Background and study aims: Miniprobe ultrasound technology allows in-vivo luminal staging of colorectal cancer with a probe that passes directly through the colonoscope’s instrument port. Conventional rigid radial ec...Background and study aims: Miniprobe ultrasound technology allows in-vivo luminal staging of colorectal cancer with a probe that passes directly through the colonoscope’s instrument port. Conventional rigid radial echoscopes are limited by the need for a second examination, an inability to image stenotic lesions, and the inaccessibility of proximal tumours. Since minimally invasive resection techniques are now possible, a sensitive preoperative staging tool is needed to optimize patient selection. The aim of this study was to examine the accuracy of miniprobe ultrasound imaging in the preoperative staging of colorectal cancer and to examine the value of the technique for management decisions. Patients and methods: In a prospective study, a total of 131 consecutive patients with adenocarcinoma or broad-based polyps of the colorectum underwent 12.5-MHz miniprobe ultrasonography examinations conducted by a single endoscopist. Staging criteria for depth of tumour infiltration and nodal status were determined. Nodal disease was defined as the presence of a hypoechoic, round, defined boundary lesion larger than 10 mm in diameter. T0-T1N0 lesions were resected using endoscopic mucosal resection, and patients with lesions staged as T2N1 were referred for surgical resection. Tumour staging using endoscopic ultrasonography was then compared with the histopathological specimens. Results: The accuracy of T staging using endoscopic ultrasonography was 96% in comparison with the histopathological specimen. Five lesions (4% ) were incorrectly overstaged as T3 - pathology stage T2. Understaging occurred in three lesions (endosco-pic ultrasound stage T3 - pathology stage T4). The overall accuracy of nodal staging using endoscopic ultrasonography was 87% (sensitivity 0.95, specificity 0.71, positive predictive value 0.87, negative predictive value 0.88). Conclusions: Miniprobe ultrasonography has a high overall accuracy for both T staging and N staging of colorectal cancer andmay have an important role in selecting patients suitable for minimally invasive resection techniques.展开更多
Background: Successful endoscopic management of early colorectal cancer using endoscopicmucosal resection requires the mandatory prediction of invasive depth and lymph node metastasis. Previous data using the Nagata c...Background: Successful endoscopic management of early colorectal cancer using endoscopicmucosal 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" i maging 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 colono scopy followed by 20/12.5 MHz ultrasound in a “back to back" design. Crystal violet staining (0.05%) at 100×x magnification permitted Nagata crypt criteria to be defined. Submucosal deep invasion (sm3+) was defined at ultrasound by the presence or absence of a dis rupted third sonographic layer. Predicted T0/1∶N0 lesions were resected using e ndoscopic 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 p reparation. Fifty two lesions from 52 patients therefore met inclusion criteria (12 sm1/13 sm2/27 sm3+). Ultrasound (20 MHz) was significantly more accurate fo r invasive depth staging compared with Nagata stage (p< 0.0001) (overall accurac y 93%and 59%, respectively). The sensitivity for lymph node metastasis detecti on 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 occ urring in the sm3+lesion group. Conclusions: High frequency 20 MHz ultrasound i s 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.展开更多
Goals: To prospectively assess the safety and efficacy of high- frequency ultrasound assisted mini- probe endoscopic mucosal resection for the treatment of colorectal submucosal tumors. Primary endpoints were tumor fr...Goals: To prospectively assess the safety and efficacy of high- frequency ultrasound assisted mini- probe endoscopic mucosal resection for the treatment of colorectal submucosal tumors. Primary endpoints were tumor free vertical/horizontal resection margins and positive histopathologic diagnosis. Outcome data over a 24- month period were assessed. Background: A 20- MHz high- frequency mini- probe ultrasound is an accurate modality for the diagnosis of stage T1m and T1 colorectal lesions. Few studies have addressed the safety and efficacy of this technology as applicable to submucosal lesions of the colorectum. Methods: Thirty patients underwent high- frequency mini- probe ultrasound- guided endoscopic mucosal resection of 30 lesions (< 20 mm diameter) using the inject and cut technique. Repeat endoscopy and ultrasound was performed at 3, 6, and 12 months post- “ index" resection. Results: A total of 27 lesions (90% ) underwent complete resection with negative histologic margin status (median diameter, 8 mm; range, 3- 20 mm). No statistical difference (P >0.1 ) was observed between submucosal lesion position and histologic resection margin negativity. Three rectal lesions (10% ) within the submucosal layer 3 failed to separate from the muscularis and underwent transanal excision of tumor. Bleeding occurred in 1 patient (3% ). No recurrence was evident at the resection site in 27 cases (median follow- up, 9 months; range, 4- 18 months). Conclusions: High- frequency mini- probe ultrasound- guided endoscopic mucosal resection is a safe and effective therapeutic modality for submucosal lesions of the colorectum. The technique offers a single- stage diagnostic and therapeutic technique for selected submucosal lesions and may offer an alternative to surgical resection.展开更多
