超声结肠镜检查在直肠肿瘤诊断中的作用

目的 评价超声结肠镜(EUS)在直肠肿瘤诊断中的作用。方法 应用EUS检查10例直肠良恶性肿瘤，将其病变所在层次和淋巴结转移情况与病理结果进行比较。结果 肿瘤所在层次EUS与病理符合率为90％，淋巴结转移情况EUS检查与病理符合率为83．3％。结论 EUS是一项对直肠病变诊断及指导选择治疗方式有用的检查手段。     

超声大肠镜检查在直肠肿瘤诊断中的应用

直肠肿瘤术前诊断至关重要,纤维及电子内窥镜的应用为直肠肿瘤的诊断提供了很大便利.近年来内镜超声(en-doscopic utrasonograp,EUS)作为一种新型的检查仪器已逐渐在临床上应用,它具有普通大肠镜及超大型声功能.应用该种仪器可以观察病变所在的层次(包括判断是否为粘膜下肿物)及周围淋巴结情况.我信应用EUS检查直肠病菌变10例,其中8例经手术治疗,1例经内镜治疗,1例随诊观察.本研究目的在于比较判断EUS对直肠病变术前临床分期诊断的准确性,以评价EUS在直肠病变术前临床分期及指导选择适当的治疗方式方面的应用价值.     

腔内超声与螺旋CT对直肠癌术前分期的对比研究

目的比较腔内超声（EUS）和螺旋CT（SCT）对直肠癌术前分期的诊断价值。方法对68例直肠癌患者术前行EUS和SCT检查，将检查结果与手术及病理结果对比；同时比较EUS和SCT对诊断直肠肿瘤浸润深度、区域淋巴结转移的准确性。结果判断T分期，EUS准确率为86．8％（59／68），SCT准确率为70．6％（48／68），两者比较差异有统计学意义（P〈0．05）。评价N分期，EUS的准确率为67．6％（46／68），SCT的准确率为63．2％（43／68），两者比较差异无统计学意义（P〉0．05）。结论EUS对判断直肠肿瘤浸润深度优于SCT，但两者对淋巴结转移的判断均存在一定的局限性。     

核磁共振与腔内超声对直肠癌术前局部分期的价值比较

目的 比较核磁共振(MRI)和腔内超声(EUS)对直肠癌术前分期的价值.方法 分别应用MRI和EUS检查对72例和55例直肠癌患者行术前分期,与手术及病理结果对比,比较MRI和EUS对直肠肿瘤浸润深度、区域淋巴结转移判断的准确性.结果 MRI判断T分期总的准确率为76.4％ (55/72),MRI评价N分期的准确率为63.9％ (46/72),EUS判断T分期总的准确率为81.8％(45/55),评价N分期的准确率为65.5％ (36/55).结论 MRI与EUS判断T分期的准确性差异无统计学意义,EUS判断早中期直肠肿瘤浸润层次的准确率高于MRI,两者判断N分期的准确率均较低.     

内镜超声在结直肠癌术前分期中的应用价值

目的 探讨内镜超声（EUS）在结直肠癌术前TNM分期中的应用价值。方法 对60例手术切除的结直肠癌患术前行内镜超声检查,术后进行病理检查,将两对肿瘤侵犯深度的诊断结果进行比较。结果 经EUS检查,发现正常结直肠壁表现为5层结构,第1、3、5民支表现为高回声,第2、4层表现为低回声。第1、2层为黏膜层,第3层为黏膜下层,第4层为固有肌层,第5层为浆膜下和浆膜层。EUS下结直肠癌表现为低回声肿块,其回声强度介于第3层高回声和第4层低回声之间。根据EUS下结直肠壁5层结构和邻近器官的改变判断肿瘤侵犯的深度,进行TNM分期诊断。肿瘤旁直径大于或等于5mm圆形的低回声病灶诊断为转移性淋巴结。EUS对本组结直肠癌TNM分期诊断总的准确率为85．0％;周围淋巴结转移诊断的敏感性和特异性为54．8％和66．7％。结论有EUS对结直肠癌侵犯深度的判断有较高的准确率,对术前TNM分期诊断有一定价值。术前EUS检查可以结直肠癌治疗选择合适的方案提供指导。     

