gnckКолопроктологияKoloproktologia2073-75562686-7303Russian Association of Coloproctology10.33878/2073-7556-2020-19-3-49-64gnck-1587Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESСРАВНИТЕЛЬНАЯ ОЦЕНКА МУЛЬТИПАРАМЕТРИЧЕСКОГО ЭНДОРЕКТАЛЬНОГО УЛЬТРАЗВУКОВОГО ИССЛЕДОВАНИЯ И КОЛОНОСКОПИИ С ПРИМЕНЕНИЕМ УЗКОГО СПЕКТРА СВЕТА В ДИАГНОСТИКЕ РАННЕГО РАКА ПРЯМОЙ КИШКИCOMPARATIVE EVALUATION OF MULTIPARAMETRIC ENDORECTAL ULTRASOUND AND ENHANCED IMAGING COLONOSCOPY IN THE DIAGNOSIS OF EARLY COLORECTAL CANCERhttps://orcid.org/0000-0001-7734-3069БогдановаЕ. М.BogdanovaE. M.

Богданова Евгения Михайловна

ул. Саляма Адиля, д. 2, Москва, 123423тел.: +7 (499) 199-66-86 

Eugenia M. Bogdanova

Salyama Adilya str., 2, Moscow, 123423tel.: +7 (499) 199-66-86 

bogdanova.zh.m@gmail.comhttps://orcid.org/0000-0002-8403-195XТрубачеваЮ. Л.TrubachevaYu. L.

ул. Саляма Адиля, д. 2, Москва, 123423

Yulia L. Trubacheva

Salyama Adilya str., 2, Moscow, 123423

https://orcid.org/0000-0003-4679-5497ЮгайО. М.YugaiO. M.

ул. Саляма Адиля, д. 2, Москва, 123423

Oleg M. Yugai

Salyama Adilya str., 2, Moscow, 123423

https://orcid.org/0000-0002-6212-9454ЧернышовС. В.ChernyshovS. V.

ул. Саляма Адиля, д. 2, Москва, 123423

Stanislav V. Chernyshov

Salyama Adilya str., 2, Moscow, 123423

https://orcid.org/0000-0002-3919-9067РыбаковЕ. Г.RybakovE. G.

ул. Саляма Адиля, д. 2, Москва, 123423

Evegeny G. Rybakov

Salyama Adilya str., 2, Moscow, 123423

https://orcid.org/0000-0002-3399-0608ХомяковЕ. А.KhomyakovE. A.

ул. Саляма Адиля, д. 2, Москва, 123423

Evgeny A. Khomyakov

Salyama Adilya str., 2, Moscow, 123423

ФГБУ «НМИЦ колопроктологии имени А.Н. Рыжих» Минздрава РоссииРоссияRyzhikh National Medical Research Center of ColoproctologyRussian Federation2020210920201934964Copyright © Богданова Е.М., Трубачева Ю.Л., Югай О.М., Чернышов С.В., Рыбаков Е.Г., Хомяков Е.А., 20202020Богданова Е.М., Трубачева Ю.Л., Югай О.М., Чернышов С.В., Рыбаков Е.Г., Хомяков Е.А.Bogdanova E.M., Trubacheva Y.L., Yugai O.M., Chernyshov S.V., Rybakov E.G., Khomyakov E.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ruproctology.com/jour/article/view/1587ЦЕЛЬ

ЦЕЛЬ: сравнительная оценка диагностических возможностей мультипараметрического эндоректального ультразвукового исследования (ЭРУЗИ) и колоноскопии с использованием уточняющих технологий в диагностике раннего рака прямой кишки.

ПАЦИЕНТЫ И МЕТОДЫ

ПАЦИЕНТЫ И МЕТОДЫ: в исследование включено 78 пациентов с эпителиальными опухолями прямой кишки. Всем пациентам проведены мультипараметрическое ЭРУЗИ и колоноскопия с осмотром в узком спектре света (NBI) при оптическом увеличении. Все больные прооперированы.

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ: при морфологическом исследовании операционных материалов в 48 случаях выявлены аденомы, в 19 препаратах – аденокарцинома in situ и T1, в 11 – аденокарцинома с инвазией в мышечный слой или глубже. При расчёте показателей точности диагностических методов для групп пациентов с аденомой, аденокарциномой Tis-T1 и аденокарциномой T2-T3 разница чувствительности и специфичности методов ни в одной из представленных групп не достигала уровня статистической значимости (p>0,05). По результатам ROC-анализа ультразвуковое исследование имеет сопоставимую с колоноскопией прогностическую значимость. Разница площадей составила 0,013 (p=0,85).

