CAJ | 학술논문

目的分析经直肠腔内超声检查(ERUS)对直肠肿瘤浸润深度分期的准确性,评价ERUS在经肛门内镜显微手术(TEM)术前分期中的应用价值.方法2010年6月至2011年12月北京协和医院行TEM局部切除术患者50例,共50个直肠肿瘤.所有患者术前均采用ERUS进行直肠肿瘤浸润程度分期,术后进行病理分期.以手术病理结果作为金标准,分别计算术前ERUS分期判断pT0、pT1、pT2期直肠肿瘤浸润深度的准确性、敏感度、特异度、阳性预测值及阴性预测值和术前ERUS诊断T0/Tis+T1期直肠癌的准确性、敏感度、特异度、阳性预测值及阴性预测值.采用Kappa一致性检验比较直肠肿瘤术前ERUS分期与术后病理分期结果.结果术后病理诊断35例直肠腺瘤(pT0期),4例原位癌(pTis),8例早期侵袭性癌(pT1期),3例进展期癌(pT2期),术前ERUS诊断uT0期38例(76.0%),uT1期8例(16.0%),uT2期4例(8.0%). ERUS判断直肠肿瘤浸润深度总的准确性为90.0%(45/50),判断pT0、pT1、pT2期直肠肿瘤浸润深度准确性分别为94.0%(47/50)、95.2%(46/50)、94.0%(47/50). ERUS诊断pT0/pTis+pT1直肠肿瘤的诊断准确性、特异度、敏感度、阳性预测值和阴性预测值分别为94.0%、95.7%、66.7%、97.8%、50.0%.结论 ERUS判断T0期直肠腺瘤和早期直肠癌浸润深度的准确性较高.虽然在影像学上区分T0期与Tis期直肠肿瘤存在困难,但不影响ERUS为TEM提供可靠的术前评估.
목적분석경직장강내초성검사(ERUS)대직장종류침윤심도분기적준학성,평개ERUS재경항문내경현미수술(TEM)술전분기중적응용개치.방법2010년6월지2011년12월북경협화의원행TEM국부절제술환자50례,공50개직장종류.소유환자술전균채용ERUS진행직장종류침윤정도분기,술후진행병리분기.이수술병리결과작위금표준,분별계산술전ERUS분기판단pT0、pT1、pT2기직장종류침윤심도적준학성、민감도、특이도、양성예측치급음성예측치화술전ERUS진단T0/Tis+T1기직장암적준학성、민감도、특이도、양성예측치급음성예측치.채용Kappa일치성검험비교직장종류술전ERUS분기여술후병리분기결과.결과술후병리진단35례직장선류(pT0기),4례원위암(pTis),8례조기침습성암(pT1기),3례진전기암(pT2기),술전ERUS진단uT0기38례(76.0%),uT1기8례(16.0%),uT2기4례(8.0%). ERUS판단직장종류침윤심도총적준학성위90.0%(45/50),판단pT0、pT1、pT2기직장종류침윤심도준학성분별위94.0%(47/50)、95.2%(46/50)、94.0%(47/50). ERUS진단pT0/pTis+pT1직장종류적진단준학성、특이도、민감도、양성예측치화음성예측치분별위94.0%、95.7%、66.7%、97.8%、50.0%.결론 ERUS판단T0기직장선류화조기직장암침윤심도적준학성교고.수연재영상학상구분T0기여Tis기직장종류존재곤난,단불영향ERUS위TEM제공가고적술전평고.
Objective To evaluate the accuracy of endorectal ultrasonography ( ERUS) in T staging of rectal tumors, and the significance of ERUS in transanal endoscopic microsurgery ( TEM). Methods Retrospective analysis was carried out in 50 patients treated by transanal endoscopic microsurgery (TEM)in Peking Union Medical College Hospital from June 2010 to December 2011.There were 50 cases of rectal tumor.All patients underwent ERUS staging before surgery .Preoperative ERUS staging was correlated to postoperative pathology findings .With the results of operation and pathology as the gold standard ,the accuracy,sensitivity,specificity,positive predictive value and negative predictive value were calculated for staging the infiltration depth of pT0,pT1,pT2 rectal tumor and T0/Tis+T1 rectal cancer preoperatively . Kappa consistency test was used to compare the staging results of preoperative ERUS and pathology .Results Postoperative pathology diagnosis included 35 cases of rectal adenoma (pT0),4 cases of carcinoma in situ (pTis),8 cases of early invasive carcinoma (pT1),3 cases of advanced cancer (pT2).ERUS staged 38 cases of uT0(76.0%),8 cases of uT1 (16.0%),4 cases of uT2 (8.0%).The overall accuracy of ERUS in T staging was 90.0%(45/50).The accuracies of ERUS for T0,T1,and T2 tumor were 94.0%(47/50), 95.2%(46/50),and 94.0%(47/50),respectively.The accuracy,specificity,sensitivity,positive predictive value and nagetive predictive value of ERUS for T 0/Tis+T1 were 94.0%,95.7%,66.7%,97.8%,and 50.0%,respectively.Conclusions ERUS is useful in confirming the diagnosis of adenoma and predicting the depth of mural invasion in early rectal cancer .ERUS is a reliable imaging modality for preoperatively staging in TEM.Differentiation between T0 and Tis lesions remains challenging ,however,this does not usually influence surgical strategy.