内镜超声对结直肠癌术前分期的评价

目的：探讨内镜超声(endoscopic ultrasonography，EUS)在结直肠癌术前TNM分期中的应用价值。方法：对81例手术切除的结直肠癌患者术前行内镜超声检查，所有病例术后均得到病理证实。结果：EUS检查发现正常结直肠壁表现为5层结构，第1，3，5层表现为高回声，第2，4层表现为低回声。第1，2层为黏膜层，第3层为黏膜下层，第4层为固有肌层，第5层为浆膜下和浆膜层。EUS下结直肠癌表现为低回声肿块，其回声强度介于第3层高回声和第4层低回声之间。根据EUS下结直肠壁5层结构和邻近器官的改变判断肿瘤侵犯的深度，进行T分期诊断。肿瘤旁直径≥5mm圆形的低回声病灶诊断为转移性淋巴结。EUS对结直肠癌T分期诊断总的准确率为82．7％，周围淋巴结转移诊断的敏感性和特异性为55．4％和68．7％。结论：EUS对结直肠癌侵犯深度的判断有较高的准确率，对术前TNM分期诊断有一定价值。术前EUS检查可以为结直肠癌选择合适的治疗方案提供指导。     

盆腔CT扫描在直肠癌病人诊治中的作用

目的 通过直肠癌细胞DNA倍体制定和临床病理学分析，验证直肠癌术前盆腔CT诊断的准确性及临床价值。方法 通过直肠癌术前盆腔CT扫描、直肠癌细胞核DNA含量测定和肿瘤病理学诊断并进行相关性研究，分析CT诊断的临床符合率。结果 直肠癌CT改变可出现在病程早期，CT判定肿瘤侵袭范围与临床病理符合率为88．5％，诊断淋巴结转移与临床病理符合率达93．1％。随肿瘤侵袭加深、病变范围扩大及转移，肿瘤细胞DNA异倍体出现率及含量明显增加，肿瘤的影像学改变与细胞DNA异倍体出现关系密切，两者符合率85％-96％，差分显著(P＜0.05)。结论 直肠癌术前CT扫描显示有明显外周侵袭征象的病例其细胞核DNA异倍体明显增加，与临床病理诊断相符，提示CT在直肠癌患者术前检查中具重要意义，为术前治疗、手术范围确定和估测预后提供可靠依据。     

超声内镜诊断肺癌纵隔淋巴结转移

目的：探讨超声内镜（EUS）对肺癌纵隔淋巴结转移的诊断价值。方法：21例肺癌患者术前行EUS检查,分别统计EUS检出及手术切除的纵隔淋巴结个数;对EUS发现,手术切除并行病理检查的103枚淋巴结的声像图进行分析,寻找EUS下恶性淋巴结的特征及诊断方法。并与CT诊断的准确性比较。结果：EUS对第5、7、8、9组转移淋巴结的检出率高于非转移淋巴结（χ^2=11.752.P=0.01),EUS发现的恶性淋巴结较良性淋巴结大（二者短径相比：t=4541,P=0.000,长径相比：t=3.278,P=0.002),恶性淋巴结的特征有：短径≥1．0cm,长径≥1．5cm,边界清楚,应用公式：P（1）＝1／[1 e-(-2.963 2.041 x1 1.681 x2)],以P（1）≥0．5作为恶性淋巴结诊断标准,其准确率,灵敏度,特异度分别为72．8％,72．7％,72．9％;EUS对第5、7、8、9组纵隔淋巴结诊断的准确性高于CT（χ^2=6.812,P=0.013),以病理检查结果为金标准,EUS诊断肺癌纵隔淋巴结转移的准确率,灵敏度,特异度分别为83．9％,80．0％,87．5％（χ^2=21.218,P=0.000)。结论：EUS可以帮助诊断肺癌纵隔淋巴结转移。     

直肠腔内三维超声对直肠癌术前分期的评价

目的：探讨直肠腔内三维超声术前诊断直肠癌分期的应用价值。方法：对200例直肠癌浸润肠壁深度、淋巴结转移及侵及周围组织脏器的情况进行前瞻性研究。结果：IR3—DUS检查直肠癌浸润肠壁深度和淋巴结转移与病理诊断符合率很高；IR3—DUS检查显示，直肠癌淋巴结转移率随着肠壁浸润的加深而增加；IR3—DUS检查直肠癌侵及周围组织脏器与术中探查所见符合率很高。结论：IR3—DUS术前诊断直肠癌分期具有较高的临床实用价值。     

