Comparison of Linear Array Endoscopic Ultrasound and Helical Computed Tomography for the Staging of Periampullary Malignancies

Background: The purpose of this study was to compare linear array endoscopic ultrasound (EUS) and helical computed tomography (CT) scan in the preoperative local staging evaluation of patients with periampullary tumors.Methods: Patients evaluated with EUS and CT for suspected periampullary malignancies from 1996 to 2000 were analyzed. Surgical/pathology staging results were the reference standard.Results: Forty-eight patients (28 men and 20 women; mean age, 62 ± 4.9 years; range, 18–90 years) were identified. Malignancy was histologically confirmed in 44 patients. Parameters evaluated included tumor size, lymph node metastases, and major vascular invasion. EUS was significantly more sensitive (100%), specific (75%), and accurate (98%) than helical CT (68%, 50%, and 67%, respectively) for evaluation of the periampullary mass (P < .05). In addition, EUS detected regional lymph node metastases in more patients than helical CT. Sensitivity, specificity, and accuracy of EUS were 61%, 100%, and 84%, in comparison to 33%, 92%, and 68%, respectively, with CT. Major vascular involvement was noted in 9 of 44 patients. EUS correctly identified vascular involvement in 100% compared with 45% with CT (P < .05).Conclusions: Linear array EUS was consistently superior to helical CT in the preoperative local staging of periampullary malignancies.Presented in part at the Society of Surgical Oncology Parallel Session, Washington, DC, March 2001.     

超声内镜与CT对胰腺及壶腹部周围肿瘤的术前诊断价值

目的评估超声内镜(endoscopic ultrasonography,EUS)和CT对胰腺及壶腹部周围肿瘤的术前诊断价值。方法回顾性分析33例胰腺及壶腹部肿瘤患者术前EUS、CT资料,与手术探查及术后病理结果对照,从肿瘤大小、部位等角度筛选出影响EUS准确性的因素。结果 EUS在判断胰周脂肪浸润、胆管扩张、胰周脏器侵犯、血管侵犯等方面敏感性、特异性与CT的差异无统计学意义(P>0．05);EUS在胰管扩张及淋巴结转移方面的诊断价值优于CT(P=0．039和P=0．004); EUS判断胰周脂肪浸润和胰周脏器侵及的准确性与肿瘤大小有关(P=0．015和P=0．022),判断胰管扩张的准确性与肿瘤部位有关(P<0．001)。结论 EUS对胰腺及壶腹部周围肿瘤诊断的临床价值很高,结合CT检查有助于加强对患者术前评价的认识。     

Correlation between spiral computed tomography, endoscopic ultrasonography and findings at operation in pancreatic and ampullary tumours

BACKGROUND: Spiral computed tomography (CT) allows high-resolution examination of the pancreas, surrounding vascular structures, lymph nodes and liver. Endoscopic ultrasonography (EUS) also allows high-resolution imaging of the pancreas and adjacent structures but is an invasive procedure. With the availability of spiral CT, the role of EUS in the investigation of patients with suspected pancreatic or ampullary tumours is unclear. METHODS: Forty-eight patients with clinical suspicion of a pancreatic or ampullary tumour underwent both spiral CT and EUS. Thirty-four patients had surgical exploration, of whom 17 underwent pancreatic resection and 17 had biliary and gastric bypass. The results of spiral CT and EUS were compared with the operative findings. RESULTS: The final histological diagnosis was ductal adenocarcinoma (24 patients), ampullary carcinoma (six), serous cystadenoma (two) and chronic pancreatitis (two). EUS demonstrated 33 and spiral CT 26 of the 34 primary lesions. EUS was particularly useful in the assessment of small resectable tumours missed by spiral CT. The sensitivity and specificity of EUS and spiral CT for detecting involvement by the tumour of the superior mesenteric vein, portal vein and lymph nodes were similar, but EUS was less effective at evaluating the superior mesenteric artery. CONCLUSION: EUS is an important additional investigation after spiral CT in patients with a suspected pancreatic or ampullary tumour.     

