EUS下食管癌分期(課件）

1、Cancer Staging:Esophageal CancerMedical Univ. ofSouth CarolinaDigestive Disease Center Dr. Ian Penman and Dr. David Williams Endoscopic ultrasound (EUS) is ideally suited to the TNM classification for tumor staging as it can accurately assess the depth of tumor penetration, the presence of locoregio

2、nal nodal metastases and can detect vascular invasion. EUS-guided FNA biopsy allows for cytopathological diagnosis of malignant primary tumors and is superior to other imaging modalities for confirmation of nodal metastases. Currently EUS is used for the locoregional staging of esophageal, gastric,

3、rectal and pancreatic cancers as well as mediastinal staging of lung cancer.TNM staging and grouping of Esophageal Cancer.(AJCC Cancer Staging Manual. Fifth Edition. 1997. Lippincott-Raven, publisher). The depth of tumor penetration and nodal metastases are important prognostic factors and determine

4、 treatment modalities in stage dependent protocols. Esophageal Cancer, T1A small ulcerated nodule was identified within a segment of Barretts mucosa during endoscopic surveillance. EUS revealed a small hypoechoic irregular tumor that was infiltrating into echogenic submucosa but had not breached und

5、erlying muscularis. Complete resection was achieved at surgery. Esophageal Cancer, T2N1On EUS, esophageal cancer presents as an area of localised or circumferential thickening of the esophageal wall with hypoechoic or mixed echotexture. A circumferential hypoechoic tumor can be seen with disruption

6、of the normal wall layer structure but without invasion of the muscularis propria. A small rounded, hypoechoic peritumoral lymph node is also seen. Esophageal Cancer, T2N1Endosonography is highly accurate in the locoregional staging of esophageal cancer. A small, discrete, hypoechoic lymph node (ins

7、et), not identified by CT, was seen at EUS adjacent to an eccentric hypoechoic tumor. Esophageal Cancer, T3With locally advanced disease, patients are candidates for nonsurgical or neoadjuvant therapy. A large, circumferential, heterogenous tumor is seen in the distal esophagus, with a distinct clea

8、vage plane between tumor and aorta. The tumor is seen to invade through the muscularis (arrow). Esophageal Cancer, T3With increasing tumor penetration there is loss of wall layer structure and loss of the smooth outer margin as tumor invades through to the periesophageal fat. An irregular hypoechoic

9、 tumor is seen in the region of the gastro-esophageal junction and is penetrating through the muscularis propria (arrow). Esophageal Cancer, T3An eccentric hypoechoic tumor can be seen invading through the muscularis propria with tumor pseudopodia formation (at the 6 oclock position). The bright ple

10、ural reflection is intact (arrow). Esophageal Cancer, T3N1EUS is more accurate than CT scan for the detection of locoregional nodal metastases. A circumferential hypoechoic tumor is identified in the mid-esophagus with invasion through the muscularis. A discrete, 5mm, rounded peritumoral lymph node

11、is seen. Esophageal Cancer, T3N1The incidence of nodal metastases increases with advancing T stage. An eccentric hypoechoic tumor is seen invading through the muscularis propria. A small rounded, hypoechoic lymph node is adjacent to the tumorEsophageal Cancer, T4, pleural invasionInvasion of adjacen

12、t sructures selects out patients for nonoperative therapies. Invasion of the pleura (bright reflection) by this esophageal tumor was not identified by CT scan. Esophageal Cancer, T4, pleural invasionThe irregular outer border of the hypoechoic tumor can be seen to breach the pleura in one section (a

13、rrow). Esophageal Cancer, celiac lymph nodeCeliac nodal involvement is considered as distant metastatic disease. A 10mm, rounded hypoechoic lymph node was identified adjacent to the celiac axis in a patient with mid-esophageal cancer. (curvilinear array echoendoscope, Pentax FG-32UA). This node was not seen on CT scanning. Esophageal Cancer, FNA celiac lymph nodeEUS-guided FNA is safe an