超声内镜结合CT扫描在食管癌临床分期中的应用

目的:比较超声内镜(EUS)、CT扫描及两者联合应用在判定胸段食管癌术前T、N分期中的应用价值.方法:48例可切除胸段食管癌患者术前均行EUS检查和CT扫描,同时分别进行T、N分期,并与术后病理分期进行对照分析.结果:食管癌术前EUS检查T、N分期的诊断准确率分别为77.1%(37,48)、75.0%(36/48),T1、T2、T3、T4期诊断准确率分别为87.5%、57.1%、94.1%和100%;食管癌术前CT检查T、N分期的诊断准确率分别为52.1%(25/48)和77.1%(37,48),T1、T2、T3、T4期诊断准确率分别为37.5%、33_3%、81.2%和100%;EUS联合CT检查T、N分期的诊断准确率分别为79.2%(38,48)和77.1%(37/48).应用EUS测得淋巴结短径构建ROC曲线,曲线下面积为0.775,以淋巴结短径≥7.5mm作为阳性淋巴结的诊断界点,可能提高判断淋巴结转移的准确性.结论:EUS检查在食管癌术前分期的价值优于CT扫描,尤其对T分期诊断的准确率比较高.     

食管癌超声内镜诊断探讨

目的 评估超声内镜(EUS)在食管癌的诊断及术前临床分期的价值.方法 对经电子胃镜检查+活检诊断为食管癌的56例行EUS检查及TNM分期,与手术病理分期结果比较.结果 食管癌术前EUS检查T、N分期的诊断准确率分别为T1期80.0%,T2期78.6%,T3期89.7%,T4期87.5%,T分期总准确率为85.7%;N0期74.1%,N1期79.3%,N分期总准确率为76.8%.结论 EUS对食管癌的诊断及T、N分期诊断准确率较高,对指导术前制定治疗方案、评估预后有重要意义.     

食管癌超声内镜诊断探讨

目的评估超声内镜（EUS）在食管癌的诊断及术前临床分期的价值。方法对经电子胃镜检查＋活检诊断为食管癌的56例行EUS检查及TNM分期,与手术病理分期结果比较。结果食管癌术前EUS检查T、N分期的诊断准确率分别为T1期80.0%,T2期78.6%,T3期89.7%,T4期87.5%,T分期总准确率为85.7%;N0期74.1%,N1期79.3%,N分期总准确率为76.8%。结论EUS对食管癌的诊断及T、N分期诊断准确率较高,对指导术前制定治疗方案、评估预后有重要意义。     

内镜超声结合血清转化生长因子β1和血管内皮生长因子表达在食管癌术前分期中的意义

目的:探讨超声内镜(endoscopic ultrasonograph, EUS)结合血清血管内皮生长因子(vascular endothelial growth factor, VEGF)和转化生长因子β1(transforming growth factor-beta1,TGF-β1)的表达对食管癌术前分期的价值.方法:125例食管癌患者于术前行胃镜和EUS检查,并进行术前分期;同时检测术前血清TGF-β1和VEGF水平,并与术后病理分期进行比较.结果:EUS对食管癌浸润深度判断的总准确率为88.0%,淋巴结转移判断的总准确率为72.0%.血清TGF-β1和VEGF的表达水平与食管癌浸润深度、EUS分期和淋巴结转移密切相关(P＜0.05).EUS联合血清TGF-β1和VEGF水平对食管癌浸润深度和淋巴结转移判断的准确率明显提高,总准确率分别达94.4%和92.0%.结论:食管癌EUS分期与血清TGF-β1和VEGF的表达密切相关,EUS联合术前血清TGF-β1和VEGF检测有助于提高对食管癌浸润和转移判断的准确性.     

64排螺旋CT扫描在食管癌术前分期诊断和制定手术方案中的价值

目的 探讨64排螺旋CT扫描在食管癌术前分期诊断和制定手术方案中的价值.方法 对病理确诊的50例食管癌患者术前进行多层螺旋CT(MSCT)检查,利用工作站进行后处理以获取CT仿真内镜(CTVE)、多平面重建(MPR)、表面阴影成像(SSD)和透明显示(Raysum)图像,并结合横断面图像,记录术前MSCT分期和预计手术方案,与术后病理分期和实际手术方案进行比较.结果 所有患者均顺利完成MSCT检查,均有阳性发现.MSCT对于食管癌术前T分期诊断的敏感度为100.0％(50/50),N分期诊断的敏感度为80.0％ (16/20),预测食管癌患者的手术切除率为96.0％ (48/50).MSCT术前评估得到CT-TNM分期准确率为90.0％,与病理TNM分期高度一致(Kappa =0.811,P＜0.05).结论 MSCT可以有效地显示肿瘤形态、大小和部位,确定肿痛的侵犯范围、淋巴结转移和远处转移等,对食管癌患者进行术前评估,为临床医师预测食管癌手术方案提供依据.     

