Hünerbein M, Dohmoto M, Haensch W, Schlag P M
Virchow Hospital, Robert Rössle Hospital and Tumor Institute, Humboldt University, Berlin, Germany.
Dis Colon Rectum. 1996 Dec;39(12):1373-8. doi: 10.1007/BF02054526.
The value of endorectal ultrasonography for postoperative follow-up of rectal cancer is limited by the inability to distinguish recurrent malignancy from benign lesions, e.g., fibrotic tissue. This study was conducted to investigate the role of three-dimensional (3D) endosonography for evaluation and biopsy of recurrent rectal cancer.
Endorectal ultrasonography was performed in routine follow-up program after resection of rectal cancer. 3D volume scans were recorded using a bifocal multiplane 3D transducer (7.5/10 MHz) with a 100 degrees longitudinal and a 360 degrees transversal scan angle. For transrectal ultrasound-guided biopsy of pararectal lesions, a specially designed targeting device was attached to the endoprobe.
Overall pararectal lesions were detected in 28 of 163 patients (17 percent) who were undergoing endorectal ultrasonography for follow-up after resection of rectal cancer. 3D image analysis facilitated assessment of suspicious pararectal lesions by contemporary display of three perpendicular scan planes or volume reconstructions of the scanned area. Ultrasound-guided biopsy was performed in all 28 patients with pararectal lesions identified by endorectal ultrasonography. Biopsy revealed recurrent disease or lymph node metastases in seven and two patients, respectively. Benign lesions explained the endosonographic findings in 17 patients. All patients with benign histology still have no evidence of recurrent disease after a median follow-up of seven months. Nonrepresentative material was obtained in only 2 of 28 patients (accuracy, 93 percent). Histology changed the endosonographic diagnosis in 28 percent of cases.
3D endosonography with ultrasound-guided biopsy improves the diagnosis of extramural recurrence after curative resection of rectal cancer. 3D image display allows precise control of the position of the biopsy needle within the target.
直肠内超声检查在直肠癌术后随访中的价值因无法区分复发性恶性肿瘤与良性病变（如纤维化组织）而受到限制。本研究旨在探讨三维（3D）内镜超声在复发性直肠癌评估和活检中的作用。
在直肠癌切除术后的常规随访程序中进行直肠内超声检查。使用具有100度纵向和360度横向扫描角度的双焦点多平面3D换能器（7.5/10MHz）记录3D容积扫描。对于直肠旁病变的经直肠超声引导活检，在内窥镜探头附加一个专门设计的靶向装置。
在163例因直肠癌切除术后接受直肠内超声随访的患者中，共检测到28例（17%）直肠旁病变。3D图像分析通过同时显示三个相互垂直的扫描平面或扫描区域的容积重建，有助于评估可疑的直肠旁病变。对经直肠内超声检查发现的所有28例直肠旁病变患者均进行了超声引导活检。活检分别在7例和2例患者中发现复发性疾病或淋巴结转移。17例患者的超声检查结果为良性病变。所有组织学结果为良性的患者在中位随访7个月后仍无复发性疾病的证据。28例患者中仅有2例获取的标本不具有代表性（准确率93%）。组织学在28%的病例中改变了超声检查诊断。
3D内镜超声结合超声引导活检可提高直肠癌根治性切除术后壁外复发的诊断率。3D图像显示可精确控制活检针在目标内的位置。