ЗАКЛЮЧЕНИЕ

ЗАКЛЮЧЕНИЕ: эндоскопический и ультразвуковой методы исследования имеют равнозначный уровень информативности в диагностике злокачественного перерождения аденом прямой кишки.

AIM

AIM: to compare multiparametric endorectal ultrasound (ERUS) and enhanced imaging colonoscopy in the diagnosis of early colorectal cancer.

PATIENTS AND METHODS

PATIENTS AND METHODS: the study included 78 patients with epithelial rectal tumor. All the patients underwent multiparametric ERUS and colonoscopy with examination by narrow beam imaging (NBI) at optical magnification. All the patients were operated.

RESULTS

RESULTS: a morphological examination removed specimens revealed adenomas in 48 cases, in 19 specimens – adenocarcinomas in situ and T1, and in 11 specimens – adenocarcinomas with invasion of the muscle layer or deeper. When calculating the accuracy indicators of diagnostic methods for groups of patients with adenoma, Tis-T1 adenocarcinoma, and T2-T3 adenocarcinoma, the difference in the sensitivity and specificity of the methods in none of the presented groups did not reach the level of statistical significance (p>0.05).ROC analysis showed that ultrasound has a prognostic value comparable to colonoscopy. The area difference was 0.013 (p=0.85).

CONCLUSION

CONCLUSION: endoscopy and ultrasound have similar value in the diagnosis of malignant transformation of rectal adenomas.