食管癌术前超声内镜T、N分期与术后病理T、N分期的比较

目的:探讨超声内镜（endoscopic ultrasonography,EUS）在食管癌术前TNM分期中的诊断价值。方法:回顾分析43例食管癌根治术患者术前超声内镜的T、N分期与术后病理学的T、N分期,以术后病理分期为金标准,比较两种分期的一致性。结果:食管癌术前EUS检查T、N分期的诊断准确率分别为82.50%和47.53%,其中T1为83.35%、T2为82.65%、T3为82.32%、T4为84.45%,N0为74.63%、N1为72.75%、N2为55.35%、N3为25.27%。EUS的T分期与病理T分期结果一致性较好（Kappa=0.724,P<0.05）;EUS的N0、N1分期与病理N0、N1分期结果一致性较好,而N2、N3的一致性则相对较差,但总体一致性比较仍具有统计学意义（Kappa=0.408,P<0.05）。结论:EUS判断食管癌T、N分期诊断准确率较高,可作为术前治疗方法选择的重要依据。     

高分辨率MRI在直肠癌术前分期中的应用价值

目的：评估高分辨率MRI直肠癌术前分期的准确性.方法：56例经组织学确诊为直肠癌的患者行高分辨率MRI扫描,并进行术前MRI分期.直肠癌分期采用TNM分期.术前MRI分期和术后病理TNM分期比较,计算MRI T分期和N分期的准确性.结果： MRI T分期的准确性为83.9%（47/56）：T2期分期的准确性为71.4%（10/14）;T3期分期的准确性为86.8%（33/38）.MRI诊断直肠肌层浸透的敏感性、特异性、阳性预测值和阴性预测值分别为87.8%（36/41）、73.3%（11/15）、90.0%（36/40）和68.6%（11/16）.MRI N分期的准确性为67.9%（36/53）：N0（52.2%,12/23）,N1期（58.8%,10/17）,N2期（66.7%,6/9）,N3期（75.5%,3/4）.MRI诊断淋巴结转移的敏感性、特异性、阳性预测值和阴性预测值分别为63.3%（19/30）、52.2%（12/23）、65.5%（19/29）和52.5%（12/23）.结论：高分辨率MRI成像能准确评估直肠癌浸润程度和术前T分期,但诊断淋巴结转移的准确性低.MRI能够术前提供准确的分期信息以帮助临床医生制定最佳的治疗方案.     

探讨非手术食管癌临床分期有效性与预测预后价值

目的 探讨非手术食管癌临床分期的有效性及预测预后的临床价值。方法 分析2003-2010年期间在本院行食管癌根治术,术前有EUS、食管镜、CT、食道造影等详细检查,术后有详细病理分期的358例患者资料。分析术前影像学分期与术后病理分期的预测值,分别按2002、2009年UICC病理分期及临床分期,分析患者无瘤生存及总生存。 结果 全组中位随访时间47个月,随访率为97.2%。有EUS+CT检查并能进行有效分期的305例（85.2%）。在305例中临床T分期对病理T分期的预测值为0~88.6%,其中T₁期最高（88.6%）、T₄期最低;临床N分期（N₀、N₁期）的预测值为62.5%~100%。虽然2002、2009年的分期间总生存率及无瘤生存率差异均有统计学意义（P=0.000、0.000）,但2002年的分期内总生存除Ⅳ期只有2例与各期别相似外差异均有统计学意义,2009年的分期内总生存各期别差异无统计学意义。按2002年UICC TNM分期标准对305例进行EUS+CT临床分期的总生存及无瘤生存均有差异统计学意义（P=0.000、0.000）。 结论 影像学检查不能有效、准确提供淋巴结转移个数,但对淋巴结定性的预测值较高。EUS+CT的临床分期能有效预测非手术食管癌的预后。     

