微探头内镜超声检查对食管癌TNM分期的价值

TNM分期对评估食管癌患者的疗效和预后至关重要，传统检查包括B超、CT、MRI仅对远处器官和淋巴结转移较敏感，不能很好地对患者进行T、N分期。内镜超声（EUS）能清楚显示食管壁层次和结构。目的：探讨微探头EUS检查对食管癌TNM分期的价值。方法：68例食管癌患者术前采用微探头EUS检查进行TNM分期，并与术后病理检查结果进行比较。结果：食管癌患者术前微探头EUS检查的T、N分期与术后病理分期符合率分别为82．4％和88．2％，其中T1、T2、L、T4期的符合率分别为87．5％、75．0％、83．7％和80．0％，N0、N1期的符合率分别为83．9％和91．9％。结论：微探头EUS检查能较准确地判断食管癌的浸润深度和局部转移，对食管癌T、N分期有较高的准确率，在临床上有助于判断患者的病情和预后。     

超声微探头在结直肠癌术前诊断中的价值

目的探讨超声微探头在结肠癌术前诊断中的价值。方法回顾性分析30例结肠癌患者的超声微探头检查结果，并与术后病理对照。结果超声微探头检查显示：结肠癌T1期7例；T2期5例，T3期17例，T4期5例；与术后病理结果对照，肿瘤的T分期诊断准确率为80．0％（24／30），N分期准确率为73．3％（22／30），其中6例癌性狭窄患者T分期准确率为83．3％（5／6），N分期准确性率66．7％（4／6），8例患者根据术前超声微探头检查结果修订的治疗方案最终证实是合理的。结论在结肠镜操作过程中一次完成的微探头超声检查提高了结直肠癌和癌性狭窄病变术前分期的准确性，在结直肠癌治疗方案制订中具有独特价值。     

微探头联合环扫内镜超声对直肠癌术前分期的价值

目的 评价微探头超声联合环扫内镜超声检查对直肠癌术前分期的特异性、敏感性和准确性以及判断其对直肠癌治疗方案选择的价值.方法 对2007年8月-2008年8月60例术前直肠癌患者行微探头和环扫超声内镜联合探查.参照TNM分期标准进行分期诊断,并与MRI、手术后组织病理学结果对比,总结EUS分期对治疗方案选择的参考价值.结果 在60例直肠癌患者中,EUS分期T1期4例,T2期18例,T3期30例,T4期8例,存在7例分期过度和4例分期不足;MRI分期T1期1例,T2期18例,T3期30例,T4期10例,存在14例分期过度和3例分期不足.微探头超声内镜结合环扫型超声内镜对直肠癌T分期诊断综合准确率为81.67%(49/60),N分期的准确率为78.33%,敏感性和特异性为71.43%和91.03%;MRI对直肠癌T分期准确率为71.67%(43/60),周围淋巴结转移诊断的准确率为83.33%,敏感性和特异性为85.71%和86.96%.结论 微探头联合环扫内镜超声检查是一有效估计直肠癌肠壁浸润深度并对其进行TN分期的方法,且操作简便、痛苦小、诊断准确率较高.     

结直肠癌的低剂量螺旋CT分期与病理对照研究

目的探讨低剂量多层螺旋CT（LDMSCT）结肠成像对结直肠癌分期的临床意义.方法采用50mAs LDMSCT扫描法对33例结肠癌进行术前分期,并与术后病理分期进行诊断性实验分析.结果LDMSCT术前T分期的准确度为75.7%（25/33）,对局限于黏膜肌层肿瘤的阳性预测（PPV）为63.6%,对浸润浆膜层及突破浆膜肿瘤的阴性预测（NPV）为86.4%.LDMSCT术前N分期的敏感度为85.71%（18/21）,N分期阳性诊断准确度为83.3%（15/18）.结论LDMSCT能够预测结肠癌,对结直肠癌能进行准确的术前分期;但对早期病变T分期还有一定限度,准确N分期必须结合肿瘤大小、形态及其生物学行为进行全面的判断.     