ранний рак прямой кишкимультипараметрическое эндоректальное УЗИкомпрессионная эластографияколоноскопияямочный рисуноккапиллярный рисунокearly rectal cancermultiparametric endorectal ultrasoundstrain elastographycolonoscopypit-patterncapillary patternReferencesJapanese Society for cancer of colon and rectum. Japanese classification of colorectal carcinoma: Tokyo: Kanehara & Co., LTD; 1997.Japanese Society for cancer of colon and rectum. Japanese classification of colorectal carcinoma: Tokyo: Kanehara & Co., LTD; 1997.Amin MB, Edge S, Greene F et al. AJCC Cancer Staging Manual. 8th Edition Springer International Publishing; 2016.Amin MB, Edge S, Greene F et al. AJCC Cancer Staging Manual. 8th Edition Springer International Publishing; 2016.Хомяков Е.А., Чернышов С.В., Рыбаков Е.Г. и соавт. Результаты 600 трансанальных эндоскопических операций по поводу аденом и аденокарцином прямой кишки. Колопроктология. 2019; № 3(69), с. 20-40. doi: 10.33878/2073-7556-2019-18-3-20-40.Khomyakov E.A., Chernyshov S.V., Rybakov E.G., et al. The results of 600 transanal endoscopic surgeries of rectal adenomas and adenocarcinomas. Koloproktologia. 2019; no. 3(69). pp. 20-40. doi: 10.33878/2073-7556-2019-18-3-20-40 (in Russ.).Kikuchi R, Takano M, Takagi K et al. Management of early invasive colorectal cancer. Risk of recurrence and clinical guidelines. Dis Colon Rectum. 1995;38:1286-1295. doi: 10.1007/bf02049154.Kikuchi R, Takano M, Takagi K et al. Management of early invasive colorectal cancer. Risk of recurrence and clinical guidelines. Dis Colon Rectum. 1995;38:1286-1295. doi: 10.1007/bf02049154.Fernández-Esparrach G, Ayuso-Colella JR, Sendino O et al. EUS and magnetic resonance imaging in the staging of rectal cancer: a prospective and comparative study. Gastrointest Endosc. 2011;74(2):347-354. doi: 10.1016/j.gie.2011.03.1257.Fernández-Esparrach G, Ayuso-Colella JR, Sendino O et al. EUS and magnetic resonance imaging in the staging of rectal cancer: a prospective and comparative study. Gastrointest Endosc. 2011;74(2):347-354. doi: 10.1016/j.gie.2011.03.1257.Yimei J, Ren Z, Lu X et al. A comparison between the reference values of MRI and EUS and their usefulness to surgeons in rectal cancer. Eur Rev Med Pharma Sci. 2012;16:2069-2077.Yimei J, Ren Z, Lu X et al. A comparison between the reference values of MRI and EUS and their usefulness to surgeons in rectal cancer. Eur Rev Med Pharma Sci. 2012;16:2069-2077.Waage JER, Leh S, Røsler C et al. Endorectal ultrasonography, strain elastography and MRI differentiation of rectal adenomas and adenocarcinomas. Colorectal Disease. 2014;17(2):124-131. doi:10.1111/codi.12845Waage JER, Leh S, Røsler C et al. Endorectal ultrasonography, strain elastography and MRI differentiation of rectal adenomas and adenocarcinomas. Colorectal Disease. 2014;17(2):124-131. doi:10.1111/codi.12845Santoro GA, Gizzi G, Pellegrini L et al. The value of high-resolution three-dimensional endorectal ultrasonography in the management of submucosal invasive rectal tumors. Dis Colon Rectum. 2009;52(11):1837-43. doi: 10.1007/DCR.0b013e3181b16ce9.Santoro GA, Gizzi G, Pellegrini L et al. The value of high-resolution three-dimensional endorectal ultrasonography in the management of submucosal invasive rectal tumors. Dis Colon Rectum. 2009;52(11):1837-43. doi: 10.1007/DCR.0b013e3181b16ce9.Iwatate M, Ikumoto T, Hattori S et al. NBI and NBI Combined with Magnifying Colonoscopy. Diagn Ther Endosc. 2012;2012:173-269. doi: 10.1155/2012/173269.Iwatate M, Ikumoto T, Hattori S et al. NBI and NBI Combined with Magnifying Colonoscopy. Diagn Ther Endosc. 2012;2012:173-269. doi: 10.1155/2012/173269.Yanai S, Nakamura S, Matsumoto T Role of magnifying colonoscopy for diagnosis of colorectal neoplasms: From the perspective of Japanese colonoscopists. Dig Endosc. 2016;28(3):274-280. doi:10.1111/den.12568.Yanai S, Nakamura S, Matsumoto T Role of magnifying colonoscopy for diagnosis of colorectal neoplasms: From the perspective of Japanese colonoscopists. Dig Endosc. 2016;28(3):274-280. doi:10.1111/den.12568.Kudo S, Rubio CA, Teixeira CR et al. Pit pattern in colorectal neoplasia: endoscopic magnifying view. Endoscopy. 2001;33(4):367-373. doi: 10.1055/s-2004-826104.Kudo S, Rubio CA, Teixeira CR et al. Pit pattern in colorectal neoplasia: endoscopic magnifying view. Endoscopy. 2001;33(4):367-373. doi: 10.1055/s-2004-826104.Sano Y, Tanaka S, Kudo S et al. Narrow-band imaging (NBI) magnifying endoscopic classification of colorectal tumors proposed by the Japan NBI Expert Team. Dig Endosc. 2016;28(5):526-533. doi:10.1111/den.12644.Sano Y, Tanaka S, Kudo S et al. Narrow-band imaging (NBI) magnifying endoscopic classification of colorectal tumors proposed by the Japan NBI Expert Team. Dig Endosc. 2016;28(5):526-533. doi:10.1111/den.12644.Шелыгин Ю.А., Орлова Л.П., Самсонова Т.В. и соавт. Возможности компрессионной ультразвуковой эластографии в диагностике малигнизации ворсинчатых опухолей прямой кишки. Колопроктология. 