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Rudolf Mennigen Dirk Tuebergen Gabriele Koehler Cristina Sauerland Norbert Senninger Matthias Bruewer 《Journal of gastrointestinal surgery》2008,12(2):256-262
Background Using an endoscopic ultrasound (EUS) miniprobe, even highly stenotic esophageal cancers precluding the passage of a conventional
probe can be examined without prior dilatation.
Objective To assess: (1) staging accuracy of conventional EUS probe and miniprobe, (2) variables influencing staging accuracy, (3) endoscopic
features predicting tumor stage.
Methods Ninety-seven consecutive patients with esophageal cancer undergoing complete surgical resection were included. Preoperative
EUS was performed using a conventional probe in nonstenotic tumors and a miniprobe in stenotic tumors. Accuracy of EUS for
T and N stages was compared to pathohistological staging.
Results Overall EUS staging accuracy was 73.2% for T stage and 74.2% for N stage. It was similar for the miniprobe used in stenotic
tumors vs the conventional probe used in nonstenotic tumors. Based on EUS, 84.5% of the patients would have been assigned
to the appropriate therapy protocol (primary surgery vs neoadjuvant therapy). Endoscopic tumor features had no influence on
staging accuracy. Tumor length >5 cm predicted advanced T and nodal positive stages.
Conclusions The miniprobe allows adequate EUS staging of stenotic esophageal tumors precluding the passage of a conventional probe. Therefore,
dilatation therapy of stenotic cancers to conduct conventional EUS should be avoided.
R. Mennigen and D. Tuebergen contributed equally to this work Poster presentation during the Digestive Disease Week, Washington,
DC, May 19–24, 2007. 相似文献
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Barbour AP Jones M Gonen M Gotley DC Thomas J Thomson DB Burmeister B Smithers BM 《Annals of surgical oncology》2008,15(10):2894-2902
Objective Accurate staging is vital for esophageal cancer management. The utility of the American Joint Committee on Cancer (AJCC) staging
system 6th edition for esophageal cancer has been questioned for resected patients who receive neoadjuvant chemoradiotherapy
(CRT). This study was undertaken to assess the AJCC staging system for patients with esophageal cancer that have received
neoadjuvant CRT and to identify clinicopathological variables that predict survival.
Methods Review of a prospective esophageal cancer database was undertaken for patients that received neoadjuvant CRT and resection.
Primary tumor response was defined as major (≤10% residual tumor cells) or minor (>10% residual tumor cells). Cox regression
and concordance analyses were used to determine prognostic factors. Median follow-up was 61 months.
Results Of 131 patients with invasive cancer, there were 40/131 (31%) with squamous cell carcinoma (SCC) and 88/131 (65%) with adenocarcinoma.
The procedure-related mortality rate was 3.8%. Median survival was 33 months. A major response was demonstrated by 79/131
(60%) patients. Survival analyses found that the AJCC 6th edition was unable to discriminate between stages 0, I, and IIa
or stages IIb and III. Multivariate survival analyses found age, pretreatment tumor length >6 cm, positive lymph nodes, and
a major tumor response were independent prognostic factors. These data were used to derive a new staging system that had improved
discrimination of stage groups over the current AJCC system.
Conclusion The current AJCC staging system for esophageal cancer is inadequate for patients that receive neoadjuvant CRT. Refinement
of the AJCC staging system should include primary tumor response for patients receiving neoadjuvant CRT. 相似文献
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制订2009第7版食管癌TNM分期标准 总被引:7,自引:1,他引:7
陈龙奇 《中国胸心血管外科临床杂志》2008,15(1):52-55
目的报告参与制订2009第7版食管癌国际TNM分期的国际协作研究结果。方法收集全世界13个协作单位的4628例食管癌单纯切除病例的资料,采用全新的统计学模型,综合各预后影响因素反向归纳至最合理的TNM分期。结果全组总的1、5、10年死亡率分别为78%、42%、31%。远期生存的主要影响因素为肿瘤侵犯深度、淋巴结转移数目、有无远处转移、肿瘤的组织学类型和分化程度。将其优化组合后新的TNM分期中T1应细化为T1a和T1b,T4应细化为T4a和T4b,N应当根据淋巴结的转移数目分级,M1的亚分级应当取消,且应加入肿瘤组织学类型(H)和分化程度(G)因素。结论2009第7版食管癌分期标准重新定义了T、N、M,并分期为0、Ⅰa、Ⅰb、Ⅱ、Ⅲa、Ⅲb、Ⅳ期,可更好地预测食管癌患者手术切除治疗的预后。 相似文献
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目的探讨直肠腔内超声(TRUS)对评估直肠癌术前分期的临床价值。方法对118例经肠镜活检病理证实为直肠癌患者行TRUS检查,观察肿块内部回声、肿瘤浸润肠壁深度及与周围组织器官的关系,根据TN分期标准进行术前分期,并与术后病理分期进行对照。结果 TRUS评估直肠癌T分期完全符合率为86.4%(102/118),T1~T4的敏感度分别为80.0%、82.3%、91.6%、83.9%和特异度分别为100.0%、90.4%、90.0%、98.8%;Kappa值为0.734,超声分期与病理分期高度一致(P0.05),对评估淋巴结转移的灵敏度为81.4%(79/97),特异度为71.4%(15/21)。结论 TRUS对评估直肠癌浸润深度及淋巴结转移等有较高的准确性,为治疗方案的选择提供可靠的参考信息。 相似文献
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Staging Anal Cancer: Prospective Comparison of Transanal Endoscopic Ultrasound and Magnetic Resonance Imaging 总被引:1,自引:0,他引:1
S. D. Otto L. Lee H. J. Buhr B. Frericks S. Höcht A. J. Kroesen 《Journal of gastrointestinal surgery》2009,13(7):1292-1298
Purpose The staging of anal cancer is extremely important for therapy and prognosis. Transanal endoscopic ultrasound and magnetic
resonance imaging are routinely applied. The aim of this prospective comparative study is to evaluate whether tumor staging
is concordant between these techniques.