直肠癌腔内超声分期的诊断价值及其与TNM分期关系

目的:探讨经直肠腔内超声(TRUS)对直肠癌术前分期的诊断价值及其与TNM分期的关系.方法:对65例经病理证实为直肠癌的患者术前进行TRUS检查, 记录癌肿浸润周径, 同时采用TNM分期标准进行分期, 并与术后TNM分期进行对照.结果:65例直肠癌术前TRUS检查总的诊断准确率为86.15%, T1-T4期TRUS诊断准确性分别为 93.85%、87.69%、90.77%及100%, 直肠癌癌肿浸润周径与TNM分期间呈正相关(r =0.89, P <0.01), 结合直肠癌癌肿浸润周径程度可以使直肠癌术前分期总的诊断准确率明显提高(95.38%).结论:TRUS检查对于直肠癌术前分期有较高的诊断准确性, 有助于制定合理的治疗方案,结合直肠癌组织浸润周径可提高术前分期诊断准确性.     

超声内镜在诊断直肠癌及其浸润深度和淋巴结转移中的价值

目的探讨超声内镜(EUS)在诊断直肠癌及其与浸润深度和淋巴结转移中的价值。方法纳入经结肠镜和临床病理证实为直肠癌患者59例,均行EUS检查,并与病理结果对比。结果以临床病理为"金标准",EUS诊断直肠癌浸润深度的准确性为84.75%,T1期、T2期、T3期、T4期诊断准确率分别为77.78%、83.33%、92.31%、66.67%,与临床病理病理T分期一致性较好(κ=0.544);EUS诊断准淋巴结转移的准确率为77.97%,N0期、N1期、N2期诊断准确率分别为79.17%、81.48%、62.50%,与临床病理N分期一致性较差(κ=0.305)。结论 EUS评估肿瘤浸润深度的准确性较高,且能够反映淋巴结转移情况,具有较高的应用价值。     

内镜超声在胃癌术前TNM分期中的临床应用

TNM分期对胃癌疗效评估和预后判断至关重要。目的：评价内镜超声（EUS）在胃癌术前TNM分期中的临床应用价值。方法：87例胃癌患者术前1周行EUS和螺旋CT（HCT）检查．参考手术和术后病理评价EUS和HCT行胃癌TNM分期的准确性。结果：EUS判断胃癌T分期的总体准确率为81．6％：EUS判断NO和N1分期的准确率与HCT接近（P〉0．05）,但判断N2和N3分期的准确率较HCT明显下降（P〈0．05）：EUS判断M分期的总体准确率低于HCT（P=0．000）,但判断MO分期的准确率与HCT相当。结论：EUS在评价胃癌术前T分期中的临床应用价值较高。但判断N2、N3和M分期的准确性还有待提高．要获得较准确的胃癌术前TNM分期以指导临床治疗方案的选择．有必要联合CT等检查。     

血清CEA水平与结直肠癌分期及分化程度的关系

目的 探讨血清癌胚抗原（CEA）水平与结直肠癌分期及分化程度之间的关系.方法 结直肠癌患者456例,术前检测血清CEA,术后标本接受病理检查并确定肿瘤TNM分期及分化程度,分析术前血清CEA水平与肿瘤TNM分期及分化程度的关系.结果 血清CEA水平随结直肠癌分期增加而升高（P＜0.05）;血清CEA水平与结直肠癌分化程度无显著相关性（P＞0.05）.结论 血清CEA水平与结直肠癌TNM分期有关,对结直肠癌术前分期的判断有一定的指导意义.血清CEA水平不能用于判断结直肠癌分化程度.     