内镜超声检查在早期胃癌术前分期的应用

目的　探讨内镜超声检查 (EUS)在早期胃癌术前分期中的临床应用价值。方法　对14 9例经胃镜活检证实的胃癌患者 (其中早期胃癌 33例 )术前行内镜超声检查 ,并与术后病理检查结果对照。结果　EUS对胃癌T分期的准确率为 80 .3% ,其中T1期为 81.8% ,T2期为 70 .4 % ,T3期为88.9% ,T4期为 71.4 %。EUS鉴别早期和进展期胃癌的准确率达 95 .1% ,而鉴别胃黏膜和黏膜下癌的准确率仅为 6 3.6 %。EUS对黏膜和黏膜下癌的判断准确率分别为 5 2 .9%和 75 .0 % ,而阳性预测值分别达 90 .0 %和 70 .6 %。EUS对隆起型和平坦型早期胃癌浸润深度的判断准确率均为 10 0 % ,对凹陷型的准确率仅 5 8.6 % ;对分化型和未分化型早期胃癌浸润深度的判断准确率分别为 71.4 %和5 7.9% ,差异无显著性 (P >0 .0 5 )。EUS对早期胃癌浸润深度的判断准确率随着肿瘤直径的增大而降低 ,对早期胃癌淋巴结状况的判断准确率为 90 .9% ,对淋巴结转移的敏感性和特异性分别为 6 6 .7%和 96 .3%。结论　内镜超声检查对早期胃癌术前分期具有较高的临床应用价值。     

双重超声造影在胃癌术前分期中的价值

目的 评价双重超声造影在胃癌手术前分期中的应用价值.方法 62例经胃镜活检证实的胃癌患者术前行双重超声造影检查进行术前分期,并与术后病理检查结果 对照.结果 胃窗超声造影术前T分期的准确率为72.9%,其中T1、,12、13和T4期的准确率分别为66.7%、60.0%、76.9%和71.4%;诊断区域淋巴结转移的敏感度为74.5%(35/47),特异度为66.7%(8/12),准确率为72.9%(43/59),Youden指数为0.41.双重超声造影T分期的准确率为88.1%,其中T1、T2、T3和T4期的准确率分别为66.7%、80.0%、89.7%和100%;诊断区域淋巴结转移的敏感度为89.4%,特异度为75.0%,准确率为86.4%,Youden指数为0.76.胃窗超声造影和双重超声造影术前T分期的准确率差异有统计学意义(P=0.036),但两者诊断区域淋巴结转移的准确率差异无统计学意义(P＞0.05).结论 双重超声造影对胃癌术前分期具有较高的临床应用价值.     

超声内镜在食管癌TN分期中的应用

目的评价超声内镜（EUS）对食管癌术前TN分期的准确性。方法40例食管癌患者术前行超声内镜检查,与术后病理结果相对照。结果EUS对食管癌侵犯深度判断总的准确性为85%。对是否有区域淋巴结转移判断的准确性为77.5%,敏感度为78.6%,特异性为76.9%,阳性预测值为64.7%,阴性预测值86.9%。结论EUS能较准确的判断食管癌TN分期,可作为术前治疗方法选择的重要依据。     

The accuracy of endoscopic ultrasound for restaging esophageal carcinoma after chemoradiation therapy

BACKGROUND: Endoscopic ultrasound (EUS) is an accurate staging modality for esophageal malignancy. Studies have determined that EUS does not retain this accuracy after chemoradiation and that it should not be used as a restaging tool for esophageal carcinoma. In this study, the authors examined their experience with esophageal carcinoma and restaging after neoadjuvant therapy with EUS. METHODS: A retrospective chart review was conducted that included 83 patients with locoregional esophageal adenocarcinoma who were treated with chemoradiation under protocol. All patients underwent surgical resection. EUS was performed for restaging, and the results were compared with findings at surgical pathology using the TNM classification system. RESULTS: All 83 patients identified underwent surgery. There were 77 males, and the mean patient age was 59 years. At restaging, the tumor status (T classification) was assessed correctly by EUS in 22 of 83 patients (29%). The sensitivity of EUS for the individual T classifications were 0% for T0 tumors, 19% for T1 tumors, 27% for T2 tumors, 52% for T3 tumors, and 0% for T4 tumors. In 19 of 83 patients, the tumor classification was correct, whereas 42 of 83 patients were over classified, and 15 of 83 patients were under classified when the EUS results were compared with the surgical pathology results. The lymph node status (N classification) was assessed correctly by EUS in 41 of 83 patients. The sensitivity of EUS for N classification was 48% for N0 disease and 52% for N1 disease. Twenty-two patients were restaged with residual disease according to the EUS results but had no evidence of residual tumor or lymph node involvement according to the surgical pathology results. CONCLUSIONS: EUS did not retain its usefulness as a restaging modality after neoadjuvant chemoradiation for esophageal adenocarcinoma when the standard TNM classification system was used.     