影像学检查对壶腹周围癌诊断价值的临床研究

目的评价各种检查手段对壶腹周围癌的诊断价值,帮助临床医师合理地选择检查方法。方法对胰头及壶腹周围癌患者３４例施行二维超声（Ｂｕｓ）、彩色多普勒超声（ＣＤＩ）、内镜超声（ＥＵＳ）、逆行性胆胰管造影（ＥＲＣＰ）、电子计算机断层扫描（ＣＴ）、核磁共振显像（ＭＲＩ）、血管造影（Ａｎｇｉｏ）及术中超声（ＯＵＳ）检查,比较它们的诊断效能。结果除Ａｎｇｉｏ的诊断符合率不足５０％外,Ｂｕｓ与ＣＤＩ,ＣＴ,ＭＲＩ的诊断符合率相当,约８０％（２７／３４）,ＥＵＳ,ＯＵＳ,ＥＲＣＰ的诊断率均达９０％（３２／３４）以上,检出全部直径大于和等于２ｃｍ的癌灶。直径小于２ｃｍ的癌灶１０例,ＥＵＳ及ＯＵＳ均检出８／１０例,ＥＲＣＰ在加用活体组织检查后全部检出,Ｂｕｓ、ＣＤＩ、ＣＴ、ＭＲＩ分别检出３例、３例、２例、４例,Ａｎｇｉｏ则无检出病例。结论ＥＵＳ和ＥＲＣＰ是目前检测微小癌灶最有效的方法,Ｂｕｓ因方便经济可做为首选的检查手段,ＣＤＩ从检测癌灶内血流信号有助判断癌灶来源     

Endoscopic ultrasound-guided fine needle aspiration for staging patients with carcinoma of the lung

Background. Endoscopic ultrasound (EUS)-guided fine needle aspiration is a safe, cost-effective procedure that can confirm the presence of mediastinal lymph node metastases and mediastinal tumor invasion. We studied the accuracy of EUS in a large population of lung cancer patients with and without enlarged mediastinal lymph nodes on computed tomographic (CT) scan.

Methods. From 1996 to 2000 all patients referred to our institution with lung tumors and no proven distant metastases were considered for EUS and surgical staging. Patients had endoscopic ultrasound with fine needle aspiration of abnormal appearing mediastinal lymph nodes and evaluation for mediastinal invasion of tumor (stage III or IV disease). Patients without confirmed stage III or IV disease had surgical staging.

Results. Two hundred seventy-seven patients met the inclusion criteria, including 121 who had EUS. Endoscopic ultrasound and fine needle aspiration detected stage III or IV disease in 85 of 121 (70%). Among patients with enlarged lymph nodes on CT, 75 of 97 (77%) had stage III or IV disease detected by EUS. Among a small cohort of patients without enlarged mediastinal lymph nodes on CT, 10 of 24 (42%) had stage III or IV disease detected by EUS. For mediastinal lymph nodes only, the sensitivity of endoscopic ultrasound and CT was 87%. The specificity of EUS (100%) was superior to that of CT (32%) (p < 0.001).

Conclusions. Endoscopic ultrasound with fine needle aspiration identified and histologically confirmed mediastinal disease in more than two thirds of patients with carcinoma of the lung who have abnormal mediastinal CT scans. Although mediastinal disease was more likely in patients with an abnormal mediastinal CT, EUS also detected mediastinal disease in more than one third of patients with a normal mediastinal CT and deserves further study. Endoscopic ultrasound should be considered a first line method of presurgical evaluation of patients with tumors of the lung.     

Is a preoperative multidiagnostic approach to predict surgical resectability of periampullary tumors still effective?

