Watari J, Saitoh Y, Obara T, Fujiki T, Taniguchi M, Nomura M, Ayabe T, Ohta T, Orii Y, Kohgo Y
Third Department of Internal Medicine, Asahikawa Medical College, Japan.
Radiology. 1997 Oct;205(1):67-74. doi: 10.1148/radiology.205.1.9314964.
To diagnose depth of invasion of early flat and depressed nonpolypoid colorectal cancers with double-contrast barium enema examination.
Ninety-seven early nonpolypoid colorectal cancers, initially identified with colonoscopy, were investigated with double-contrast barium enema examination. Depth of invasion in resected specimens obtained with endoscopic mucosal or surgical resection was determined. Cancer confined to the mucosal layer or with focal extension to the submucosal layer was defined as Ca-m; moderate to massive extension of cancer into the submucosal layer was classified Ca-sm.
In flat elevated and depressed cancers, converging folds and semilunar deformity were observed significantly more frequently in Ca-sm than in Ca-m tumors (P < .05 and P < .01, respectively). Sensitivities and specificities of these findings for Ca-sm tumor were 42%, 93% and 86%, 85%, respectively. Deep depression, irregular surface of the depression, and tumor size larger than 20 mm were also predictive findings for depressed Ca-sm tumors (P < .05); the specificity of each was 100%. With use of these radiographic predictors, overall accuracy for diagnosing depth of invasion was 85%.
Findings on double-contrast barium enema study are highly predictive of depth of invasion of early nonpolypoid colorectal cancer. Radiographic findings of converging folds, semilunar deformity, deep depression, irregular surface of the depression, and tumor size are predictors of Ca-sm tumor.
通过双重对比钡剂灌肠检查诊断早期扁平型和凹陷型非息肉样结直肠癌的浸润深度。
对97例最初经结肠镜检查发现的早期非息肉样结直肠癌患者进行双重对比钡剂灌肠检查。确定经内镜黏膜切除术或手术切除获得的切除标本中的浸润深度。局限于黏膜层或局灶性浸润至黏膜下层的癌定义为Ca-m；癌中度至大量浸润至黏膜下层的分类为Ca-sm。
在扁平隆起型和凹陷型癌中，Ca-sm肿瘤中观察到的聚集皱襞和半月形畸形明显比Ca-m肿瘤更常见（分别为P <.05和P <.01）。这些表现对Ca-sm肿瘤的敏感性和特异性分别为42%、93%和86%、85%。深度凹陷、凹陷表面不规则以及肿瘤大小大于20 mm也是凹陷型Ca-sm肿瘤的预测性表现（P <.05）；每种表现的特异性均为100%。使用这些影像学预测指标，诊断浸润深度的总体准确率为85%。
双重对比钡剂灌肠检查结果对早期非息肉样结直肠癌的浸润深度具有高度预测性。聚集皱襞、半月形畸形、深度凹陷、凹陷表面不规则以及肿瘤大小的影像学表现是Ca-sm肿瘤的预测指标。