超声内镜对126例胃癌术前TNM分期的临床分析

目的 评价超声内镜(EUS)对胃癌患者术前TNM分期的准确性.方法 126例行外科手术治疗的胃癌患者,于术前1周行EUS和腹部螺旋CT检查,确定肿瘤浸润深度(T)、淋巴结转移(N)、远处转移(M)等分期情况,并与术后病理TNM分期进行对照,以评价EUS对TNM分期的准确性.数据处理采用配对x2检验.结果 与术后病理结果比较,EUS对胃癌T1、T2、T3、T4分期的准确率分别为84.6％、14/18、82.0％、85.7％;EUS对胃癌N0、N1、N2、N3分期的准确率分别为74.2％、75.0％、57.9％、5/17.螺旋CT对胃癌N0、N1、N2、N3分期的准确率分别为80.6％、75.0％、73.7％、12/17.EUS与螺旋CT对N0和N1分期判断的准确率接近,而对N2和N3分期的判断,螺旋CT较EUS有明显优势(x2=4.89,P=0.027;x2=13.88,P＜0.01).对于胃癌远处转移M1分期的比较,EUS与螺旋CT的准确率分别为36.4％、95.5％,螺旋CT对M1的判断优于EUS(x2=7.90,P=0.001).结论 EUS对胃癌术前T分期具有较高的临床应用价值,而对淋巴结转移的N2、N3分期及远处转移的M分期的准确性有待提高.为获得较准确的术前TNM分期以指导治疗方案的选择,有必要联合螺旋CT检查.     

高分辨薄层直肠核磁共振新序列（3.0T RESOLVE-DWI）在直肠癌临床分期中的价值评估

目的探讨高分辨薄层直肠MRI新序列（3.0T RESOLVE-DWI）在直肠癌术前临床分期中的准确性。 方法回顾性分析四川大学华西医院75例行术前高分辨薄层直肠MRI新序列扫描的直肠癌根治性切除术的病例,分析MRI影像中肿瘤浸润深度（T）,并测量肿瘤及周围淋巴结（N）的表观弥散系数（ADC）值。以术后病检结果为金标准,分析MRI评估T分期的准确性,ADC值与肿瘤T、N分期及分化程度的相关性。 结果MRI从T1到T4期的诊断准确性在未行新辅助治疗的患者中分别为0%、38.1%、72%、14.3%（κ=0.200）,在行新辅助治疗的患者中分别为50%、33%、75%、0%（κ=0.270）。肿瘤ADC值与T分期（F=0.074,P=0.929;F=0.737,P=0.496）、肿瘤分化程度（F=1.889,P=0.783;F=4.385,P=0.627）在两组均无显著相关性。在未行新辅助治疗的患者中,淋巴结ADC值在术后病理淋巴结阳性组高于淋巴结阴性组（F=0.073,P=0.012）,而在新辅助治疗组差异无统计学意义（F=0.035,P=0.793）。 结论直肠癌高分辨薄层MRI新序列对T3期直肠癌的诊断准确率高,整体准确率较低;新序列ADC值对于直肠癌N分期的评估具有一定价值,还需进一步研究验证。     

微探头超声对下消化道疾病的诊断价值

目的 探讨微探头超声检查对下消化道疾病的诊断价值。方法 应用微探头超声对115例下消化道病灶进行内镜超声检查（EUS）。结果 结直肠癌81例，EUS下表现为低回声肿块，微探头超声检查对肿瘤侵犯深度诊断总的准确率为82．7％（67／81），肠壁周围淋巴结转移的敏感性55．4％（36／65）和特异性68．8％（11／16）；粘膜下肿瘤15例，除1例平滑肌瘤误诊为平滑肌肉瘤外其余全部得到正确诊断；溃疡性结肠炎10例，克罗恩氏病9例。结论 微探头超声对结直肠癌侵犯深度和粘膜下肿瘤的诊断有很高的准确率，术前微探头超声检查可以为结直肠癌和粘膜下肿瘤选择合适的治疗方案提供指导。     

