2种探头经肛直肠腔内超声在不同位置直肠癌术前T分期中的应用价值比较

Comparison of the application value of endorectal ultrasonography with two kinds of probes in preoperative T staging of rectal cancer at different positions

目的:比较2种探头经肛直肠腔内超声(endorectal ultrasonography,ERUS)在直肠癌术前T分期的应用价值及2种探头在不同位置直肠癌分期中的价值。方法:收集重庆医科大学附属第一医院2014年1月至2021年9月440例直肠癌患者资料(直凸探头277例、环扫探头163例),筛选出术前行ERUS检查及有术后病检结果的患者共301例,然后将术前超声T分期(u T)与病理分期(参考美国癌症委员会AJCC第八版)结果进行对照,计算术前超声分期的敏感度、特异度和准确度。结果:180例(直凸探头)直肠癌超声检查与病理结果比较,经ERUS的T分期总准确度为73%,各分期的准确率分别为T1 97%;T2 91%;T3 79%;T4 79%。121例(环扫探头)直肠癌超声检查与病理结果比较,经ERUS的T分期总准确度为74%,各分期的准确率分别为T1 93%;T2 84%;T3 83%;T4 88%。不同位置2种探头直肠癌诊断的准确率分别为直凸探头高位60%;中位75%;低位73%,环扫探头高位73%;中位75%;低位75%。结论:2种探头对于直肠癌术前T分期均有重要价值,对于不同位置直肠癌术前诊断,环扫探头的准确率稍高于直凸探头。结合实际情况,选择合适的探头或联合使用2种探头,能提高术前分期的准确率,为临床医师治疗提供良好依据。

Objective:To compare the application value of endorectal ultrasonography(ERUS)with two kinds of probe in preoperative T staging of rectal cancer and the value of the two probes in the staging of rectal cancer at different positions. Methods:The data of440 patients with rectal cancer in our hospital from January 2014 to September 2021 were collected(277 cases of straight convex probe and 163 cases of circumferential scanning probe),and 301 patients with preoperative ERUS and postoperative pathological findings were screened out. Then the results of preoperative ultrasound T-staging(uT) and pathological staging(refer to the eighth edition of AJCC)were compared to calculate the sensitivity,specificity and accuracy of preoperative ultrasound staging. Results:The results of ultrasonography and pathology of 180 cases of rectal cancer(straight convex probe)were compared,and the total accuracy of u T by ERUS was 73%. The accuracy of each stage was T1 97%;T2 91%;T3 79%;T4 79%. The results of ultrasonography and pathology of 121 cases of rectal cancer(circumferential scanning probe)were compared,and the total accuracy of uT by ERUS was74%. The accuracy of each stage was:T1 93%;T2 84%;T3 83%;T4 88%. The accuracy of the two probes in the diagnosis of rectal cancer at different positions were as follows:that of straight convex probe at the upper position was 60%,the middle positon was75%,and the lower position was 73%. And that of circumferential scanning probe at the upper position was 73%,the middle positon was 75% and the lower position was 75%. Conclusion:The two probes are both of great importance for preoperative uT of rectal cancer.For the preoperative diagnosis of rectal cancer at different positions,the accuracy rate of circumferential scanning probe is slightly higher than that of straight convex probe. Based on the actual situation,choosing the appropriate probe or using two probes in combination can improve the accuracy of preoperative staging and provide a good basis for the treatment.