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首页> 美国卫生研究院文献>Gut >High magnification chromoscopic colonoscopy or high frequency 20 MHz mini probe endoscopic ultrasound staging for early colorectal neoplasia: a comparative prospective analysis
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High magnification chromoscopic colonoscopy or high frequency 20 MHz mini probe endoscopic ultrasound staging for early colorectal neoplasia: a comparative prospective analysis

机译：高倍率结肠镜结肠镜检查或高频20 MHz微型探头内镜超声分期对早期结直肠肿瘤的发展：比较性前瞻性分析

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>Background: Successful endoscopic management of early colorectal cancer using endoscopic mucosal resection requires the mandatory prediction of invasive depth and lymph node metastasis. Previous data using the Nagata crypt types Vn(B)/(C) as clinical indicators of T2/N+ disease have shown low specificity (50%) with a tendency to over stage lesions. New mini probe ultrasound “through the scope” imaging permits staging of lesions proximal to the rectum using direct endoscopic visualisation.>Aim: To compare the staging accuracy of the Nagata crypt type V with mini probe high frequency 20 MHz endoscopic ultrasound.>Methods: Sixty two patients with a Paris type II flat cancer were imaged using magnification colonoscopy followed by 20/12.5 MHz ultrasound in a “back to back” design. Crystal violet staining (0.05%) at 100× magnification permitted Nagata crypt criteria to be defined. Submucosal deep invasion (sm3+) was defined at ultrasound by the presence or absence of a disrupted third sonographic layer. Predicted T0/1:N0 lesions were resected using endoscopic mucosal resection with the remaining referred for surgery. Ultrasound and magnification staging were then compared with the resected histopathological specimens.>Results: One patient was excluded from the study due to poor bowel preparation. Fifty two lesions from 52 patients therefore met inclusion criteria (12 sm1/13 sm2/27 sm3+). Ultrasound (20 MHz) was significantly more accurate for invasive depth staging compared with Nagata stage (p<0.0001) (overall accuracy 93% and 59%, respectively). The sensitivity for lymph node metastasis detection using ultrasound and magnification was 80% and 31%, respectively (p<0.001). The negative predictive value of ultrasound for invasive depth was better than that observed using magnification (88%/47%, respectively). The prevalence of nodal disease overall was 19% (10/52), with 80% (8/10) node positive lesions occurring in the sm3+ lesion group.>Conclusions: High frequency 20 MHz ultrasound is superior to magnification alone when differentiating T1/2 disease with a high positive predictive value for sm3 differentiation. Sm3+ invasion was associated with nodal metastasis.
机译：>背景：使用内窥镜粘膜切除术成功地对早期大肠癌进行内窥镜治疗需要对浸润深度和淋巴结转移进行强制性预测。使用永田隐窝类型Vn（B）/（C）作为T2 / N +疾病的临床指标的先前数据显示特异性低（50％），且有过度分期病变的趋势。新的微型探头超声“通过范围”成像可使用直接内窥镜可视化对直肠近端病变进行分期。>目标：比较长形隐窝V型与微型探头高频20 MHz的分期精度内镜超声检查。>方法：采用放大结肠镜检查法对62例巴黎II型扁平癌患者进行成像，然后采用“背对背”设计进行20 / 12.5 MHz超声检查。在100倍放大倍数下的结晶紫染色（0.05％）允许定义Nagata隐窝标准。超声下通过存在或不存在破裂的第三超声图层来定义粘膜下深度浸润（sm3 +）。使用内窥镜黏膜切除术切除预期的T0 / 1：N0病变，其余的则进行手术。然后将超声和放大分期与切除的组织病理学标本进行比较。>结果：由于肠准备不良，该患者被排除在研究之外。因此，来自52例患者的52个病灶符合纳入标准（12 sm1 / 13 sm2 / 27 sm3 +）。与Nagata阶段相比，超声（20 MHz）对侵入性深度分期的准确性显着更高（p <0.0001）（总体准确性分别为93％和59％）。使用超声波和放大倍数检测淋巴结转移的敏感性分别为80％和31％（p <0.001）。超声对浸润深度的阴性预测值要好于放大倍数（分别为88％/ 47％）。结节病的总体患病率为19％（10/52），在sm3 +病变组中有80％（8/10）个淋巴结阳性病变。>结论：高频20 MHz超声优于区分T1 / 2疾病时单独放大，对sm3分化具有较高的阳性预测价值。 Sm3 +入侵与淋巴结转移有关。

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