Endoscopic assessment of invasion of colorectal tumors with a new high-frequency ultrasound probe,☆☆,,★★,

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Abstract

The present study was carried out to clarify the usefulness of and problems associated with a new ultrasound probe in the assessment of invasion of colorectal tumors. Normal colorectal wall of 23 resected specimens from colorectal cancer cases was examined in vitro with the probe. Fifty-one patients with colorectal carcinoma and 16 patients with rectal carcinoid tumor were presurgically examined using the probe via the biopsy channel of a conventional colonoscope. After endoscopic and ultrasonographic examination, 27 patients underwent endoscopic resection and 40 underwent surgical resection. The ultrasonographic findings were compared with histologic findings in all cases. Carcinomas and carcinoid tumors were visualized as an echo-poor region with the probe. The overall accuracy rate for depth of invasion was 76% (39/51) for colorectal cancer. The accuracy rates for tumors limited to the mucosa and tumors invading the submucosa were 83% and 90%, respectively; these rates were higher than those for tumors invading the muscularis propria (50%) and beyond the muscularis propria (73%). In all 16 cases of carcinoid tumor, the depth of invasion was accurately shown to be limited to the submucosa. This probe is useful to assess invasion of colorectal tumors, especially small and flat lesions limited to the mucosa or submucosa. (Gastrointest Endosc 1994;41:587-92.)

Section snippets

In vitro study

Twenty-three formalin-fixed resected specimens from colorectal cancer cases were examined in a water bath with the new probe and with conventional EUS (CF-UM20, Olympus Optical Co. Ltd., Tokyo, Japan) at a frequency of 7.5 MHz. To compare ultrasonographic images of normal colorectal walls with histologic findings in all cases, we inserted one needle in the middle of the submucosa and one in the muscularis propria of the specimen before scanning. After in vitro ultrasonographic examination,

In vitro study

The image of the normal colorectal wall using both the ultrasound probe and conventional EUS was seen as a seven-layered structure in vitro. The first (high-echo) layer and the second (low-echo) layers correspond to the interface echo and the mucosa, respectively. The third (high-echo) layer corresponds to the submucosa. The fourth (low-echo), fifth (high-echo), and sixth (low-echo) layers correspond to the muscularis propria; the fifth (high-echo) layer corresponds to the interface echo and

DISCUSSION

EUS has been used for nearly 10 years in the diagnosis of gastrointestinal disease.1, 2, 3, 4, 5, 6, 7, 13, 14, 15 EUS is of value clinically because it makes possible the visualization of intramural and transmural tumor growth in malignancy,16 and it has been reported to be useful for the assessment of extent of invasion of rectal tumor.17, 18, 19 Since the development of the fiberoptic echocolonoscope, the number of reports on colorectal tumors has been increasing.4, 5, 6 However,

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    From the Second Department of Internal Medicine, Nagoya University School of Medicine, Tsuruma-cho, Showa-ku, Nagoya, Japan, and the Department of Internal Medicine, Toyoashi Municipal Hospital, Mastuba-cho, Toyohashi, Japan.

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    Reprint requests: Masahiro Yoshida, MD, Second Department of Internal Medicine, Nagoya University School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya 466, Japan.

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