剪切波弹性成像在直肠癌T分期中的应用价值

目的 探讨实时二维剪切波弹性成像（SWE）联合直肠腔内超声（ERUS）在直肠癌术前浸润深度（T分期）诊断的准确性,并与ERUS和增强磁共振成像（MRI）进行比较。方法 收集85例经病理确诊为直肠癌患者的临床资料,患者均于术前进行ERUS、SWE和增强MRI检查,以术后病理T分期为金标准,分析ERUS、SWE联合ERUS和MRI这3种检查方法对直肠癌术前T分期诊断的准确性。结果 采用SWE获得的杨氏模量平均值在直肠癌各T分期中差异有统计学意义（P < 0.05）。受试者工作特征 （ROC） 曲线显示T1/T2、T2/T3、T3/T4最佳分期截断值分别为63.5、114.9和190.7 kPa,其曲线下面积为0.864~0.994。SWE联合ERUS对直肠癌患者术前T分期的诊断与病理的符合率高于ERUS（P < 0.05）,稍高于MRI检查,但比较差异无统计学意义（P > 0.05）。在亚组分析中,对于T1~T2期直肠癌,SWE联合ERUS与病理分期的符合率高于ERUS和MRI（P均 < 0.05）,对于T3~T4期直肠癌,MRI与病理的符合率高于ERUS（P < 0.05）,稍高于SWE联合ERUS,但比较差异无统计学意义（P > 0.05）。结论 SWE能够直观反映肿瘤硬度, SWE联合ERUS在直肠癌术前T分期诊断准确率高于ERUS,且稍高于增强MRI检查,尤其在T1~T2期直肠癌分期中优于MRI和ERUS。     

直肠腔内超声对直肠癌术前新辅助放化疗疗效评估

  目的  评估直肠腔内超声(endorectal ultrasound, ERUS)对直肠癌术前新辅助放化疗后分期的应用价值。  方法  回顾性分析2011年9月至2012年9月北京协和医院收治的直肠癌患者62例, 所有患者在放化疗前后完成ERUS检查并分期, 最终经直肠全系膜切除术(total mesorectal excision, TME)切除肿瘤, 并进行病理分期, 比较ERUS分期与手术病理分期结果。  结果  62例患者中8例放化疗后肿瘤消失, 达到病理完全缓解(pT0N0), 但ERUS均未准确诊断; 30例对放化疗反应较好的患者中仅7例肿瘤浸润深度超声分期(uT分期)准确。ERUS的uT总准确性仅40.3%(25例), 过高分期58.1%(36例), 过低分期1.6%(1例)。ERUS诊断转移淋巴结的敏感性、特异性、阳性预测值、阴性预测值分别为60.0%、84.6%、42.9%、91.7%。  结论  ERUS对直肠癌放化疗后肿瘤浸润深度超声分期(uT分期), 尤其是对放化疗反应较好的肿瘤分期准确性偏低, 且无法诊断肿瘤完全病理缓解。ERUS对淋巴结转移诊断的特异性和阴性预测值较高, 可对直肠癌预后作出很好的预判。     

