Radiologia, Università Cattolica del S. Cuore, Policlinico A. Gemelli, Roma, Italy.
Rays. 1995 Apr-Jun;20(2):145-55.
The work-up conducted in order to reach a correct diagnosis based on a combined modality staging in patients with low risk rectal cancer, is presented. The diagnostic accuracy of each imaging technique is analyzed by the comparison of the radiologic TN with the histologic TN in 13 patients directly referred to surgery based on combined modality staging. Control with histologic findings has staged as T1-T2 13 patients directly referred to surgery, while only a patient was shown to have microinfiltration of perirectal fat. As for T, diagnostic accuracy was 90% for transrectal US, 66% for MRI, 61% for CT. Accuracy of transrectal sonography in the differentiation of T1 from T2 was 70% with a trend towards overstaging. None of the procedures has suggested the presence of metastatic lymph nodes while on histology small neoplastic foci were evidenced in a normal-sized perirectal lymph node. The high diagnostic accuracy of US in the definition of T in rectal cancer is confirmed. It is underlined that no procedure enables the detection of neoplastic microinfiltration of normal lymph nodes.
本文介绍了为基于联合分期对低风险直肠癌患者做出正确诊断而进行的检查。通过比较13例基于联合分期直接接受手术的患者的放射学TN与组织学TN，分析了每种成像技术的诊断准确性。根据组织学结果进行的对照显示，13例直接接受手术的患者分期为T1-T2，而仅1例患者显示有直肠周围脂肪微浸润。至于T分期，经直肠超声的诊断准确性为90%，MRI为66%，CT为61%。经直肠超声区分T1和T2的准确性为70%，有过度分期的趋势。在组织学检查中，正常大小的直肠周围淋巴结中有小的肿瘤病灶，但所有检查均未提示存在转移性淋巴结。经直肠超声在直肠癌T分期定义中的高诊断准确性得到了证实。需要强调的是，没有任何检查能够检测出正常淋巴结的肿瘤微浸润。