Endoscopic ultrasonography in the preoperative staging of colorectal cancer

BACKGROUND/AIMS: Endoscopic ultrasonography presents a significant progress in imaging methods for the examination of the digestive system and is commonly used in cancer staging. The aim of this study was to quantify the potential of this modality for diagnosis and staging of colorectal cancer. METHODOLOGY: Eighty patients with histologically proven colorectal cancer were included in this study. All patients were preoperatively diagnosed by colonoscopy and biopsies, abdominal computed tomography and endoscopic ultrasonography. The latter was also used to evaluate the depth of tumor invasion and presence of lymph node or distant metastasis prior to surgery. RESULTS: Endoscopic ultrasonography presented 100% sensitivity in cancer detection versus 60% for computed tomography (P < 0.001). Endoscopic Ultrasonography sensitivity in T, N, M and TNM staging was 93.8%, 93.8%, 92.5% and 82.5% with corresponding specificities of 99.2%, 97.9%, 92.5% and 94.2%. Overall, Endoscopic Ultrasonography staging of the patients did not present statistically significant differences with histological staging (P > 0.05). CONCLUSIONS: Endoscopic ultrasonography is of satisfactory accuracy in diagnosis and preoperative staging of colorectal cancer.     

综合评价EUS在结直肠癌分期及治疗中的应用价值

目的:评价超声内镜在结直肠癌分期及治疗中的应用价值.方法:对我科电子肠镜下病理活检确诊的56例结直肠癌患者行超声内镜术前TN分期,根据分期结果,行不同的手术方式治疗,结合术后病理分期,对2期及3期患者给予辅助化疗.并以术后病理为金标准,统计EUS检查TN分期诊断准确率,随访患者,分析2年内不同分期患者的复发率.结果:结、直肠癌EUS(T)分期准确率分别为:88.89%(T1),83.33%(T2),85.71%(T3),75.00%(T4),总准确率为83.23%;EUS(N)分期准确率分别为:81.25%(uN(+))和80.00%(uN(-)),总准确率为80.63%;随访显示共有6例患者出现复发,2期患者复发1例,3期患者复发5例,总复发率为10.71%.结论:EUS在结直肠癌分期及治疗中有指导价值.     

Usefulness of endoscopic ultrasonography in preoperative TNM staging of gastric cancer

AIM:To evaluate the value of endoscopic ultrasono-graphy (EUS) in the preoperative TNM staging of gastriccancer.METHODS :Forty-one patients with gastric cancer(12 early stage and 29 advanced stage) provedby esophagogastroduodenoscopy and biopsiespreoperatively evaluated with EUS according to TNM(1997) classification of International Union ContreleCancer (UICC).Pentax EG-3630U/Hitachi EUB-525 echoendoscope with real-time ultrasound imaging linearscanning transducers (7.5 and 5.0 MHz) and Dopplerinformation was used in the current study.EUS stagingprocedures for tumor depth of invasion (T stage) wereperformed according to the widely accepted five-layerstructure of the gastric wall.All patients underwentsurgery.Diagnostic accuracy of EUS for TNM stagingof gastric cancer was determined by comparingpreoperative EUS with subsequent postoperativehistopathologic findings.RESULTS:The overall diagnostic accuracy of EUS inpreoperative determination of cancer depth of invasionwas 68.3% (41128) and 83.3% (12110),60% (20112),100% (5/5),25% (4/1) for T1,T2,T3,and T4,respectively.The rates for overstaging and understagingwere 24.4% (41/10),and 7.3% (41/3),respectively.EUStended to overstage T criteria,and main reasons foroverstaging were thickening of the gastric wall due toperifocal inflammatory change,and absence of serosallayer in certain areas of the stomach.The diagnosticaccuracy of metastatic lymph node involvement or Nstaging of EUS was 100% (17/17) for NO and 41.7%(24/10) for N ,respectively,and 66% (41/27) overall. Misdiagnosing of the metastatic lymph nodes was relatedto the difficulty of distinguishing inflammatory lymphnodes from malignant lymph nodes,which imitate similarecho features.Predominant location and distribution oftumors in the stomach were in the antrum (20 patients),and the lesser curvature (17 patients),respectively.Three cases were found as surgically unresectable (T4 N ),and included as being correctly diagnosed by EUS.     