直肠腔内超声血流动力学参数与剪切波弹性成像在直肠癌鉴别诊断及T分期中的应用研究

目的：探讨直肠腔内超声(ERUS)血流动力学参数与剪切波弹性成像(SWE)在直肠癌鉴别诊断及T分期中的应用价值。方法：选取128例直肠肿瘤患者的临床资料进行回顾性分析,选取时间为2018年5月至2020年6月,经病理活检确诊为直肠癌(恶性组)共68例、直肠腺瘤(良性组)共60例,均予以超声、剪切波弹性成像技术检查,对比恶性组与良性组的RI、PI、PSV、EDV等血流动力学参数、Emean指标;观察直肠癌不同分期血流动力学参数与Emean值;以及评估RI、PI、PSV、EDV、血流动力学综合参数、Emean诊断直肠癌的AUC、敏感度、特异度、约登指数。结果：恶性组的RI、PI低于良性组,而PSV、EDV、Emean均高于良性组(P＜0.05)。单因素方差分析显示,T1、T2、T2、T4期的RI、PI、PSV、EDV、Emean比较,差异存在统计学意义(P＜0.05)。ROC曲线分析显示,RI、PI、PSV、EDV、血流动力学综合参数、Emean诊断直肠癌的AUC分别为(0.914、0.747、0.666、0.839、0.999、0.996,P＜0.05);敏感度分别为88.20%、48.50%、72.10%、64.70%、98.50%、100.00%;特异度为83.30%、100.00%、56.70%、95%、98.30%、93.30%。结论：ERUS血流动力学参数与SWE用于直肠癌鉴别诊断中均具有较高的临床价值,其中SWE可作为ERUS的辅助手段,两者联合能更好地进行T分期,为临床诊治提供客观依据。     

经直肠超声与体部线圈磁共振检查对直肠癌T分期的比较研究

目的比较经直肠超声(ERUS)和体部线圈MRI对直肠癌T分期诊断准确性。方法回顾性分析31例术前未接受新辅助放化疗的直肠癌患者,对所有患者均于术前1周行ERUS和MR检查、后行一期手术切除。以术后病理结果作为金标准,比较ERUS和MRI对直肠癌T分期的诊断效能。结果 31例患者中,术后病理诊断T1期7例,T2期6例,T3期18例。ERUS显示病变累及肠管长度约(28.18±13.30)mm,MRI显示约为(35.58±18.24)mm,二者差异有统计学意义(t=3.497,P=0.002),但两种检查所测得病变下缘距肛门距离、病灶厚度的差异均无统计学意义(P均>0.05)。ERUS诊断直肠癌T1、T2、T3、T4期的准确率分别为93.55%,93.55%,87.10%和100%,总准确率为93.55%;MRI诊断直肠癌T1、T2、T3、T4期的准确率分别为87.10%,70.97%,64.52%和93.55%,总准确率为79.03%;ERUS、MRI诊断的直肠癌各期以及总准确率的差异均无统计学意义(P均>0.05)。结论 ERUS和MRI均为直肠癌术前分期诊断的可靠检查方法,ERUS对于T分期的准确性稍高于MRI。     

The role and value of endorectal ultrasonography in diagnosing T1 rectal tumors

Rectal carcinoma in 50% to 60% of cases is localized in the rectum and, if diagnosed early can be locally excised. The authors evaluated the diagnostic accuracy of the preoperative endorectal ultrasonography (ERUS) in the staging of rectal tumors and the usefulness of the method to assess patients' suitability for local excision. In the retrospective analysis, we analyzed 29 patients with rectal cancer. The depth of invasion into the rectal wall was assessed by ERUS and all patients were qualified for tumor excision with transanal endoscopic microsurgery (TEM). We analyzed overall accuracy of ERUS and the effectiveness of treatment. In the analyzed group, diagnostic accuracy of ERUS in assessing T1 carcinomas was 89.2%, sensitivity 92.3% and specificity 50%. Local excision with TEM was deemed to be curative in 86.2% patients with rectal tumors detected by ERUS. ERUS is an accurate method of preoperative assessment of T1 and T2 carcinomas and its diagnostic accuracy is sufficient to qualify patients for anal-saving operations.     

