Hordijk M L, Kok T C, Wilson J H, Mulder A H
Department of Internal Medicine II, University Hospital Rotterdam Dijkzigt, The Netherlands.
Endoscopy. 1993 Nov;25(9):592-6. doi: 10.1055/s-2007-1010411.
Endoscopic ultrasonography (EUS) is currently considered the best available technique for the local staging of esophageal cancer. In a prospective study 11 patients with esophageal squamous cell carcinoma were investigated to evaluate the usefulness of EUS in the assessment of response to induction chemotherapy. Response to chemotherapy was evaluated by means of history of dysphagia, endoscopy, computed tomography (CT) and EUS to assess relief of clinical symptoms, reduction of tumor bulk and depth of tumor invasion (T-stage). One patient was excluded because EUS failed. Tumor response was best correlated with relief of dysphagia and by tumor bulk reduction as determined on endoscopy and CT. We found it not useful to measure reduction of tumor bulk with EUS because of tumor compression by the instrument, stenosis, or the hypoechoic thickening of the esophageal wall caused by an inflammatory reaction after chemotherapy. There was no change in EUS T-staging after induction chemotherapy compared to prechemotherapy assessment. EUS T-staging after induction chemotherapy was accurate in 6 of 10 patients compared to the histopathologic examination of the resected specimen. There was EUS T3-overstaging in 4 patients, caused by partial or complete replacement of the tumor by an inflammatory reaction due to chemotherapy. We conclude that inflammatory changes induced by chemotherapy lead to EUS overstaging of the T stage thus making it a less reliable tool in restaging after chemotherapy.
内镜超声检查（EUS）目前被认为是食管癌局部分期的最佳可用技术。在一项前瞻性研究中，对11例食管鳞状细胞癌患者进行了调查，以评估EUS在评估诱导化疗反应中的作用。通过吞咽困难病史、内镜检查、计算机断层扫描（CT）和EUS来评估化疗反应，以评估临床症状的缓解、肿瘤体积的缩小和肿瘤浸润深度（T分期）。1例患者因EUS检查失败被排除。肿瘤反应与吞咽困难的缓解以及内镜检查和CT确定的肿瘤体积缩小最相关。我们发现，由于仪器压迫肿瘤、狭窄或化疗后炎症反应导致食管壁低回声增厚，用EUS测量肿瘤体积缩小并无帮助。与化疗前评估相比，诱导化疗后EUS的T分期没有变化。与切除标本的组织病理学检查相比，诱导化疗后EUS的T分期在10例患者中有6例是准确的。4例患者出现EUS T3期过度分期，原因是化疗引起的炎症反应部分或完全取代了肿瘤。我们得出结论，化疗引起的炎症变化导致EUS对T期过度分期，因此使其在化疗后重新分期中成为一种不太可靠的工具。
