超声内镜对早期结直肠癌的诊断价值分析

目的 探讨超声内镜用于早期结直肠癌T分期的准确性及影响因素。方法 顺序纳入2017年9月至2021年6月于首都医科大学附属北京友谊医院住院并行内镜切除的早期结直肠癌患者186例(200灶),收集临床信息、病理诊断、普通内镜以及超声内镜表现。参照病理分期，分析超声内镜的诊断效能，并采用Logistic回归模型分析影响超声内镜诊断准确率的因素。结果 超声内镜对早期结直肠癌浸润深度诊断的总体准确率为75.0%(150/200),对黏膜内癌和黏膜下层浸润癌的准确率分别为85.0%和35.0%。单因素分析显示，超声内镜诊断准确性与病变部位、大小、形态无关，而与组织学类型、病变深度相关(P<0.001)。多因素分析显示，组织学类型是深度判断错误的危险因素，当肿瘤为中低分化腺癌、黏液腺癌及印戒细胞癌时准确率显著降低(P=0.019)。结论 超声内镜可用于辅助判断早期结直肠癌的浸润深度，肿瘤有中低分化或未分化成分时准确率降低。

Diagnostic value analysis of endoscopic ultrasound for early colorectal cancer

Objective To investigate the accuracy and influencing factors of endoscopic ultrasound for T-staging of early colorectal cancer. Methods A total of 186 patients (with 200 lesions) with early colorectal cancer who were hospitalized and underwent endoscopic resection at Beijing Friendship Hospital, Capital Medical University from September 2017 to June 2021 were included. The clinical information, pathological diagnosis, colonoscopy and endoscopic ultrasound manifestations were retrieved. The diagnostic efficacy of endoscopic ultrasound was analyzed with reference to pathological staging, and the factors affecting the accuracy of endoscopic ultrasound were analyzed by Logistic regression model. Results The overall accuracy of endoscopic ultrasound in diagnosing the depth of infiltration of early colorectal cancer was 75.0% (150/200), and the accuracy rates for intramucosal and submucosal infiltrating cancers were 85.0% and 35.0%, respectively. Univariate analysis showed that the diagnostic accuracy of endoscopic ultrasound was not related to lesion site, size, or morphology, but related to histologic type and lesion depth (P<0.001). Multivariate analysis showed that histologic type was a risk factor for misjudgment of depth, and the accuracy was significantly lower for moderately/poorly differentiated adenocarcinoma, mucinous adenocarcinoma or signet-ring cell carcinoma (P=0.019). Conclusion Endoscopic ultrasound is useful for determining the depth of infiltration in early colorectal cancer. However, the accuracy is reduced when the tumor has a moderately/poorly differentiated or undifferentiated component.