直肠腔内超声对直肠癌术前新辅助放化疗疗效评估简

目的评估直肠腔内超声（endorectal ultrasound,ERUS）对直肠癌术前新辅助放化疗后分期的应用价值。方法回顾性分析2011年9月至2012年9月北京协和医院收治的直肠癌患者62例,所有患者在放化疗前后完成ERUS检查并分期,最终经直肠全系膜切除术（total mesorectal excision,TME）切除肿瘤,并进行病理分期,比较ERUS分期与手术病理分期结果。结果62例患者中8例放化疗后肿瘤消失,达到病理完全缓解（pT0N0）,但ERUS均未准确诊断;30例对放化疗反应较好的患者中仅7例肿瘤浸润深度超声分期（uT分期）准确。ERUS的uT总准确性仅40．3％（25例）,过高分期58．1％（36例）,过低分期1．6％（1例）。ERUS诊断转移淋巴结的敏感性、特异性、阳性预测值、阴性预测值分别为60．O％、84．6％、42．9％、91．7％。结论ERUS对直肠癌放化疗后肿瘤浸润深度超声分期（uT分期）,尤其是对放化疗反应较好的肿瘤分期准确性偏低,且无法诊断肿瘤完全病理缓解。ERUS对淋巴结转移诊断的特异性和阴性预测值较高,可对直肠癌预后作出很好的预判。     

Shear Wave Elastography in Rectal Cancer Staging,Compared with Endorectal Ultrasonography and Magnetic Resonance Imaging

The goal of the study described here was to investigate the value of shear wave elastography (SWE) in pre-operative staging of rectal cancer. Fifty-five patients with rectal cancer underwent pre-operative conventional endorectal ultrasonography (ERUS), SWE and enhanced magnetic resonance imaging (MRI) examinations. Pathologic results were used as the gold standard for cancer staging. The concordance rate with pathologic stage by ERUS and MRI and the stiffness values measured by SWE for tumors in different stages were compared. The concordance rates for cancer staging were 72.7% and 70.9% for conventional ERUS and enhanced MRI, respectively; the difference was not significant (p > 0.05). SWE indicated that the mean and maximum stiffness values of the tumors increased with advance in stage. The differences in stiffness values between T1 and T2, T1 and T3–4, as well as T2 and T3–4, were all statistically significant (p < 0.001). When the maximum stiffness values of 65.0 and 90.7 kPa are used for the diagnosis of T1, T2 and local advanced rectal cancer, the concordance rate of cancer staging was 85.5%, which was slightly higher than those of ERUS and MRI, although the difference was not statistically significant (p > 0.05). SWE is useful in judging the depth of invasion of rectal tumors. The value of tumor stiffness can provide a quantifiable indicator for pre-operative diagnosis of cancer staging and can be used as a supplement to conventional ERUS. Further studies with larger sample sizes are needed.     

高频微探头内镜超声在胃癌TN分期中的应用评价

目的评价高频微探头内镜超声检查（EUS）在胃癌TN分期中的价值。 方法胃癌患者98例均行高频微探头内镜超声检查,了解肿瘤侵犯深度、局部淋巴结转移情况,采用外科手术后病理为金标准进行对照,了解EUS在胃癌TN分期中的准确性。 结果（1）EUS对TN分期阳性诊断正确率分别为88.78%,66.33%;（2）EUS对TN分期诊断过深率分别为6.12%,0（P〈0.05）;过浅率分别为5.10%,33.67%（P〈0.05）;（3）EUS对T分期有较高的敏感性（87.10%～100%）和特异性（81.25%～100%）,阳性预测值83.33%～100%,阴性预测值94.37%～100%;EUS对N分期阳性诊断的敏感性、特异性、阳性及阴性预测值分别为52.17%、100%、100%、46.77%。 结论高频微探头内镜超声检查对判断肿瘤侵犯深度的诊断（T分期）较准确,对判断局部淋巴结转移的诊断（N分期）有一定价值。     

高频微探头超声内镜检查在结直肠癌术前TN分期中的价值

目的:探讨高频微探头超声内镜(EUS)检查在结直肠癌TN分期中的价值.方法:145例结直肠癌患者术前采用高频微探头EUS检查进行TN分期,并与术中探查和术后病理检查结果进行比较.结果:结直肠癌患者术前高频微探头EUS检查的T、N分期与术后病理分期符合率分别为84.83％和70.34％,其中T1、T2、T3、T4期的符合率分别为88.89％、85.71％、84.27％和80.00％.对有无淋巴结转移的诊断符合率较高,分别为98.41％(N+)、92.68％ (N0).N1、N2分期的符合率分别为76.92％和16.22％.结论:高频微探头EUS检查能较准确地判断结直肠癌的浸润深度(T分期),尤其适用于早期结直肠癌和癌性狭窄患者的术前分期;对有无淋巴结转移判断较准确,对N分期,尤其N2分期准确性有待提高.     

