超声内镜检查在食管癌术前临床分期的应用价值

背景与目的:食管癌术前临床分期对选择合理治疗方案至关重要,超声内镜(endoscopicultrasonography,EUS)对食管癌T、N分期诊断准确率高,目前已成为国外食管癌治疗前的常规诊断方法。本研究对食管癌超声内镜检查与手术病理结果进行对照研究,以评价其在食管癌术前临床分期中应用价值。方法:对72例食管癌患者行术前EUS检查及术后病理检查,按UICC(1997)TNM分期标准分期,将EUS分期结果和手术病理分期结果进行对照研究。结果:食管癌术前EUS检查T、N分期的诊断准确率分别为80.6%(58/72)、88.9%(64/72)。T0期诊断准确率为50.0%(2/4),T1期为75.0%(3/4),T2期为70.6%(12/17),T3期为90.0%(36/40),T4期为71.4%(5/7);N0期诊断准确率为92.3%(36/39),N1期为84.8%(28/33),其中纵隔淋巴结和腹部淋巴结诊断准确率分别为90.0%和64.5%。EUST分期、N分期结果与病理分期结果有显著相关性(r=0.687,P<0.001;r=0.776,P<0.001)。EUS检查判断分期不准确的22例中,T分期14例,其中8例难以鉴别T2、T3;N分期8例,其中5例为难以鉴别炎性淋巴结和转移淋巴结。结论:EUS对食管癌术前T、N分期诊断准确率较高,其中对T3期食管癌和纵隔淋巴结诊断价值尤其高;准确鉴别T2和T3分期、转移淋巴结和炎性淋巴结及正确诊断腹部淋巴结转移是提高EUS诊断率的重点和难点。

Application of endoscopic ultrasonography to preoperative clinical staging of esophageal cancer

BACKGROUND & OBJECTIVE: Preoperative clinical staging is the key to choose ideal therapy plan for esophageal cancer. Endoscopic ultrasonography (EUS), an accuracy diagnostic technique for TN staging of esophageal cancer, is used commonly in foreign countries, but seldom in China. This study was to evaluate the application of EUS to preoperative clinical staging of esophageal cancer. METHODS: A total of 72 patients were examined preoperatively with EUS, and staged according to UICC (1997) TNM staging system. The EUS findings were compared with surgical pathologic findings. RESULTS: The accuracy rates of T staging and N staging by EUS were 80.6% (58/72) and 88.9% (64/72), respectively. The accuracy rates of T staging were 50.0% (2/4) for T0, 75.0% (3/4) for T1, 70.6% (12/17) for T2, 90.0% (36/40) for T3, and 71.4% (5/7) for T4; those of N staging were 92.3% (36/39) for N0 and 84.8% (28/33) for N1, of which the accuracy rates of diagnosing mediastinum and abdomen lymph node metastases were 90.0% and 64.5%. The staging results by EUS were significantly accordant with those by surgical pathology: T staging, association coefficient = 0.687, P < 0.001; N staging, association coefficient = 0.878, P < 0.001. Twenty-two cases were staged incorrectly, including 14 cases of T staging, of which 8 cases were due to not distinguishing T2 and T3 correctly, and 8 cases of N staging, of which 5 cases were due to not distinguishing lymphadenitis and metastatic lymph nodes correctly. CONCLUSIONS: The accuracy rate of EUS is high for preoperative staging of esophageal carcinoma, especially for T3 and mediastinum lymph node. Distinguishing T2 and T3, lymphadenitis and metastatic lymph nodes correctly and diagnosing abdomen lymph node metastasis can improve the diagnosis accuracy rate of EUS.