Hünerbein M, Dohmoto M, Rau B, Schlag P M
Virchow Hospital, Robert Rössle Hospital and Tumor Institute, Humboldt University, Lindenbergerweg 80, 13122 Berlin, Germany.
Surg Endosc. 1996 Dec;10(12):1205-9. doi: 10.1007/s004649900280.
The purpose of the present study was to evaluate the accuracy of endoscopic ultrasonography (EUS) with a curved-array transducer and to determine the value of endosonography-guided biopsy.
EUS was performed in 162 consecutive patients for preoperative staging of gastric or esophageal cancer (n = 122) or for EUS-guided biopsy (n = 40). All patients were examined using a flexible echoendoscope (Pentax FG32-UA) equipped with a 7.5-MHz curved-array transducer. A specially designed fine needle was used for EUS-guided biopsy of submucosal or extrinsic lesions.
Surgery was performed in 19 of 48 patients with esophageal cancer and 60 of 74 patients with gastric cancer. The accuracy in the assessment of the infiltration depth of esophageal cancer and in the determination of lymph node involvement was 84% and 88%, respectively. In gastric cancer the tumor infiltration depth was assessed correctly in only 65% of the patients. The identification of early gastric cancer proved to be a major problem. The accuracy in the detection of lymph node involvement was 73%. Obstructing tumors were examined in 17 patients with carcinoma of the esophagus or the gastric cardia. The accuracy of EUS in determining the T-stage and the N-stage of stenotic tumors was 88% and 86%, respectively. Endosonography-guided needle biopsy was successfully performed in all 40 patients. Histologic analysis revealed malignancy in 50% of the patients. Only two biopsy specimens contained nonrepresentative material (accuracy: 95%). No complications were observed related to the procedure.
EUS with a curved-array transducer provides high accuracy rates in staging of esophageal carcinoma. Evaluation of gastric cancer with this technique appears to be more difficult than with radial transducers. A major advantage of the linear transducer is the ability to perform EUS-guided biopsies of submucosal or extamural lesions.
本研究旨在评估使用弯阵换能器的内镜超声检查（EUS）的准确性，并确定内镜超声引导下活检的价值。
对162例连续患者进行EUS检查，用于胃癌或食管癌的术前分期（n = 122）或EUS引导下活检（n = 40）。所有患者均使用配备7.5MHz弯阵换能器的可弯曲超声内镜（宾得FG32-UA）进行检查。使用专门设计的细针进行EUS引导下的黏膜下或外生性病变活检。
48例食管癌患者中的19例和74例胃癌患者中的60例接受了手术。食管癌浸润深度评估和淋巴结受累判定的准确率分别为84%和88%。在胃癌中，仅65%的患者肿瘤浸润深度评估正确。早期胃癌的识别是一个主要问题。淋巴结受累检测的准确率为73%。对17例食管癌或贲门癌患者的梗阻性肿瘤进行了检查。EUS确定狭窄性肿瘤T分期和N分期的准确率分别为88%和86%。所有40例患者均成功进行了内镜超声引导下针吸活检。组织学分析显示50%的患者为恶性。只有两份活检标本包含非代表性材料（准确率：95%）。未观察到与该操作相关的并发症。
使用弯阵换能器的EUS在食管癌分期中具有较高的准确率。用该技术评估胃癌似乎比用径向换能器更困难。线性换能器的一个主要优点是能够对黏膜下或壁外病变进行EUS引导下活检。