Methods Forty-five anal cancer patients underwent endoscopic ultrasound and magnetic resonance imaging. Histological confirmation
was obtained in all patients. The two test methods were compared with the kappa concordance index and sensitivity for the
initial method of tumor detection was calculated. For six patients who were operated upon because of tumor progression, the
results were evaluated against the histological tumor stage.
Results High concordance was found in the assessment of tumor size and nodal status (kappa index 0.63 and 0.77). Cancer patients were
correctly identified with 100% sensitivity (45/45) by endoscopic ultrasound and with 88.9% (40/45) sensitivity by magnetic
resonance imaging. In the six operated patients, T stage was correctly assessed in four of six patients by endoscopic ultrasound
and in three of six patients by magnetic resonance imaging.
Conclusion The results of endoscopic ultrasound strongly coincide with those of magnetic resonance imaging. Endoscopic ultrasound may
be superior to magnetic resonance imaging for detection of small superficial tumors. However, magnetic resonance imaging is
needed for N staging. 相似文献
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Jikke M. T. Omloo Mark van Heijl Jacques J. G. H. M. Bergman Mia G. J. Koolen Mark I. van Berge Henegouwen J. Jan B. van Lanschot 《Journal of gastrointestinal surgery》2008,12(11):1874-1879
Introduction Esophageal cancer is an aggressive disease with a strong tendency to infiltrate into surrounding structures. The aim of the
present study is to determine the additional value of bronchoscopy for detecting invasion of the tracheobronchial tree after
endoscopic ultrasonography (EUS) in the preoperative assessment of patients with esophageal cancer at or above the carina.
Materials and Methods Between January 1997 and December 2006, 104 patients were analyzed for histologically proven esophageal cancer at or above
the carina. All patients underwent both EUS and bronchoscopy (with biopsy on indication) in the preoperative assessment of
local resectability.
Results and Discussion After extensive diagnostic workup, 58 of 104 patients (56%) were eligible for potentially curative esophagectomy; nine of
these 58 patients (9/58, 15%) appeared to be incurable peroperatively because of ingrowth in the tracheobronchial tree (five
patients), ingrowth in other vital structures (two patients) or distant metastases (two patients). Of the 46 non-operable
patients, local irresectability (T-stage 4) was identified in 26 patients (26/46, 57%) due to invasion of vital structures
on EUS: invasion of the aorta in six patients, invasion of the lung in 11 patients; in 12 patients invasion of the tracheobronchial
tree was described, which was confirmed by bronchoscopy in only five patients. No patients with T4 were identified by bronchoscopy
alone.
Conclusion For patients with esophageal tumors at or above the carina, no additional value of bronchoscopy (with biopsy on indication)
to exclude invasion of the tracheobronchial tree was seen after EUS in a specialized centre. Although based on relatively
small numbers, we conclude that bronchoscopy is not indicated if no invasion of the airways is identified on EUS.
Presented at: NVGE/NVGIC (Dutch Society of Gastrointestinal Surgery), October 2007, Veldhoven the Netherlands (oral presentation);
United European Gastroenterology Week, October 2007, Paris, France (poster presentation); European Society of Esophagology,
September 2007, Dublin, Ireland (poster presentation).
