直接法与助显剂充盈法经直肠超声对直肠癌浸润深度的诊断价值
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摘要
目的:探讨360°环阵探头比较直接法及助显剂充盈法经直肠超声(transrectal ultrasonography,TRUS)对直肠癌浸润深度诊断准确性的差异。方法:对67例原发性直肠癌患者术前行TRUS检查,先后使用直接法及助显剂充盈法,判断直肠癌的浸润深度,并与病理结果进行对照,使用Kappa检验评估两者结果的一致性。结果:直接法及助显剂充盈法TRUS评估直肠癌浸润深度总准确率分别为91. 0%和92. 5%。两种方法与病理结果的一致性均较高,但后者(Kappa=0. 846,P=0. 000)明显高于前者(Kappa=0. 685,P=0. 000)。两种方法评估T_1及T_2期直肠癌的准确率分别为89. 2%、95. 6%及90. 4%、93. 7%。助显剂充盈法对T_1及T_2期直肠癌的诊断准确率明显高于直接法。结论:助显剂充盈法TRUS对直肠癌浸润深度的诊断准确率高于直接法,并且T_1及T_2期的应用价值更高。
Objective: To explore the difference of diagnostic accuracy of direct method and co-agent filling method in tumor invasion depth( T-staging) of rectal cancer by 360° transrectal ultrasonography( TRUS). Methods:67 patients with rectal cancer underwent TRUS before surgery to predict T-staging. The results were compared with the postoperative pathological results. Their consistency was evaluated by Kappa test. Results: The total accuracy rate of direct method and co-agent filling method of TRUS in T-staging of rectal cancer were 91. 0% and 92. 5%. The ultrasound result of two kinds of methods was highly consistent with the pathological result,but the latter( Kappa= 0. 846,P = 0. 000) was obviously higher than the former( Kappa = 0. 685,P = 0. 000). The diagnostic accuracy of T_1 and T_2 stage of rectal cancer evaluated by two kinds of methods were 89. 2%,95. 6% and 90. 4%,93. 7%. The diagnostic accuracy of T_1 and T_2 stage of rectal cancer of co-agent filling method was obviously higher than direct method. Conclusion: The diagnostic accuracy of tumor invasion depth of rectal cancer by co-agent filling method TRUS is higher than direct method,meanwhile,there are higher application value for T_1 and T_2 stage.
Objective: To explore the difference of diagnostic accuracy of direct method and co-agent filling method in tumor invasion depth( T-staging) of rectal cancer by 360° transrectal ultrasonography( TRUS). Methods:67 patients with rectal cancer underwent TRUS before surgery to predict T-staging. The results were compared with the postoperative pathological results. Their consistency was evaluated by Kappa test. Results: The total accuracy rate of direct method and co-agent filling method of TRUS in T-staging of rectal cancer were 91. 0% and 92. 5%. The ultrasound result of two kinds of methods was highly consistent with the pathological result,but the latter( Kappa= 0. 846,P = 0. 000) was obviously higher than the former( Kappa = 0. 685,P = 0. 000). The diagnostic accuracy of T_1 and T_2 stage of rectal cancer evaluated by two kinds of methods were 89. 2%,95. 6% and 90. 4%,93. 7%. The diagnostic accuracy of T_1 and T_2 stage of rectal cancer of co-agent filling method was obviously higher than direct method. Conclusion: The diagnostic accuracy of tumor invasion depth of rectal cancer by co-agent filling method TRUS is higher than direct method,meanwhile,there are higher application value for T_1 and T_2 stage.
引文
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[15]Chen LD,Wang W,Xie XY,et al.Value and progress of endorectal ultrasound in the treatment decision of rectal cancer[J].Chin Arch Gen Surg(Electronic Edition),2017,11(5):352-356.
[16]Liu XY,Liu GJ,Zhou ZY,et al.Endorectal ultraspund in evaluation on mesorectal fascia invasion in preoperative rectal cancer[J].Chin J Med Imaging Technol,2017,33(9):1357-1361.]
[2]Lee JW,Lee JH,Kim JG,et al.Comparison between preoperativeand postoperative concurrent chemoradiotherapy for rectal cancer:An institutional analysis[J].Radiat Oncol J,2013,31(3):155-161.