Improvement in T-staging of rectal carcinoma: using a novel endorectal ultrasonography technique with sterile coupling gel filling the rectum

Our purpose was to study the accuracy of using endorectal ultrasonography (ERUS) with sterile coupling gels filling the rectum in the preoperative T-staging of rectal carcinoma. A total of 189 patients with confirmed rectal carcinoma were recruited. All underwent ERUS and surgery within the week following sonography. EURS was performed by introducing sterile coupling gel into the rectum. Two radiologists looked at the images at the same time and agreed upon staging. Rectal carcinoma was staged from Tis to T4. The accuracy of T-staging by ERUS was 89.95%. The sensitivity, specificity, PPV and NPV for ERUS at different stages were calculated. For early stage (Tis and T1), these values were 93.62%, 97.89%, 93.62% and 97.89%, respectively. ERUS filling with sterile coupling gel in the rectum overcomes the pressure effect from a water bath and the restriction caused by tumor stenosis, thus, greatly improving the accuracy of T-staging. The examination is real-time, safe and inexpensive.     

经直肠超声术前评估直肠癌累及直肠系膜筋膜

目的 探讨经直肠超声（ERUS）术前评估直肠癌累及直肠系膜筋膜（MRF）的价值。方法 44例直肠癌患者术前均接受ERUS检查,其中18例接受新辅助放化疗,26例未接受;所有患者于接受ERUS检查后1周内行全直肠系膜切除手术（TME）。以术后病理诊断环周切缘（CRM）的结果为金标准,判断ERUS术前评估直肠癌累及MRF的诊断效能。结果 44例患者中,术后病理诊断T1期2例,T2期17例,T3期25例;CRM阳性2例,CRM阴性42例。低位直肠癌16例,中位直肠癌28例。肿瘤位于前壁和前侧壁26例,后壁和后侧壁13例,累及肠壁全周5例。ERUS对术前接受和未接受新辅助放化疗的患者诊断准确率分别为83.33%（15/18）和92.31%（24/26）;肿物位于前壁和前侧壁时,诊断准确率为80.77%（21/26）,而肿物位于后壁和后侧壁时为100%（13/13）;对于低位和中位直肠癌,诊断准确率分别为75.00%（12/16）和96.43%（27/28）;总准确率为88.64%（39/44）。结论 ERUS是术前评估直肠癌是否累及MRF的有效辅助检查方法。     

多平面三维超声诊断膀胱肿瘤及其术前分期

目的 探讨多平面三维超声结合表面三维成像诊断膀胱肿瘤及其术前分期的应用价值.方法 对75例膀胱肿瘤患者进行二维、多平面三维和表面三维超声检查,并与手术病理诊断和分期结果及CT术前分期结果进行对照.结果 二维与三维超声诊断符合率分别为 93.3%与 98.7%;二维与三维超声分期诊断符合率分别为 83.5%与 93.2%,两者差异有统计学意义(P＜0.05);术前CT对膀胱肿瘤的诊断符合率为 90.7%,分期符合率为 79.7%.将三维超声分期符合率与CT分期对照,两者差异有统计学意义(P＜0.05).结论 多平面三维超声结合表面三维诊断膀胱肿瘤及其对肿瘤的术前分期符合率较高,可为临床诊断本病提供更多的信息.