Sources of financial support: JMT Omloo is supported by a grant from Zon Mw Health Care Efficiency Research (945-04-510). 相似文献
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《European urology》2020,77(6):727-732
BackgroundMagnetic resonance imaging (MRI) has been proposed as a staging tool for bladder cancer (BC), but its use has been limited by its high costs and limited availability. Microultrasound (mUS) is a novel technology capable of providing high-resolution images of the prostate.ObjectiveTo test the feasibility of high-resolution mUS in patients diagnosed with BC and its ability to differentiate between non-muscle-invasive BC (NMIBC) and muscle-invasive BC (MIBC).Design, setting, and participantsThis is an observational prospective study performed in 23 patients with a diagnosis of primary BC scheduled for an endoscopic treatment.Surgical procedureMicro-US was performed before transurethral resection of bladder tumor using the ExactVu system with an EV29L 29-MHz side-fire transducer (Exact Imaging, Markham, Canada).MeasurementsThe endpoints were to test the feasibility, describe the normal bladder wall anatomy, identify the lesions, and compare the mUS findings with the histopathological results.Results and limitationsMicro-US was accurate in differentiating the three layers of the bladder wall in all cases. Bladder cancers were clearly identified as heterogeneous structures protruding from the normal bladder wall. In 14 cases the lesions appeared confined to the lamina propria, and in all cases NMIBC was confirmed by the final pathological report. In the other patients, the lesions seemed to extend into the muscular layer, but MIBC was confirmed in five out of seven cases (71.4%) from the pathologist. The small sample size was the main limitation of the current study.ConclusionsOur findings showed that mUS is able to differentiate the bladder wall layers and identify the bladder cancer stage. Further studies with a larger population and imaging correlation with MRI are warranted before its introduction in clinical practice.Patient summaryIn this report, a new imaging technique was tested for the characterization of bladder cancer. Microultrasound appears to be feasible and capable of discriminating between superficial and invasive tumors. 相似文献
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《Surgical pathology clinics》2020,13(1):57-71
Lung cancer staging is a foundation of patient care, informing management decisions and prognosis. This comprehensive overview of the current 8th edition American Joint Committee on Cancer Cancer Staging Manual addresses common difficulties in staging, such as measuring the invasive component of adenocarcinomas and staging multiple lung nodules. 相似文献
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Juan Carlos Molina Eric Goudie Clare Pollock Vanessa Menezes Pasquale Ferraro Edwin Lafontaine Jocelyne Martin Basil Nasir Moishe Liberman 《The Annals of thoracic surgery》2021,111(4):1150-1155
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Pitfalls of Positive Findings in Staging Esophageal Cancer With F-18-Fluorodeoxyglucose Positron Emission Tomography 总被引:6,自引:0,他引:6
van Westreenen HL Heeren PA Jager PL van Dullemen HM Groen H Plukker JT 《Annals of surgical oncology》2003,10(9):1100-1105
Background: 18-F-fluorodeoxyglucose positron emission tomography (FDG-PET) is valuable in staging of esophageal cancer. However, FDG-PET may falsely upstage patients leading to incorrect exclusion from surgical treatment. This study was performed to determine the false-positive rate and possible causes.Methods: The rate of false-positive lesions on FDG-PET was documented in 86 out of a group of 98 patients. Lesions were defined as false positive when pathological examination was negative or as absence of tumor activity within 6 months of follow-up. To evaluate the influence of a learning curve on the false-positive rate, the PET scans were revised recently.Results: False-positive lesions were found in 13 patients (13 of 86; 15%). FDG-PET incorrectly revealed only locoregional node metastases in 5 patients in whom surgery with curative intent was performed. Ten lesions in the other 8 patients were classified as distant organ or as nonregional node metastases (M1a/1b). Finally, 5 patients upstaged to M1a/1b underwent a curative resection. The number of false-positive lesions decreased from 16 to 5 (6%) after revision.Conclusions: Proper interpretation of FDG-PET in staging esophageal cancer is impeded by false-positive results. Even after completion of the learning curve, positive FDG-PET findings still have to be confirmed by additional investigations. 相似文献
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淋巴结转移范围较数目能更好地反映食管癌手术治疗的预后 总被引:4,自引:0,他引:4
目的为了完善食管癌淋巴结分级,探索食管癌淋巴结转移的理想分级方法。方法回顾性分析1985年1月至1989年12月期间236例胸段食管癌切除,且淋巴结清扫数目≥6枚的患者的临床病理及随访资料,采用Cox风险比例模型筛选风险因子,Log—rank检验对按淋巴结转移数目、距离、范围的分级进行生存分析。结果患者10年随访率为92.3%(218/236),全组总的1年、5年、10年生存率分别为80.2%、43.1%和34.2%;其中112例(47.4%)有淋巴结转移,其5年生存率低于无淋巴结转移患者(14.8% vs.66.6%;Х^2=77.18,P=0.000)。Cox回归分析:除了侵及深度、分化程度及有无淋巴结转移外,还有淋巴结转移个数、转移距离及转移范围均为影响预后的独立危险因素。单因素Log—rank检验:按转移淋巴结数分组时,总体生存率差异有统计学意义(Х^2=96.00,P=0.000),但N2与N3组间生存率差异无统计学意义(P〉0.05);按淋巴结转移距离分组,总体生存率差异有统计学意义(Х^2=79.29,P=0.000),但S1,S2,S3组间生存率差异无统计学意义(P〉0.05);按淋巴结转移范围分组(0,1和≥2野),总体生存率差异有统计学意义(Х^2=87.47,P=0.000),并且各组间生存率差异亦有统计学意义(Х^2=5.14,P=0.023)。结论按照淋巴结转移的范围(无转移、1野转移、≥2野转移)来修订食管癌TNM分期的N分级,更为合理并能更好地反映食管癌切除手术患者的预后。 相似文献
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L Convie RJ Thompson R Kennedy WDB Clements PD Carey JA Kennedy 《Annals of the Royal College of Surgeons of England》2015,97(2):146-150