- 期刊
內視鏡超音波於胃癌診斷與分期之探討
Endoscopic Ultrasonography in the Diagnosis and Staging of Gastric Cancer
摘要
內視鏡超音波(endoscopic ultrasonography, EUS)出現在臨床使用，已有20多年的歷史，且在日常醫療使用上愈來愈普及。自從EUS可呈現出胃壁多層結構與組織學上的分層相吻合，同時可清楚掃描鄰近胃之組織與器官後，EUS已成為胃癌診斷與評估其局部腫瘤侵犯及淋巴結轉移最準確之檢查方式。文獻上，EUS對於胃癌之腫瘤分期採用1987年之TNM系統，其中腫瘤侵犯(T stage)準確度(accuracy)高達78-92%，而淋巴結轉移(N stage)準確度則為50-78%。整體而言，對胃癌的局部分期，EUS優於一般腹部超音波、電腦斷層、核磁共振，甚至外科剖腹檢查。然而，EUS仍存在困難區分癌性侵犯和良性組織發炎、水腫或潰瘍纖維化(ulcer fibrosis)的問題。而判斷良、惡性淋巴結及偵測出癌細胞細微侵犯(microinvasion)更是不容易。今日，胃癌的治療多樣化，預後也和腫瘤分期息息相關，如何提高治療前胃癌分期的準確度，更顯得重要。隨著更多更新EUS的應用和發展，應可解決目前EUS面臨的困難。
並列摘要
Endoscopic Ultrasonography (EUS) appeared in the clinical use for more than 20 years and it has now become a popular technique in daily hospital practice. Since it was found that gastric wall is visualized as a multi-layered structure corresponding to the histological layers of the wall and EUS can clearly scan the perigastric tissues and organs, EUS has become the most accurate method for diagnosing and assessing the local staging of gastric cancer. Tumor staging of gastric cancer by EUS is based on 1987 TNM staging system, and the local tumor invasion (T stage) has a high accuracy rate up to 78-92% and lymph node involvement (N stage), 50-78% from the literature. In general, EUS is superior to transabdominal ultrasonography, computed tomography, magnetic resonance imaging and even intraoperative assessment for local staging of gastric cancer. However, difficulties exist among the differentiation between cancer invasion and benign tissue inflammation, edema or ulcer fibrosis. Moreover, discrimination between benign and malignant lymphadenopathy and detection of microscopic cancer invasion are not easy, too. Currently, with multimodal therapy of gastric cancer and well correlation between tumor staging and prognosis being accepted, it has become more important to improve the accuracy of pretreatment staging. The problems of EUS can be solved with more newer EUS applications and development.