Accuracy of endorectal ultrasonography and computed tomography for restaging rectal cancer after preoperative chemoradiation
Accuracy of endorectal ultrasonography and computed tomography for restaging rectal cancer after preoperative chemoradiation
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DOI：
10.1016/j.jamcollsurg.2008.01.002
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发表时间：
2008-07-01
影响因子：
5.2
通讯作者：
Sohn, Seung-Kook
中科院分区：
文献类型：
--
作者：
Huh, Jung Wook;Park, Yoon Ah;Sohn, Seung-Kook
背景：放疗直肠癌的术前重新定位是制定最佳治疗方案的必要条件。本研究的目的是比较直肠内超声（ERUS）和CT在直肠癌术前放化疗后再分期中的准确性，并评价影响ERUS准确性的因素。研究设计：83例原发性局部晚期直肠癌患者在术前放化疗后和手术前通过ERUS （n = 60）和CT （n = 80）进行前瞻性评估。所有患者随后接受手术切除并完成病理分期。结果：在重新确定侵犯深度时，ERUS的总体准确率为38.3%(60分之23)，CT的总体准确率为46.3%（80分之37）。两种成像方式的过度分期比分期不足更常见。ERUS对淋巴结转移的再诊断准确率为72.6%（51人中37人），CT为70.4%（71人中50人）。ERUS对淋巴结阴性病例的预测价值略低于CT（分别为81.1%和85.4%）。病理证实的完全缓解在11例患者中没有正确预测任何影像学方式。病理T、N分期与ERUS分期准确性相关（p = 0.028, p = 0.001）。结论：ERUS和CT可以很好地预测结阴性直肠癌，尽管它们是预测直肠壁治疗反应的不准确方式。新方法的解释和诊断标准的ERUS和CT是必不可少的，以提高癌症预测的准确性在高危患者。
BACKGROUND: Preoperative restaging of irradiated rectal cancer is essential for the planning of optimal therapy. The aim of this study was to compare the accuracy of endorectal ultrasonography (ERUS) and CT in restaging rectal cancer after preoperative chemoradiation and to evaluate the factors affecting the accuracy of ERUS.STUDY DESIGN: Eighty-three patients with initial, locally advanced rectal cancer were prospectively evaluated by ERUS (n = 60) and CT (n = 80) after preoperative chemoradiation and just before surgery. All patients then underwent subsequent surgical resection and complete pathologic staging.RESULTS: In restaging the depth of invasion, the overall accuracy was 38.3% (23 of 60) by ERUS and 46.3% (37 of 80) by CT. Overstaging was more common than understaging with both imaging modalities. Accuracy for restaging lymph node metastasis was 72.6% (37 of 51) by ERUS and 70.4% (50 of 71) by CT. The predictive value of node-negative cases by ERUS was somewhat lower than that of CT (81.1% versus 85.4%, respectively). Complete pathology-proved remission was not correctly predicted in any of the 11 patients by any imaging modalities. Pathologic T and N staging correlated with the staging accuracy of ERUS (p = 0.028 and p = 0.001, respectively).CONCLUSIONS: ERUS and CT may allow good prediction of node-negative rectal cancers, although they are inaccurate modalities for predicting treatment response on the rectal wall. New methods of interpretation and diagnostic criteria for ERUS and CT are essential for increasing the accuracy of cancer prediction in at-risk patients.