[3]Peng S,Huang P,Yu H,et al.Prognostic value of carcinoembryonic antigen level in patients with colorectal cancer liver metastasis treated with percutaneous microwave ablation under ultrasound guidance[J].Medicine(Baltimore),2018,97(10):e0044.
[4]Escal L,Nougaret S,Guiu B,et al.MRI-based score to predict surgical difficulty in patients with rectal cancer[J].Br J Surg,2018,105(1):140-146.
[5]Bipat S,Glas AS,Slors FJ,et al.Rectal cancer:Local staging and assessment of lymph node involvement with endoluminal US,CT,and MR imaging:A Meta-analysis[J].Radiology,2004,232(3):773-783.
[6]Xu D,Ju HX,Qian CW,et al.The value of TRUS in the staging of rectal carcinoma before and after radiotherapy and comparison with the staging postoperative pathology[J].Clin Radiol,2014,69(5):481-484.
[7]Rafaelsen SR,Sorensen T,Jakobsen A,et al.Transrectal ultrasonography and magnetic resonance imaging in the staging of rectal cancer.Effect of experience[J].Scand J Gastroenterol,2008,43(4):440-446.
[8]Stepansky A,Halevy A,Ziv Y.Preoperative staging using transrectal ultrasound in high and low rectal cancer[J].Iar Med Assoc J,2010,12(5):270-272.
[9]De Vargas Macciucca M,Casale A,Manganaro L,et al.Rectal villous tumours:MR features and correlation with TRUS in the preoperative evaluation[J].Eur J Radiol,2010,73(2):329-333.
[10]Wu CJ,Wang X,Zhang GC.Application of rectal ultrasonography in diagnosis and treatment of rectal cancer[J].Chinese Journal of Clinicians(Electronic Edition),2017,14(6):401-404.[吴长君,王希,张光晨.经直肠超声检查对直肠癌诊疗的应用[J].中华医学超声杂志(电子版),2017,14(6):401-404.]
[11]Liu XY,Liu GJ,Wen YL,et al.Value of endorectal ultrasonography in preoperative assessment of rectal cancer post neoadjuvant chemoradiation therapy[J].Chinese Journal of Clinicians(Electronic Edition),2017,14(6):411-416.[刘小银,刘广健,文艳玲,等.经直肠超声检查在直肠癌新辅助放化疗后术前评估中的应用价值[J].中华医学超声杂志(电子版),2017,14(6):411-416.]
[12]Yang SY,Yang YL,Yang RJ,et al.Preoperative evaluation of tumor invasion depth in rectal cancer by transrectal ultrasound[J/CD].Chinese Journal of Clinicians(Electronic Edition),2014,8(7):1263-1266.[杨思扬,杨一林,杨瑞静,等.经直肠超声检查术前评估直肠癌累及程度的临床研究[J/CD].中华临床医师杂志(电子版),2014,8(7):1263-1266.]
[13]Yang SH,Cai XH,Zhou T,et al.The diagnostic efficacy of transrectal ultrasonography in the pathological staging of rectal cancer[J].Contemporary Medicine,2016,22(9):50-51.[杨术华,蔡鑫华,周涛,等.经直肠超声检查对直肠癌病理分期的诊断效能分析[J].当代医学,2016,22(9):50-51.]
[14]Lu X,Wang DW,Fan W,et al.The application and advance of transrectal ultrasound in preoperative staging of rectal cancer[J].Progress in Modern Biomedicine,2017,17(7):1375-1378.[路旭,汪大伟,范维,等.经直肠超声在直肠癌术前分期中的应用及进展[J].现代生物医学进展,2017,17(7):1375-1378.]
[15]Chen LD,Wang W,Xie XY,et al.Value and progress of endorectal ultrasound in the treatment decision of rectal cancer[J].Chin Arch Gen Surg(Electronic Edition),2017,11(5):352-356.
[16]Liu XY,Liu GJ,Zhou ZY,et al.Endorectal ultraspund in evaluation on mesorectal fascia invasion in preoperative rectal cancer[J].Chin J Med Imaging Technol,2017,33(9):1357-1361.]