文摘Background and study aims: Miniprobe ultrasound technology allows in-vivo luminal staging of colorectal cancer with a probe that passes directly through the colonoscope’s instrument port. Conventional rigid radial echoscopes are limited by the need for a second examination, an inability to image stenotic lesions, and the inaccessibility of proximal tumours. Since minimally invasive resection techniques are now possible, a sensitive preoperative staging tool is needed to optimize patient selection. The aim of this study was to examine the accuracy of miniprobe ultrasound imaging in the preoperative staging of colorectal cancer and to examine the value of the technique for management decisions. Patients and methods: In a prospective study, a total of 131 consecutive patients with adenocarcinoma or broad-based polyps of the colorectum underwent 12.5-MHz miniprobe ultrasonography examinations conducted by a single endoscopist. Staging criteria for depth of tumour infiltration and nodal status were determined. Nodal disease was defined as the presence of a hypoechoic, round, defined boundary lesion larger than 10 mm in diameter. T0-T1N0 lesions were resected using endoscopic mucosal resection, and patients with lesions staged as T2N1 were referred for surgical resection. Tumour staging using endoscopic ultrasonography was then compared with the histopathological specimens. Results: The accuracy of T staging using endoscopic ultrasonography was 96% in comparison with the histopathological specimen. Five lesions (4% ) were incorrectly overstaged as T3 - pathology stage T2. Understaging occurred in three lesions (endosco-pic ultrasound stage T3 - pathology stage T4). The overall accuracy of nodal staging using endoscopic ultrasonography was 87% (sensitivity 0.95, specificity 0.71, positive predictive value 0.87, negative predictive value 0.88). Conclusions: Miniprobe ultrasonography has a high overall accuracy for both T staging and N staging of colorectal cancer andmay have an important role in selecting patients suitable for minimally invasive resection techniques.
文摘Background: Successful endoscopic management of early colorectal cancer using endoscopicmucosal 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" i maging 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 colono scopy followed by 20/12.5 MHz ultrasound in a “back to back" design. Crystal violet staining (0.05%) at 100×x magnification permitted Nagata crypt criteria to be defined. Submucosal deep invasion (sm3+) was defined at ultrasound by the presence or absence of a dis rupted third sonographic layer. Predicted T0/1∶N0 lesions were resected using e ndoscopic 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 p reparation. Fifty two lesions from 52 patients therefore met inclusion criteria (12 sm1/13 sm2/27 sm3+). Ultrasound (20 MHz) was significantly more accurate fo r invasive depth staging compared with Nagata stage (p< 0.0001) (overall accurac y 93%and 59%, respectively). The sensitivity for lymph node metastasis detecti on 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 occ urring in the sm3+lesion group. Conclusions: High frequency 20 MHz ultrasound i s 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.
文摘Goals: To prospectively assess the safety and efficacy of high- frequency ultrasound assisted mini- probe endoscopic mucosal resection for the treatment of colorectal submucosal tumors. Primary endpoints were tumor free vertical/horizontal resection margins and positive histopathologic diagnosis. Outcome data over a 24- month period were assessed. Background: A 20- MHz high- frequency mini- probe ultrasound is an accurate modality for the diagnosis of stage T1m and T1 colorectal lesions. Few studies have addressed the safety and efficacy of this technology as applicable to submucosal lesions of the colorectum. Methods: Thirty patients underwent high- frequency mini- probe ultrasound- guided endoscopic mucosal resection of 30 lesions (< 20 mm diameter) using the inject and cut technique. Repeat endoscopy and ultrasound was performed at 3, 6, and 12 months post- “ index" resection. Results: A total of 27 lesions (90% ) underwent complete resection with negative histologic margin status (median diameter, 8 mm; range, 3- 20 mm). No statistical difference (P >0.1 ) was observed between submucosal lesion position and histologic resection margin negativity. Three rectal lesions (10% ) within the submucosal layer 3 failed to separate from the muscularis and underwent transanal excision of tumor. Bleeding occurred in 1 patient (3% ). No recurrence was evident at the resection site in 27 cases (median follow- up, 9 months; range, 4- 18 months). Conclusions: High- frequency mini- probe ultrasound- guided endoscopic mucosal resection is a safe and effective therapeutic modality for submucosal lesions of the colorectum. The technique offers a single- stage diagnostic and therapeutic technique for selected submucosal lesions and may offer an alternative to surgical resection.