BACKGROUND: Multimodality staging is recommended in patients with periampullary tumors to optimize preoperative determination of resectability. We investigated the potency of currently used diagnostic procedures in order to determine resectability. METHODS: Ninety-five consecutive patients with periampullary tumors prehospitally staged resectable underwent preoperative diagnostic tests: helical-computed tomography (CT) with maximum intensity projection of arterial vessels (MIP), magnetic resonance imaging (MRI), magnetic resonance cholangiopancreaticography (MRCP), endoscopic ultrasonography (EUS), endoscopic retrograde cholangiopancreaticography (ERCP), digital subtraction angiography (DSA), and positron emission tomography (PET). Diagnoses were verified by surgery and histopathology. RESULTS: In 45 patients with benign and 50 patients with malignant periampullary tumors sensitivity for tumor diagnosis was 89% to 96% in CT, MRI, EUS, and PET. Small tumors were best diagnosed by EUS (100%). Diagnosis of malignancy was made with 85% (EUS), 83% (CT), 82% (PET), and 72% (MRI) accuracy. Arterial vessel infiltration was best predicted by CT/MIP with an accuracy of 85%. For venous vessel infiltration MRI reached 85% accuracy. Accuracy rates for local nonresectability were 93% (EUS), 92% (MRI), and 90% (CT). Two and 4 of 8 patients with distant metastases were identified by CT and PET, respectively. The correct diagnosis of malignancy and determination of resectability was made by CT in 71% and by MRI in 70%. Biliary stenting reduced accuracy of CT diagnosis of malignancy from 88% to 73%. CONCLUSIONS: CT obtained before stenting was the single most useful test, providing correct diagnosis in 88% and resectability in 71% of patients. If no tumor is depicted in CT, EUS should be added. Uncertain venous vessel infiltration can be verified by MRI or EUS. Angiography should no longer be a routine diagnostic procedure. Equivocal tumors or possible metastasis may be further examined with PET.     

壶腹周围病变超声内镜诊断价值的探讨

目的 探讨超声内镜（EUS）对壶腹周围病变的诊断价值。方法 对56例壶腹周围病变患（肿瘤性病变44例，非肿瘤性病变12例）施行超声内镜检查，并与体外超声（US），CT检查比较。结果 对照手术结果，EUS对肿瘤性病变正确诊断率为88.6%(39/44)，漏诊3例，误诊2你；非肿瘤性病变正确诊断率83.4%(10/12)，误诊2例。EUS对全部病例的诊断符合率为87.5%(49/56)。US与CT分别为53.6%(30/56）与46.4%(26/56)。有显差异（P=0.011)。结论 EUS是诊断壶腹周围病变的良好手段，特别是对小病变有显的优越性。     

Staging of pancreatic and ampullary cancers for resectability using laparoscopy with laparoscopic ultrasound

Background: Cancers of the pancreas and periampullary region are rarely curable. We set out to determine the efficacy of laparoscopy with laparoscopic ultrasound in the staging of pancreatic and ampullary malignancies for resectability. Methods: Between January 1994 and September 1999, we retrospectively reviewed the laparoscopic staging (LS) of tumors already deemed resectable by standard radiologic criteria in 27 patients using laparoscopy with laparoscopic ultrasound (LUS). Patients found to be resectable by LS evaluation underwent laparotomy (LA). We then compared the results of the LS and LA findings. Results: Of the 27 patients evaluated, 17 were men and 10 were women. Their mean age was 66 years. Preoperative computerized tomography (CT) scans were done in all 27 patients (100%), and transabdominal and endoscopic ultrasound (EUS) was done in 21 (78%). By LS, seven patients (26%) were found to have unresectable disease. Two patients with mesenteric tumor infiltration (one with peritoneal implants, and one with a visible liver metastasis) were judged to be unresectable by laparoscopy alone. LUS revealed that one patient had portal vein (PV) occlusion and two had metastases to the lymph nodes or liver that were not revealed by preoperative studies or laparoscopy alone. Among 20 patients (74%) deemed resectable by LS, two (10%) were found to be unresectable at LA, one due to PV involvement and the other due to local tumor extension with superior mesenteric lymph node metastasis. Eighteen of those in whom resection was attempted (90%) were resectable, with no unexpected findings of distant lymph node or hepatic metastasis. Pathology examination showed that eight had regional metastases (44%). The sensitivity of LS in determining unresectability was 77% (seven true positives and two false negatives). The negative predictive value (reflecting resectability) was 90%. Laparoscopy alone had a sensitivity of 44%, with a negative predictive value of 78%. The sensitivity and positive predictive value of LS was 100%, reflecting no false positive examinations. Conclusions: LS can effectively stage most patients and reliably predict which of them will benefit from LA. Intervention for unresectable patients can then be limited to laparoscopic or endoscopic bypass. The main limitation is that LS may underestimate PV and regional lymph node involvement.     