腔内三维超声扫查在直肠癌术前分期中的应用

自１９９１年１１月～１９９２年１２月，我们对６３例直肠癌病人进行了直肠腔内三维超声检查，旨在对直肠癌的分期进行前瞻性研究。结果：腔内三超声对直肠癌浸润深度判断的总符合率为９３．６５％，对淋巴结转移癌诊断的符合率为９２．１％。对直肠癌进行术前Ｄｕｄｅｓ分期与病理的总率为９３．６５％，Ｐ＜０．００１。因此，我们认为腔内三维超声可有效的判断直肠癌浸润深度，可靠的检测淋巴结转移情况，准确的用于术前Ｄｕｋｅ     

Can depth of tumour invasion predict lymph node positivity in patients undergoing resection for early rectal cancer? A comparative study between T1 and T2 cancers

Objective The present study investigated the risk of lymph node metastasis according to the depth of tumour invasion in patients undergoing resection for rectal cancer. Method The histology of patients undergoing oncological resection with regional lymphadenectomy for rectal cancer at St Marks Hospital from 1971 to 1996 was reviewed. Of the total number of 1549 patients, 303 patients with T₁ or T₂ rectal cancers were selected. The tumour type, grade, evidence of vascular invasion, depth of submucosal invasion (classed into ‘sm1‐3’) were evaluated as potential predictors of lymph node positivity using univariate and multi‐level logistic regression analysis. Results Tumour stage was classified as T₁ in 55 (18.2%) and T₂ in 248 (81.2%) patients. The incidence of lymph node metastasis in the T₁ group was 12.7% (7/55), compared to 19% (47/247) in the T₂ group. The node positive and negative groups were similar with regard to patient demographics, although the former contained a significantly higher number of poorly differentiated (P = 0.001) and extramural vascular invasion tumours (P = 0.002). There was no significant difference in the number of patients with sm1‐3, or T₂ tumour depths within the lymph node positive and negative groups. On multivariate analysis the presence of extramural vascular invasion (odds ratio = 10.0) and tumour grade (odds ratio for poorly vs well‐differentiated = 11.7) were independent predictors of lymph node metastasis. Conclusion Whilst the degree of vascular invasion and poor differentiation of rectal tumours were significant risk factors for lymph node metastasis, depth of submucosal invasion was not. This has important implications for patients with superficial early rectal cancers in whom local excision is being considered.     

Efficacy of 3-dimensional endorectal ultrasonography compared with conventional ultrasonography and computed tomography in preoperative rectal cancer staging

BACKGROUND: This study was performed to verify reports of the decreased accuracy of endorectal ultrasonography (EUS) in preoperative staging of rectal cancer, and to compare the efficacy of 3-dimensional (3D) EUS with that of 2-dimensional (2D) EUS and computed tomography (CT). METHODS: Eighty-six consecutive rectal cancer patients undergoing curative surgery were evaluated by 2D EUS, 3D EUS, and CT scan. RESULTS: The accuracy in T-staging was 78% for 3D EUS, 69% for 2D EUS, and 57% for CT (P < .001-.002), whereas the accuracy in evaluating lymph node metastases was 65%, 56%, and 53%, respectively (P < .001-.006). Examiner errors were the most frequent cause of misinterpretation, occurring in 47% of 2D EUS examinations and in 65% of 3D EUS examinations. By eliminating examiner errors, the accuracy rates in T-staging and lymph node evaluation could be improved to 88% and 76%, respectively, for 2D EUS, and to 91% and 90%, respectively, for 3D EUS. Conical protrusions along the deep tumor border on 3D images were correlated closely with infiltration grade, advanced T-stage, and lymph node metastasis. CONCLUSIONS: We found that 3D EUS showed greater accuracy than 2D EUS or CT in rectal cancer staging and lymph node metastases. Concrete 3D images based on tumor biology appear to provide more accurate information on tumor progression.     