Abstract：

Objective To evaluate the clinical value of multi-tomographic imaging mode of three-dimensional ultrasound combined with surface imaging in diagnosing and staging bladder tumors.Methods Seventy-five patients were examined with three-dimensional ultrasound and two-dimensional ultrasound.In addition,54 cases were undergone preoperative multislice spiral CT.All cases were proved by pathology after operation.Results The qualitation accuracy in the diagnosis of bladder tumor with two-dimensional ultrasound was 93.3%(70/75) and that of three-dimensional ultrasound was 98.7%(74/75).The staging accuracy rates with two-dimensional ultrasound and three-dimensional ultrasound were 83.5%(106/127) and 93.2%(123/132) respectively.The difference of bladder tumor staging between three-dimensional ultrasound and two-dimensional ultrasound was significant (P＜0.05).The qualitation accuracy in the diagnosis of bladder tumor with CT was 90.7%(49/54).The preoperative staging rate of CT was 79.7%(59/74),compared with that of three-dimensional ultrasound,the difference was significant(P＜0.05).Conclusions Multi-tomographic imaging mode of three-dimensional ultrasound combined with surface imaging can provide useful information and makes an improvement in detecting and staging bladder tumors.     

腔内超声在直肠癌分期中的应用

直肠腔内超声是直肠癌术前分期较有效的方法。与CT和MRI比较,腔内超声对直肠癌浸润及肠周系膜淋巴结转移诊断准确性均较高,同时有许多因素限制腔内超声诊断准确性。为了早期发现肿瘤复发,腔内超声广泛应用于术后随访。     

直肠腔内弹性成像对直肠癌新辅助治疗后肿瘤浸润深度降期的评估

目的评估直肠腔内弹性成像应变比值（SR）判断直肠癌新辅助治疗后肿瘤浸润深度（T分期）降期的临床应用价值。 方法收集北京协和医院收治的进展期直肠癌（T₃期）患者62例,在新辅助放化疗前后,分别行常规直肠腔内超声（ERUS）和直肠腔内弹性成像检查。计算放化疗前后病灶SR差值及SR降幅,以SR降幅判断T分期降期。比较常规ERUS与弹性成像判断T分期降期的准确性。 结果放化疗后,58例（58/62,94%）直肠癌病灶的SR值呈明显下降（t=2.823,P<0.01）,另有4例（7%）SR值升高。pT_0~2期的SR平均值为2.20±0.85,pT₃期的SR平均值为3.19±0.90,两者差异具有统计学意义（t=3.684,P<0.01）。以SR降幅≥33.80%判断放化疗后T分期降期的准确性为69%（40/58）,高于常规ERUS的准确性45%（28/62）,但两者差异无统计学意义（P>0.05）。结合SR降幅,常规ERUS准确诊断降期由14例升高至28例,较好地提高了常规ERUS对T分期降期的诊断准确性。 结论应用SR降幅可较好地辅助常规ERUS,提高直肠癌放化疗后T分期降期诊断准确性,为直肠癌新辅助放化疗疗效及预后评估提供一种新型的较为可靠、无创而又简便的影像学方法。     

Comparison of three-dimensional, two-dimensional and color Doppler ultrasound in predicting the presence of a nuchal cord at birth.

OBJECTIVES: To compare the use of two-dimensional, color Doppler and three-dimensional ultrasound for predicting the presence of a nuchal cord at birth. METHODS: Eighty-five singleton pregnancies without nuchal cord and 35 with nuchal cord (30 with a single coil of cord, four with a double coil, and one in which the cord was coiled around the neck three times) were studied within 1 week before delivery using transabdominal three-dimensional sonography. Two-dimensional and color Doppler ultrasound were also conducted for comparison. RESULTS: Two-dimensional, color Doppler and three-dimensional sonography identified in utero 24 (69%), 29 (83%) and 25 (71%), respectively, of the cases of nuchal cord found at birth. There were no significant differences in overall diagnostic indices of each diagnostic modality for detecting nuchal cord. However, the ability to view the nuchal cord (subjective assessment of the ease of visualization of nuchal cord) was better with three-dimensional sonography than with two-dimensional or color Doppler ultrasound. CONCLUSIONS: Three-dimensional surface imaging does not provide more useful diagnostic information compared with two-dimensional and color Doppler ultrasound for detecting nuchal cord in utero.     