Endoscopic ultrasonographic detection of carcinomatous invasion and of lymph nodes in the thoracic esophagus

The use of endoscopic ultrasonography (EUS) for diagnosing the depth of carcinomatous invasion into the esophageal wall and in detecting mediastinal lymph nodes in patients with esophageal carcinoma was assessed. EUS was performed before surgery in 33 patients who underwent subtotal esophagectomy with lymph node dissection in our department of surgery between January 1987 and February 1989. The findings of EUS prospectively correlated with intraoperative macroscopic findings and histopathologic findings of the resected specimens. An accurate diagnosis of the depth of invasion into the esophageal wall was made in 30 of the 33 patients (90.1%). Visualization rates of mediastinal lymph nodes were 92.9%, 53.1%, and 1.0% when the nodes were greater than 10 mm in maximum diameter, 5 to 9 mm, and less than 5 mm, respectively. Although EUS had no diagnostic value for patients in whom the ultrasonic probe could not be inserted beyond the tumor, it is an excellent method for evaluating the depth of invasion and detecting lymph nodes greater than 10 mm in diameter. Detection is not feasible when the lymph node is less than 5 mm in diameter. EUS provides the surgeon with one more tool for the preoperative determination of curability.     

MR/MRCP/MRA对胆胰管恶性阻塞性疾病术前诊断及治疗抉择的评价

目的 探讨现代影像学检查对胆胰管恶性阻塞性疾病术前诊断的准确性及临床应用价值。方法 对４４例胆胰管恶性阻塞性疾病患者进行磁共振成像（ＭＲ）、磁共振胆胰管造影（ＭＲＣＰ）以及磁共振动态增强血管显影（ＭＲＡ）检查,并与同期进行Ｂ超（Ｂ－us）、内窥镜逆行性胰胆管造影（ＥＲＣＰ）以及电子计算机断层扫描（ＣＴ）等检查结果对照。结果 ４４例患者中诊断为胰头部和壶腹周围癌者２８例,胰体尾部癌５例,肝胆管癌１１例,其定位准确率为８２％,定性准确率为７６％。Ｂ-us定位准确率、定性准确率分别为７３％和６８５,ＥＲＣＰ定位准确率、定性准确率分别为９６％和８４％。结论 ＭＲ／ＭＲＣＰ／ＭＲＡ对胆胰管恶性阻塞性疾病术前诊断的准确性优于Ｂ超、ＣＴ和ＥＲＣＰ,对胰胆管肿瘤转移和周围组织浸润,尤其是对肿瘤血管浸润可明确显示,其影像学结果对病变程度估计及指导临床治疗抉择有重要价值。     

Assessment of adventitial involvement of esophageal carcinoma by endoscopic ultrasonography

Summary The adventitial involvement (AI) of esophageal squamous cell carcinoma in 20 patients was analyzed by endoscopic ultrasonography (EUS) and computed tomography (CT). The findings were compared with the histologic evidence of tumor invasion in the resected specimens. AI was detected as an irregularity or interruption of the third layer of the esophageal wall on ultrasound examination. The overall accuracy in the assessment of depth of tumor invasion by EUS and CT scan was 80% and 68%, respectively. EUS diagnosed AI in 17 patients and detected direct tumor invasion of either the aorta, trachea or pericardium in 7 of them. In 4 patients who had severe stenotic lesions, EUS underestimated the depth of tumor invasion when compared to the histologic findings. Overall, these results, show that EUS when combined with CT scanning is a useful means of preoperatively evaluating tumor invasion in patients with esophageal carcinoma.     