2017; № 4(62), с. 60-66.Shelygin Yu.A., Orlova L.P., Samsonova T.V. et al. Strain elastography as diagnostic tool for evaluation of rectal neoplasms. Koloproktologia. 2017; no. 4(62), pp. 60-66. (in Russ.).Sung HY, Kang WK, Kim SW et al. Risk factors for lymph node metastasis in patients with submucosal invasive colorectal carcinoma. J Korean Surg Soc. 2010;78:207-212. doi: 10.4174/jkss.2010.78.4.207.Sung HY, Kang WK, Kim SW et al. Risk factors for lymph node metastasis in patients with submucosal invasive colorectal carcinoma. J Korean Surg Soc. 2010;78:207-212. doi: 10.4174/jkss.2010.78.4.207.Leufkens A., van Oijen M, Vleggaar F et al. Factors influencing the miss rate of polyps in a back-to-back colonoscopy study. Endoscopy. 2012;44(05):470-475. doi:10.1055/s-0031-1291666.Leufkens A, van Oijen M, Vleggaar F et al. Factors influencing the miss rate of polyps in a back-to-back colonoscopy study. Endoscopy. 2012;44(05):470-475. doi:10.1055/s-0031-1291666.Веселов В.В., Нечипай А.М., Полторыхина Е.А. и соавт. Первый опыт полноспектральной колоноскопии. Колопроктология. 2017; № 2(60), с. 36-46.Veselov V.V., Nechipay A.M., Poltoryhina E.A. et al. First experience in full-spectrum colonoscopy. Koloproktologia. 2017; no. 2(60), pp. 36-46. (in Russ.).Чернышов С.В., Орлова Л.П., Жданкина С.Н. и соавт. Высокая частота малигнизации ворсинчатых опухолей прямой кишки, как фактор выбора трансанальных эндоскопических операций. Колопроктология. 2013; № 2(44), с. 3-8.Chernyshov S.V., Orlova L.P., Zhdankina S.N. et al. High incidence of hidden malignancies in villous adenoma as a factor of choice for transanal endosurgery. Koloproctologia. 2013; no. 2(44), pp. 3-8. (in Russ.).Fukunaga S, Nagami Y, Shiba M et al. Impact of preoperative biopsy sampling on severe submucosal fibrosis on endoscopic submucosal dissection for colorectal laterally spreading tumors: a propensity score analysis. Gastrointest Endosc. 2019;89(3):470-478. doi: 10.1016/j.gie.2018.08.051.Fukunaga S, Nagami Y, Shiba M et al. Impact of preoperative biopsy sampling on severe submucosal fibrosis on endoscopic submucosal dissection for colorectal laterally spreading tumors: a propensity score analysis. Gastrointest Endosc. 2019;89(3):470-478. doi: 10.1016/j.gie.2018.08.051.Makino T, Kanmura S, Sasaki F et al. Preoperative classification of submucosal fibrosis in colorectal laterally spreading tumors by endoscopic ultrasonography. Endosc Int Open. 2015;3(4):363-367. doi:10.1055/s-0034-1391782.Makino T, Kanmura S, Sasaki F et al. Preoperative classification of submucosal fibrosis in colorectal laterally spreading tumors by endoscopic ultrasonography. Endosc Int Open. 2015;3(4):363-367. doi:10.1055/s-0034-1391782.Valero M, Robles-Medranda C. Endoscopic ultrasound in oncology: An update of clinical applications in the gastrointestinal tract. World J Gastrointest Endosc. 2017;9(6):243-254. doi:10.4253/wjge.v9.i6.243.Valero M, Robles-Medranda C. Endoscopic ultrasound in oncology: An update of clinical applications in the gastrointestinal tract. World J Gastrointest Endosc. 2017;9(6):243-254. doi:10.4253/wjge.v9.i6.243.Waage JER, Rafaelsen SR, Borley NR et al. Strain Elastography Evaluation of Rectal Tumors: Inter- and Intraobserver Reproducibility. Ultraschall Med. 2015;36(6):611-7. doi: 10.1055/s0034-1398985.Waage JER, Rafaelsen SR, Borley NR et al. Strain Elastography Evaluation of Rectal Tumors: Inter- and Intraobserver Reproducibility. Ultraschall Med. 2015;36(6):611-7. doi: 10.1055/s0034-1398985.Nuernberg D, Saftoiu A, Barreiros A et al. EFSUMB Recommendations for Gastrointestinal Ultrasound Part 3: Endorectal, Endoanal and Perineal Ultrasound. Ultrasound Int Open. 2019;05(01):34-51. doi:10.1055/a-0825-6708.Nuernberg D, Saftoiu A, Barreiros A et al. EFSUMB Recommendations for Gastrointestinal Ultrasound Part 3: Endorectal, Endoanal and Perineal Ultrasound. Ultrasound Int Open. 2019;05(01):34-51. doi:10.1055/a-0825-6708.Badea R, Gersak MM, Dudea SM et al. Characterization and staging of rectal tumors: endoscopic ultrasound versus MRI/CT. Pictorialessay. Med Ultrason. 2015;17(2):241-247. doi: 10.11152/mu.2013.2066.172.mri.Badea R, Gersak MM, Dudea SM et al. Characterization and staging of rectal tumors: endoscopic ultrasound versus MRI/CT. Pictorialessay.Med Ultrason. 2015;17(2):241-247. doi: 10.11152/mu.2013.2066.172.mri.Tankova L, Nakov R, Stoilov G et al. Endorectal power Doppler ultrasonography is a reliable method for evaluation of rectal cancer angiogenesis. Eur Rev Med Pharmacol Sci. 2019;23(4):1661-1667. doi: 10.26355/eurrev_201902_17127.Tankova L, Nakov R, Stoilov G et al. Endorectal power Doppler ultrasonography is a reliable method for evaluation of rectal cancer angiogenesis. Eur Rev Med Pharmacol Sci. 2019;23(4):1661-1667. doi: 10.26355/eurrev_201902_17127.

The authors declare that there are no conflicts of interest present.