MRI在直肠癌TME术前评价中的价值

目的:本研究通过回顾性分析直肠癌侵犯直肠系膜的MRI表现,以进一步明确MRI对TME的术前评估价值。材料与方法:48例中低位直肠癌患者中,经手术证实36例癌肿不同程度侵犯直肠系膜。该36例患者中,男26例,女10例,年龄35-77岁,平均年龄58岁。结果:本组经手术证实的36例中低位直肠癌均有不同程度侵犯直肠系膜,即肿物侵犯范围超出直肠纤维膜向肠腔外生长侵犯。其中8例直肠系膜筋膜(盆腔脏层筋膜)受累,MR表现为直肠系膜筋膜局限性增厚8例;边界不规则不光滑6例;病灶呈不均匀长T1、稍长T2信号6例;呈长T1等T2信号2例。该8例患者中,癌肿或转移性淋巴结与直肠系膜筋膜之间距离分别为≤1mm者3例;1-2mm之间4例;3mm者1例。无直肠系膜筋膜受累的28例患者中,癌肿或转移性淋巴结与直肠系膜筋膜之间距离为5-20mm。结论:MRI检查在TME手术前评估中具有较大的价值。     

Correlation between Disease Activity and Endorectal Ultrasound Findings of Chronic Radiation Proctitis

The aim of this study was to summarize the imaging features of chronic radiation proctitis (CRP) on endorectal ultrasound (ERUS) and investigate the value of ERUS in the evaluation of disease activity. 40 CRP patients and 30 control patients were investigated by ERUS. Rectal wall thickness and layers, ulcers and rectovaginal fistulas were evaluated by B-mode ultrasound. Power Doppler imaging was used to evaluate the vascularity of the rectal wall using a semiquantitative score. Disease activity was calculated according to the National Cancer Institute Common Terminology Criteria for Adverse Events 4.0 (CTCAE 4.0). Imaging findings for patients with mild and severe CRP were compared. For 30 patients in the control group, the average maximum thickness of the rectal wall was 3.07 ± 0.73 mm, with all exhibiting typical wall stratification and level 0 vascularity. For the 40 CRP patients, there was marked thickening of the rectal wall (average thickness = 9.42 ± 1.94 mm), which was significantly thicker than in the control group (p < 0.05). The rectal walls of the mild group were significantly thinner than those of the severe group (8.71 ± 1.67 mm vs. 10.00 ± 2.00 mm, p < 0.05). Among the 22 severe cases, 19 cases (19/22, 86.4%) exhibited hyper-vascularity (level IV) or blurred wall stratification (including hypo-echoic submucosa, ulcer and fistula); 12 of the 18 mild cases (166.7%) exhibited a vascularity of level III and typical wall stratification. A significant association (p < 0.05) was observed between stratification and vascularity of the rectal wall and CRP activity. When ERUS findings of blurred rectal wall stratification or increasing vascularity (level IV) were used to evaluate CRP activity, the sensitivity was 86.4% (95% confidence interval: 64.0–96.4) and the specificity was 66.7% (95% confidence interval: 41.2–85.6). Thickening of the rectal wall, blurred wall stratification and increased vascularity are characteristic ERUS findings of CRP. ERUS is helpful in the comprehensive evaluation of disease activity and may provide objective evidence during treatment planning and follow-up.     