Predicting resectability of periampullary cancer with three-dimensional computed tomography

The radiographic assessment of extent of tumor burden and local vascular invasion appears to be enhanced with three-dimensional computed tomography (3D-CT). The purpose of this study was to evaluate the impact of preoperative 3D-CT in determining the resectability of patients with periampullary tumors. Intraoperative findings from exploratory laparotomy were gathered prospectively from 140 patients who were thought to have periampullary tumors and were deemed resectable after undergoing preoperative 3D-CT imaging. CT findings were compared to intraoperative findings, and the accuracy of 3D-CT in predicting tumor resectability and, ultimately, the likelihood of obtaining a margin-negative resection were assessed. Of the 140 patients who were thought to have resectable periampullary tumors after preoperative 3D-CT, 115 (82%) were subsequently determined to have periampullary cancer. The remaining 25 patients had benign disease. Among the patients with periampullary cancer, the extent of local tumor burden involving the pancreas and peripancreatic tissues was accurately depicted by 3D-CT in 93 % of the patients. 3D-CT was 95% accurate in determining cancer invasion of the superior mesenteric vessels. Preoperative 3D-CT accurately predicted periampullary cancer resectability and a margin-negative resection in 98% and 86% of patients, respectively. For patients with pancreatic adenocarcinoma (n=85), preoperative 3D-CT resulted in a resectability rate and a margin-negative resection rate of 79% and 73%, respectively. The ability of 3 D-CT to predict a margin-negative resection for periampullary cancer, including pancreatic adenocarcinoma, relies on its enhanced assessment of the extent of local tumor burden and involvement of the mesenteric vascular anatomy. Presented in part at the Fourth Americas Congress of the American Hepato-Pancreato-Biliary Association, Miami, Florida, February 27-March 2, 2003. Supported in part by a grant from the Stavros S. Niarchos Foundation.     

The value of endoscopic ultrasonography in predicting resectability and margins of resection for periampullary tumors

Cure of pancreatic head and other periampullary neoplasms continues to be infrequent and is unattainable unless clear surgical margins are achieved during Whipple pancreaticoduodenectomy. Endoscopic ultrasonography (EUS) is a relatively recent gastrointestinal tumor imaging modality and may be superior to other techniques used in locoregional staging. We hypothesized that EUS can accurately predict not only tumor resectability, but also negative resection margins with Whipple resection. A retrospective review was undertaken of 81 consecutive patients with periampullary tumors who underwent preoperative CT and EUS followed by surgical exploration for intended Whipple resection. Correlations among preoperative EUS results, successful resection, and surgical margins on final histopathology were investigated. Of the 81 patients, 61 (75%) underwent successful Whipple resection, and 20 (25%) were found to be unresectable at laparotomy. Resection was achieved in 57 (86%) of 66 patients predicted to be resectable by EUS. Of the 61 resected patients, 52 (85%) had negative margins and nine (15%) had positive margins on final pathology. Margins were determined to be negative in 50 (88%) of 57 resected patients predicted to have negative margins by EUS. We conclude that EUS is a powerful and desirable imaging modality in the preoperative assessment of periampullary neoplasms.     