微探头超声内镜和CT扫描在胸段食管癌术前分期中的应用

目的对比微探头超声内镜（MCUS）及CT在胸段食管癌术前进行T、N分期中的应用价值,探讨MCUS判断淋巴结转移的标准。方法对35例初治胸段食管癌患者分别进行MCUS扫描和CT扫描,并同时分别进行T、N分期;以术后病理为金标准,比较在对淋巴结转移的判断中,本研究试行的3种标准的准确率（即真实性）、灵敏度、特异度、阳性及阴性预测值等参数,判断其临床应用价值,并且,就MCUS扫描对淋巴结转移的判断标准进行探讨。结果本组35例中,MCUS的T分期准确率（85．7％）高于CT（45．7％）,差异有统计学意义（P=0．000）;MCUS的N分期中,两种标准的准确率（分别为85．7％及80．0％）均略高于CT（74．3％）,但差异无统计学意义（P〉0,05）。应用淋巴结短径及短长轴比例（S／L）结合的方法,研究结果显示,检测的灵敏度有所提高。结论MCUS在胸段食管癌术前分期中有重要作用,其T分期准确率明显高于传统CT扫描。以淋巴结短径与S／L结合进行分析,有望提高判断淋巴结转移的准确性。     

Role of endoscopic ultrasonography in the staging and follow-up of esophageal cancer.

PURPOSE: To evaluate the role of endoscopic ultrasonography (EUS) in the initial staging and follow-up of esophageal cancer on the basis of a review of the published literature. METHODS: Articles published from 1985 to 2005 were searched and reviewed using the following keywords: "esophageal cancer staging," "endoscopic ultrasound," and "endoscopic ultrasonography." RESULTS: For initial anatomic staging, EUS results have consistently shown more than 80% accuracy compared with surgical pathology for depth of tumor invasion (T). Accuracy increased with higher stage, and was >90% for T3 cancer. EUS results have shown accuracy in the range of 75% for initial staging of regional lymph nodes (N). EUS has been invariably more accurate than computed tomography for T and N staging. EUS is limited for staging distant metastases (M), and therefore EUS is usually performed after a body imaging modality such as computed tomography or positron emission tomography. Pathologic staging can be achieved at EUS using fine-needle aspiration (FNA) to obtain cytology from suspect Ns. FNA has had greatest efficacy in confirming celiac axis lymph node metastases with more than 90% accuracy. EUS is inaccurate for staging after radiation and chemotherapy because of inability to distinguish inflammation and fibrosis from residual cancer, but a more than 50% decrease in tumor cross-sectional area or diameter has been found to correlate with treatment response. CONCLUSION: EUS has a central role in the initial anatomic staging of esophageal cancer because of its high accuracy in determining the extent of locoregional disease. EUS is inaccurate for staging after radiation therapy and chemotherapy, but can be useful in assessing treatment response.     

基于IMRT同步化疗疗效的食管鳞癌非手术分期临床分析

目的 对IMRT同期化疗食管癌病例采用不同分期标准进行验证比较,探讨更准确、更适用的非手术治疗临床分期标准。方法 选取2008—2014年间就诊于本院242例IMRT化疗食管鳞癌患者的临床资料,用2009年中国分期、第6版分期和建议分期进行预后判断比较。Kaplan-Meier法计算生存率并Logrank检验,Cox模型预后分析。结果 3年样本数168例。全组患者3年生存率为47.4%,食管肿瘤体积和淋巴结转移最大径是影响预后的因素(P=0.000、0.000)。中国分期和第6版分期T₃、T₄期生存曲线有交叉(P=0.696、0.594),中国分期的N₁、N₂期生存曲线有交叉(P=0.068);建议分期采用食管肿瘤体积的T分期、淋巴结转移最大径的N分期以及结合的临床分期,各期的生存曲线分离度较好(P=0.000、0.000、0.000)。结论 采用食管肿瘤体积的T分期和淋巴结转移最大径的N分期结合进行IMRT化疗食管鳞癌的非手术临床分期能较好预测患者预后,简便易行。     

Staging of esophageal carcinoma: endoscopic ultrasonography

Endoscopic ultrasonography (EUS) has gained ground in the staging of esophageal cancer because of its high accuracy in determining depth of tumor invasion (greater than 80%) and lymph node metastases. The accuracy of EUS increases with increasing stage. However within T1 tumors, EUS performance in distinguishing mucosal (T1m) form submucosal invasion (T1sm) is poor. In this context high-frequency ultrasonography probes can play a major role. The advent of EUS-guided fine-needle aspiration (EUS-FNA) has dramatically changed the impact of EUS on nodal staging, providing cytological confirmation of malignancy from peritumoral and celiac lymph nodes. Especially celiac node metastases, have a major clinical impact on patient management. Widespread use of EUS in the staging of esophageal cancer should be encouraged. However, EUS should not be considered as first line test for evaluation of these patients and should always be performed after negative CT or PET/CT.