Role of endoscopic ultrasonography in preoperative staging of gastric carcinoma

Background: Preoperative staging of tumour extent in upper gastrointestinal malignancy greatly facilitates planning of therapy. The present study was undertaken to see whether preoperative endoscopic ultrasonography (EUS) accurately predicts the tumour stage in gastric carcinoma. Methods: Endoscopic ultrasonography was performed preoperatively on 112 patients with gastric cancer. All 112 patients underwent surgery. The results of EUS were compared with postoperative histological staging. Results: Endoscopic ultrasonography was correct in determining the primary tumour (T) and regional lymph node (N) staging in 83.0% and 64.2% of patients, respectively. EUS was correct in determining the absence of lymph node metastasis in 87.5% but was not reliable in determining metastasis in one to six regional lymph nodes (N1) and metastasis in seven to 15 regional lymph nodes (N2) stages; (61.5% and 33.3%, respectively). Of 26 patients with N1 stage, 10 had false negative results, whereas 11 patients in stage N2 were diagnosed endoscopically as stage N1. The sensitivity and specificity were 67.2% and 89%, respectively. The actual resection rate (75%) was almost identical to the rate predicted preoperatively by EUS (78%). Conclusion: Endoscopic ultrasonography staging is the most accurate method for discriminating between potentially resectable (tumour invading lamina propria or submucosa (T1) to tumour that penetrates the serosa (visceral peritoneum) without invading adjacent structures (T3)) and potentially non‐resectable (tumour invading adjacent structures (T4)) cases of upper gastrointestinal cancer.     

Endoscopic ultrasonography of the upper gastrointestinal tract

Summary Endoscopic ultrasonography was used for assessment of the extent of tumour invasion of the upper gastrointestinal (GI) tract, including analysis of submucosal tumour and detection of lymph-node metastasis. The normal oesophageal and gastric wall was depicted as five layers by endoscopic ultrasonography (EUS). The outer layer invaded by cancer was defined as the depth of tumour invasion. In 173 cases of oesophageal cancer, the depth of cancer invasion was diagnosed correctly in 88%. In 146 cases of gastric cancer, it was diagnosed correctly in 79%. In submucosal tumours of the GI tract, the site of tumour in the wall was diagnosed correctly in 99% and the histological type of tumour was predicted. EUS can also be used to detect small lymph nodes. According to the criteria, used in this study, EUS had a sensitivity of 84%, a specificity of 88% and an overall accuracy of 88% for detection of lymphnode metastases. Presented at the International Congress on Surgical Endoscopy, Ultrasound, and Interventional Techniques, Berlin 1988     

Metastatic 'early' colorectal cancer

If colorectal carcinomas where the primary tumours are confined to the wall are considered 'early', the likelihood of lymph node metastasis in these tumours is 21% and for those that do not extend beyond the submucosa it is 13%. Because of the renewed interest in local treatment of small accessible rectal tumours and the use of colonoscopy for the removal of 'polyps' with invasive carcinoma, we analysed our long-term cancer survival figures for 'early' cancers in this combined surgical series spanning more than 30 years. The presence of regional lymph node metastasis in 'early' rectal cancer was associated with a significantly (P = 0.001) reduced proportion of long-term survivors (56%) compared to those without nodal involvement (79%). Long term survival in 'early' colonic cancer was less influenced (P less than 0.05) by whether lymph node metastasis was present (73%) or not (77%). The authors conclude that until more information is available with regard to the risk of lymph node spread from 'early' tumours, resection is advised for all invasive tumours of the colon in good risk patients, but the indications for local excision of 'early' rectal cancers can be extended in view of the ease of careful follow-up and the use of salvage procedures in those with recurrence.     

Prediction of lymph node metastasis of well-differentiated rectal neuroendocrine tumours using multiple diagnostic modalities

Aim

The preoperative prediction of lymph node metastasis of well-differentiated rectal neuroendocrine tumours is highly desirable and useful in defining surgical indication more accurately. We aimed to evaluate lymph node metastasis in rectal neuroendocrine neoplasms using multiple imaging modalities.

Methods

The clinical records and radiological images of 70 patients with well-differentiated rectal neuroendocrine tumours who received treatment at the University of Tokyo Hospital between 2010 and 2022 were retrospectively analysed. The relationship between evaluation by multiple imaging modalities and pathological lymph node metastasis was analysed.

Results

The receiver operating characteristic curves showed that a maximum lymph node diameter ≥4 mm on computed tomography and ≥8 mm on magnetic resonance imaging were the optimal predictive factors for lymph node metastasis. Accumulation in the lymph nodes on somatostatin receptor scintigraphy (P = 0.058) and Delle's findings on colonoscopy (P = 0.014) were also significant predictors of pathological lymph node positivity, and combination of multiple modalities was useful. Pathologically, lymphatic (P = 0.0030)/venous (P = 0.0007) invasion were risk factors for lymph node metastasis.

Conclusions

In addition to pathological risk factors, a combination of multiple radiological imaging modalities is useful for predicting lymph node metastasis in well-differentiated rectal neuroendocrine tumours.     