Preoperative staging of rectal cancer using a 7.5 MHz front-loading US probe

BACKGROUND: Conventional echoendoscopes have disadvantages when used for staging colorectal cancer including the inability to pass the instrument through tight stenosis and limited maneuverability. This study evaluated the preoperative use of a newly developed 7.5 MHz front-loading ultrasound probe (FLUP) for local staging of rectal cancer. METHODS: A 7.5 MHz FLUP, diameter 7.3 mm, was used in this study. The mechanical shaft portion of the probe can be passed in retrograde fashion through the accessory channel of a standard colonoscope. Thirty-nine patients with rectal cancer underwent ultrasonography with this probe. The tumors were staged using the TNM system, and the results were compared with the histologic findings of the resected specimens. RESULTS: The FLUP proved to be satisfactory, with respect to maneuverability, for traversing stenosis and accurate recognition of small tumors under direct endoscopic control. The accuracy of the FLUP for T staging was 82% (32 of 39) for all tumors, 90% in pT1, and 79% in pT2 to pT4 tumors. The accuracy of the FLUP for N staging was 72% (23 of 32) overall. The sensitivity was 83%, the specificity was 65%, the positive predictive value was 59%, and the negative predictive value was 87%. CONCLUSIONS: The 7.5 MHz FLUP appears to be useful for preoperative local staging of rectal cancer. This system makes it technically easier to image small cancers as well as advanced rectal cancers.     

超声内镜联合CT检查对结直肠癌术前TNM分期诊断价值探讨

目的探讨超声内镜(EUS)联合多层螺旋CT扫描(MSCT)检查对结直肠癌(CRC)术前TNM分期判断的准确性。方法连续选取在我院外科手术治疗并符合入组条件的CRC患者共39例,以术后病理TNM分期作为金标准,评价EUS、MSCT及两者联合对CRC患者术前TNM分期的准确性。结果本组患者EUS对CRC的T分期判断准确率分别为75.0%~83.3%,N分期为50.0%~80.0%;MSCT对CRCR的N分期判断准确率为60.0%~83.3%,EUS、MSCT对于N0、N1的判断的准确率接近,而对于N2的判断,两者联合较EUS优势明显(91.7%vs 50.0%,P0.05)。结论 EUS对CRC术前T分期及N0、N1分期具有较高的临床应用价值;而MSCT对N2、M分期的准确性较高,两者联合检查,可获得更精准的术前TNM分期。     

内镜超声检查在胃癌诊断和分期中的临床应用

目的评价内镜超声检查(EUS)对胃癌患者术前诊断和分期的准确性,以指导临床治疗方案的选择。方法22例经胃镜加活检病理检查确诊(17例)和疑诊为胃癌但常规活检阴性的患者(5例),同时行EUS、腹部螺旋CT检查,疑诊者在EUS检查的同时行EUS引导下细针穿刺活检(FNAB)以明确诊断。确定肿瘤侵犯深度(T)、局部淋巴结转移(N)、周围及远处器官转移(M)等分期情况,并与手术及病理对照,以评价EUS对胃癌诊断及TNM临床分期的准确性。结果5例疑诊者行EUS引导下FNAB全部成功取得肿瘤组织,病理诊断腺癌4例,印戒细胞癌1例。1例术前EUS诊断为T1N0M0期的患者行内镜下黏膜切除术,其余患者全部行外科胃癌根治术。与手术和病理结果比较,EUS对于TNM分期诊断总的敏感性和特异性分别为T:84.9%,74.2%;N:92.1%,77.1%;M:63.4%,87.5%。螺旋CT对于胃壁是否增厚及N、M分期的敏感性和特异性分别为T:27.3%,75%;N:31.5%,100%;M:50%,100%。其中EUS对于T和N分期的敏感性较CT高(P<0.05)。结论EUS术前评价胃癌临床分期具有显著的优越性,尤其是对于肿瘤侵犯深度和局部淋巴结转移的诊断,对指导临床治疗方案的选择及术后随访具有重要的参考价值。     

