Solomon M J, McLeod R S
Department of Surgery, University of Toronto, Ontario, Canada.
Dis Colon Rectum. 1993 Feb;36(2):200-5. doi: 10.1007/BF02051183.
The significant risk of local recurrence after curative resection and the relative inaccuracy of preoperative clinical assessment justify a more sophisticated assessment for carcinoma of the rectum. Endoluminal rectal ultrasonography (EU) can directly visualize the degree of rectal wall penetration by tumor and the immediate pararectal lymph nodes. Despite several reports reporting excellent accuracy of EU compared with pathology in detecting the degree of tumor penetration, EU remains restricted in terms of widespread availability. A review of the literature was performed to determine the accuracy, reliability, and current validity of EU. Raw data were collected from cross-sectional surveys assessing the degree of tumor penetration in 873 patients and lymph node involvement in 571 patients with primary rectal cancer. EU is very accurate at determining tumor penetration (kappa = 0.85) but is only moderately accurate at detecting lymph node involvement (kappa = 0.58). The reliability of EU has not been assessed, and a simple protocol is proposed. The validity of EU was assessed in only a few studies. EU is credible and feasible, makes intuitive biologic sense, and is, perhaps, sensitive to change. The ability to make clinical decisions based on EU (content validity) will decide whether widespread implementation is applicable.
根治性切除术后局部复发的高风险以及术前临床评估的相对不准确性，使得对直肠癌进行更精细的评估成为必要。腔内直肠超声检查（EU）能够直接观察肿瘤穿透直肠壁的程度以及紧邻的直肠旁淋巴结。尽管有几份报告称EU在检测肿瘤穿透程度方面与病理学相比具有出色的准确性，但EU在广泛应用方面仍受到限制。我们进行了一项文献综述，以确定EU的准确性、可靠性和当前有效性。从横断面调查中收集了原始数据，这些调查评估了873例原发性直肠癌患者的肿瘤穿透程度以及571例患者的淋巴结受累情况。EU在确定肿瘤穿透方面非常准确（kappa = 0.85），但在检测淋巴结受累方面仅具有中等准确性（kappa = 0.58）。尚未评估EU的可靠性，本文提出了一个简单的方案。仅在少数研究中评估了EU的有效性。EU是可信且可行的，具有直观的生物学意义，并且可能对变化敏感。基于EU做出临床决策的能力（内容效度）将决定其是否适用于广泛应用。