Endoscopic ultrasound for preoperative staging of esophageal carcinoma

Background Endoscopic ultrasound (EUS) is potentially the best method for pretreatment staging of esophageal carcinoma once distant metastases have been excluded by other methods. However, its apparent accuracy might be influenced by the use of neoadjuvant therapy. To determine the accuracy of EUS in patients undergoing esophageal resection, the authors reviewed their experience with EUS. Methods A total of 73 patients with esophageal carcinoma who underwent an esophagectomy between April 2000 and February 2005 were examined using preoperative EUS and computed tomography (CT). Of these patients, 39 also underwent preoperative neoadjuvant chemoradiotherapy. Both EUS and CT scan were used to determine the depth of tumor penetration (T-stage) and the presence of lymph node metastases (N-stage). These results then were compared with staging determined after pathologic examination of the resected surgical specimen. Results For patients not undergoing neoadjuvant therapy, T-stage was accurately determined by EUS in 79%, N-stage in 74%, and tumor node metastasis (TNM) classification in 65% of the cases. However, when patients who had undergone neoadjuvant chemoradiotherapy were included, the overall accuracy of EUS was 64% for T-stage, 63% for N-stage, and 53% for TNM classification. For the patients who underwent neoadjuvant therapy, EUS indicated a more advanced T-stage in 49%, N-stage in 38%, and TNM classification in 51% of the cases, as compared with pathology. The overall accuracy of EUS for T- and N-stage carcinomas was superior to that of CT scanning. Conclusion For patients who do not undergo preoperative neoadjuvant chemotherapy and radiotherapy, EUS is a more accurate method for determining T- and N-stage resected esophageal carcinomas. Neoadjuvant therapy, however, results in apparent overstaging, predominantly because of tumor downstaging, and this reduces the apparent accuracy of EUS (and CT scanning) in this patient group. Nevertheless, EUS staging before neoadjuvant therapy could be more accurate than pathologic staging after treatment, thereby providing better initial staging information, which can be used to facilitate treatment.     

腹腔镜超声在胰腺壶腹部肿瘤分期诊断和治疗中的价值

目的 评价腹腔镜超声技术(LapUS)在胰腺和壶腹部癌肿分期诊断和治疗中的临床应用价值。方法 自1996年12月～1999年12月连续对46例怀疑胰腺和壶腹部肿瘤病人进行腹腔镜和腹腔镜超声分期诊断。并与术前影像学检查、手术中发现及术后标本病理学检查进行前瞻对比研究。着重检查肿瘤范围、周围血管侵犯、周围淋巴结转移、浆膜浸润和肝、邻近脏器转移;对可疑病变和肿大的淋巴结进行腹腔镜超声引导下穿刺活检。判断肿瘤切除性。结果 46例病人中。LapUS发现肿块性病灶44例,2例阻塞性黄疸确诊为壶腹部结石嵌顿排除肿瘤。44例肿块性病变中41例为恶性肿瘤,3例为炎性病变,肿瘤诊断正确率为93．2％。本组未发生腹腔镜和腹腔镜超声检查有关并发症。结论腹腔镜和腹腔镜超声检查应列为重要的分期诊断工具,剖腹探查前常规应用可明显提高诊断正确率、完善肿瘤分期诊断和可切除性判断。可避免不必要的剖腹探查术。在微创外科诊治中具有重要的临床应用价值。     

Selektion von Patienten mit Rektumtumoren zur lokalen Exzision aufgrund der präoperativen Diagnostik