Correlation between Spiral CT Preoperative Staging of Pancreatic Cancer and PTEN and COX-2 Expression

Background/Aims: The aim of the present study was to evaluate the efficacy of TNM staging of pancreatic cancer by multilayer spiral computed tomography (MSCT) and its correlation with tissue PTEN and COX-2 expression. Methodology: Fifty-two patients with pancreatic cancer had MSCT for TNM staging and PTEN and COX-2 expression were detected in pancreatic cancer tissue by immunohistochemistry. Results: The total accuracy of MSCT was 79.5% in diagnosis of TMN staging of pancreatic cancer, with 73.1% for T staging (70.0% in T1, 65.0% in T2, 82.4% in T3 and 80.0% in T4), 76.9% for N staging (81.8% in N0 and 73.3% in N1) and 88.5% for M staging (89.7% in M0 and 84.6% in M1). The PTEN expression was not related to tumor size (p>0.05) but correlated with T staging, lymph node metastasis and clinical staging (p<0.05). COX-2 expression was not related to tumor size and T staging (p>0.05) but correlated with lymph node metastasis and clinical staging (p<0.05). Conclusions: TNM staging of pancreatic cancer was accurately conducted by MSCT-thin-layer-imaging. The correlation with PTEN and COX-2 expression implied that combined application of both approaches can improve the accuracy of diagnosis and staging in pancreatic cancer.     

超声内镜对食管癌治疗方式的术前评估价值

目的探讨超声内镜在食管癌的临床诊断上的应用价值以及对各种治疗方式的术前评估作用。方法内镜检查57例食管癌,了解癌肿的影像特征、浸润深度及癌旁淋巴结转移情况,并与术后情况进行比较。结果超声内镜显示肿瘤影像特征为不规则的低回声肿块伴部分或全部管壁结构的破坏,对肿瘤浸润深度诊断总符合率为84．2％（48／57）,对T分期的诊断总符合率为87．7％（50／57）;对N分期的诊断总符合率为84．2％（48／57）。结论超声内镜对食管癌不同治疗方法的选择、手术方式的确定和预后的评估具有重要的参考价值。     

Relationship between preoperative staging by endoscopic ultrasonography and MMP-9 expression in gastric carcinoma

AIM： To investigate the relationship between the staging by endoscopic ultrasonography （EUS） and the expression of carcinoma metastasis associated gene in the patients with gastric carcinoma.
METHODS： Sixty-three patients with gastric cancer were diagnosed by electric gastroscopy and EUS. The preoperative staging of gastric cancer was measured by EUS and compared with pathologic staging and MMP-9 expression. Peripheral serum level of MMP-9 was measured with enzyme-linked immunosorbent assay （ELISA）, while the expression of MMP-9 protein was tested with immunohistochemistry and hybridization in situ in the gastric carcinoma tissues.
RESULTS： The total accuracy of EUS in estimating invasive depth of gastric cancer was 80.95%, while that in estimating lymphatic metastasis was 73.02%.Serum MMP-9 levels were consistent with the expression of MMP-9 protein and MMP-9 mRNA in tissue, a result closely correlated with invasive degree, staging with EUS and lymphatic metastasis in gastric cancer （P 〈 0.05）.The total accuracy of estimating invasive depth in gastric cancer was 95.22% using both EUS and MMP-9.
CONCLUSION： The MMP-9 level of preoperative serum presents the reference value for preoperative staging by EUS in the patients with gastric cancer. When serum MMP-9 level in gastric cancer is significantly high,physicians should pay closer attention to the metastasis which reaches the serosa or beyond. Combining EUS and MMP-9 improves the accuracy in deciding the invasion and metastasis in the patients with gastric carcinoma.