Impacto de la obesidad en las características anatomopatológicas de los tumores colorrectales. Estudio observacional

BackgroundTo asses the influence of body mass index on the tumour characteristics of patients subjected to colorectal cancer surgery.Materials and methodsRetrospective observational study. Patients subjected to curative elective colorectal cancer surgery at Hospital Josep Trueta de Girona (Spain), from 1990 to 2001.Univariate and bivariate analyses were performed to evaluate differences in tumour characteristics with regard to body mass index.ResultsA total of 369 patients with colorectal cancer were included into the study, 213 (57.7%) with colon cancer, and 156 (42.3%) with rectal cancer. For colon cancer patients, when the BMI was higher than 25 kg/m², the tumour grade was worst (P=0.011), and when BMI was above 30 kg/m² there were more lymph node metastasis. For rectal tumours, the higher the BMI, the more lymph node metastasis (P=0.041), and higher tumour stage (P=0.023).ConclusionsPatients with a higher BMI have more lymph node metastasis when submitted to elective colorectal cancer surgery. In the case of colon cancer they also have worst tumour grades, and in the case of rectal cancer, a more advanced tumour stage.     

E‐cadherin Expression in Canine Mammary Carcinomas with Regional Lymph Node Metastases

E‐cadherin (E‐cad) is a cell adhesion molecule known for its tumour invasion‐suppressor function. This study investigated the immunohistochemical expression of E‐cadherin in 19 cases of malignant mammary tumours of the dog and the relationship between E‐cadherin expression in primary tumours and in regional lymph node metastases. E‐cadherin expression is not always parallel in the primary tumour and in the lymph node metastasis. One year follow‐up was available in 12 of 19 cases. Three different patterns of expression were revealed in the lymph node metastases compared with the primary tumour: downregulation when the protein expression was weaker in the metastasis than in the primary tumour; upregulation when E‐cadherin was stronger in the lymph node than in the primary tumour, and a similarly intense expression when it was equal in the metastasis and in the tumour. The lymph node pattern revealed a prevalent upregulation or downregulation with respect to the primary tumour, whereas a similar expression of E‐cadherin was encountered in less than 50% of cases.     

腔内超声对直肠癌术前放化疗后再分期诊断准确性的Meta分析

目的评价腔内超声对直肠癌术前放化疗后再分期诊断的准确性。方法利用PubMed、EMbase、OVID和WOK数据库,全面检索腔内超声对直肠癌术前放化疗后再分期相关的英文文献,利用SAS和MetaDiSc软件对腔内超声对直肠癌术前放化疗后再分期的敏感性和特异性进行meta分析。结果最终纳入11篇,共651例患者。腔内超声对直肠癌术前放化疗后T3-4分期诊断的敏感性为87.6%(70.9%,95.4%),特异性为66.4%(47.2%,81.4%),诊断比数比(DOR)为17.81(4.03,78.79);对淋巴结阳性诊断的敏感性和特异性,以及DOR分别为49.8%(40.1%,59.5%),78.7%(69.5%,85.7%)和3.96(2.44,6.44)。结论超声对于直肠癌术前放化疗后再分期仍然存在挑战。对于T0-2期的直肠癌,为避免过度扩大切除范围,可以先使用腔内超声对直肠癌进行再分期。不过结果提示部分T0-2期会被过度分期为T3-4期。超声对于直肠癌术前放化疗后的淋巴结的判断不佳。     

METASTATIC ‘EARLY’ COLORECTAL CANCER

If colorectal carcinomas where the primary tumours are confined to the wall are considered ‘early’, the likelihood of lymph node metastasis in these tumours is 21 % and for those that do not extend beyond the submucosa it is 13%. Because of the renewed interest in local treatment of small accessible rectal tumours and the use of colonoscopy for the removal of ‘polyps’ with invasive carcinoma, we analysed our long-term cancer survival figures for‘early’ cancers in this combined surgical series spanning more than 30 years. The presence of regional lymph node metastasis in ‘early’rectal cancer was associated with a significantly (P= 0.001) reduced proportion of long-term survivors (56%) compared to those without nodal involvement (79%). Long term survival in ‘early’ colonic cancer was less influenced (P < 0.05) by whether lymph node metastasis was present (73%) or not (77%). The authors conclude that until more information is available with regard to the risk of lymph node spread from ‘early’ tumours, resection is advised for all invasive tumours of the colon in good risk patients, but the indications for local excision of ‘early’ rectal cancers can be extended in view of the ease of careful follow-up and the use of salvage procedures in those with recurrence.