INTRODUCTION: The aim of our study was to evaluate the accuracy of clinical staging (CS), biopsies, and endoluminal ultrasonic examination (EUS) in preoperative staging of rectal tumors treated with transanal local excision. This local excision is an adequate procedure for benign rectal polyps and low-risk T1 carcinoma. PATIENTS AND METHODS: The study included 552 patients with rectal adenocarcinoma, villous adenoma, or tumors with other histologic characteristics who underwent a transanal excision (transanal endoscopic microsurgery n=513 or transanal excision n=39). We compared the results of CS, biopsies, and EUS with postoperative pathology findings. RESULTS: Preoperative histological diagnosis of the rectal carcinoma depended on tumor size (52% in cancers <3 cm, 25% in cancers >3 cm; p=0.001) and was correct in 56% of cases. Transanal ultrasonography (uT0/1) had superior sensitivity (95% vs 78%) and a higher positive predictive value (93% vs 85%) than clinical staging (CS I) in detecting adenoma or T1 rectal carcinoma, whereas specificity was similar in both (62% vs 58%). In patients in whom preoperative histological analysis revealed adenomas, transanal ultrasonography was accurate (uT0/1) for the postoperatively assessed adenoma pT1 in 97%, whereas diagnosis (uT0/1) was correct in only 71% of cases in which preoperative histological analyses showed rectal carcinomas. CONCLUSIONS: In patients with rectal tumors, preoperative staging with transanal ultrasonography and biopsy is essential for the indication and allows selection of patients for transanal local excision.     

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。     

趋化因子受体CCR7在胃癌中的表达及其与淋巴结转移的关系

目的探讨趋化因子受体CCR7的表达对预测胃癌淋巴结转移的临床价值。方法对132例行胃癌根治术和30例内镜活检的胃癌组织标本采用免疫组化法检测CCR7的表达。结果CCR7在56.8%的病例中呈阳性表达。CCR7在伴有淋巴结转移病例中的表达显著高于无淋巴结转移者(P<0.001);其与肿瘤大小(P<0.01)、浸润深度(P<0.001)、淋巴管浸润(P<0.001)和TNM分期(P<0.001)相关,并与多层螺旋CT(MSCT)和病理检查判断的淋巴结转移密切相关(P<0.05,P<0.01);但与年龄、性别、肿瘤位置、Lauren分类和血管浸润无关。在回顾性研究中,CCR7表达对胃癌淋巴结转移判断的敏感性、特异性、阳性预测值(PPV)、阴性预测值(NPV)和准确率分别为83.1%、73.8%、78.7%、78.9%和78.8%;在前瞻性研究中,CCR7表达对胃癌淋巴结转移判断的敏感性、特异性、PPV、NPV和准确率分别达85.0%、60.0%、80.9%、66.7%和76.7%。结论CCR7表达与胃癌淋巴结转移密切相关,对内镜活检组织检测CCR7的表达有助于预测胃癌淋巴结转移及决定淋巴结清扫的手术范围。CCR7可能成为胃癌治疗的新靶点。     

超声内镜和CT检查对判断食管癌根治性切除的临床价值

目的探讨超声内镜（EUS）和CT对判断食管癌能否根治性切除的临床价值。方法回顾性分析经手术治疗的746例食管癌患者的临床资料．按术前所行检查分为CT组（480例）、EUS组（151例）和EUS加CT组（115例）,采用双盲法,对EUS和CT影像进行回顾性阅片,并将各组结果和手术病理结果进行对照研究。结果CT组、EUS组和EUS加CT组患者的手术根治性切除率分别为91．0％、93．4％和93．9％：3组间差异无统计学意义（X2=1．551,P=0．484）。CT组、EUS组和EUS加CT组术前判断手术根治切除率分别为81．7％、94．7％和96．5％（Xz=15．131,P=0．000;x2=15．662,P=0．000：X2=0．502．P=0．346）;诊断主动脉受侵率分别为91．3％、98．7％和98．3％（X2=9．764,P=0．000;x2=6．659,P=0．004;x2=0．076,P=0．581）;诊断气管支气管受侵率分别为91.3％、96．0％和98．3％（X2=3．729,P=0．034;X2=6．659,P=0．004;X2=1．117,P=0．248）。结论EUS诊断食管癌根治切除和主动脉受侵的临床价值高于CT：EUS和CT诊断气管支气管受侵的价值均较低：与单独应用EUS相比．CT和EUS的联合应用未能显著提高诊断食管癌的根治切除率。     

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.