超声内镜对胃癌术前分期的临床意义

目的探讨超声内镜对胃癌术前分期的意义。方法对69例胃癌患者进行术前内镜超声检查,并与术后组织病理分期比较。结果在判断胃癌浸润深度T分期上,EUS总的正确率36.2%,其中T1m41.7%,T1sm75%,T2mp100%,T3se66.7%,T4si25%;在判断淋巴结转移N分期上,EUS总的正确率62.3%,其中N-100%,N+53.8%。结论EUS对胃癌术前T及N分期具有重要意义,但是如何避免分期过深或过浅、如何鉴别良恶性淋巴结方面,尚需进一步探讨。     

超声造影与超声内镜在膀胱癌临床分期中的价值

目的对比分析术前超声造影与超声内镜在膀胱癌临床分期中的应用价值。方法选取我院收治的膀胱癌患者97例,均行超声造影和超声内镜检查,术后均行病理诊断和分期。以患者病理分期结果为金标准,比较超声造影和超声内镜对膀胱癌临床分期的诊断符合率;绘制受试者工作特征(ROC)曲线,比较两种检查方法在膀胱癌临床分期中的价值。结果病理分期结果显示,97例膀胱癌患者T1、T2、T3、T4期分别为27、23、30、17例,超声造影和超声内镜对T1~T4期的诊断符合率分别为77.78%、86.96%、56.67%、88.24%和74.07%、65.22%、36.67%、17.65%,两种检查方法对T1、T2、T3期的诊断符合率比较差异无统计学意义,超声造影对T4期的诊断符合率高于超声内镜(P<0.05)。ROC曲线分析显示,超声造影诊断T4期膀胱癌的敏感性、特异性、阳性预测值、阴性预测值、曲线下面积分别为87.50%、82.35%、58.33%、95.89%、0.849,均高于超声内镜(67.50%、64.71%、29.73%、90.00%、0.661),差异均有统计学意义(均P<0.05)。结论术前超声造影与超声内镜均可用于膀胱癌临床分期,但超声造影在T4期膀胱癌患者中的诊断价值更高。     

Prospective comparison of catheter-based endoscopic sonography versus standard endoscopic sonography: evaluation of gastrointestinal-wall abnormalities and staging of gastrointestinal malignancies

PURPOSE: Endoscopic sonography (EUS) is an important imaging modality for evaluating benign and malignant luminal gastrointestinal-tract abnormalities. The objectives of this study were to evaluate the feasibility of catheter-based EUS (C-EUS) during standard upper and lower endoscopy in patients with malignancies and other abnormalities of the gastrointestinal-tract lumen, to assess the image quality obtained with the 12.5-MHz catheter-based ultrasound transducer, and to prospectively compare the interpretations of C-EUS images with those of the standard EUS (S-EUS) images. METHODS: One hundred thirty-seven consecutive patients referred for EUS were evaluated with C-EUS followed by S-EUS. The patients were assigned to 1 of 2 groups: group A, patients with intramural masses or intestinal wall thickening, with biopsies negative for malignancy; and group B, patients with esophageal, gastric, duodenal, or rectal cancer referred for staging. The results of C-EUS and S-EUS were compared for each group. RESULTS: C-EUS was completed in 134 patients: 81 patients with 83 lesions in group A and 53 patients in group B. For group A, C-EUS image interpretation concurred with that of S-EUS in 74 (89%) of 83 lesions. For group B, C-EUS concurred with S-EUS for tumor depth (T) and nodal (N) classifications in 19 cases (36%) and 26 cases (49%), respectively. The depth of invasion was underestimated by C-EUS in all 34 cases in which the T classifications by C-EUS and S-EUS were discordant. In 1 of 6 patients with stenotic cancer that was nontraversable by S-EUS, C-EUS identified lymphadenopathy (incorrectly classified as N0 by S-EUS). CONCLUSIONS: C-EUS was easily performed, and the C-EUS images were comparable to the S-EUS images in assessing mucosal and intramural lesions. The limited depth of penetration of the catheter-based transducer resulted in understaging the extent of tumor invasion and underestimating the nodal spread.