Endoscopic Ultrasonography in the Invasion Depth Diagnosis for Polypoid Type Early Colorectal Carcinomas Yusuke Saitoh 1 , Yu Kobayashi 1 , Yuhei Inaba 1 , Moe Yoshida 1 , Ryuji Sugiyama 1 , Ryuji Sukegawa 1 , Kenichiro Ozawa 1 , Masaki Taruishi 1 , Mikihiro Fujiya 2 1Digestive Disease Center, Asahikawa City Hospital, Asahikawa, Japan 2Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan Keyword: 超音波内視鏡 , EUS , 隆起型早期大腸癌 , polypoid type early colorectal carcinomas , ESD , EMR pp.877-888
Published Date 2019/5/25
DOI https://doi.org/10.11477/mf.1403201763
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 Here, we used EUS(endoscopic ultrasonography)for diagnosing the invasion depth of polypoid type early colorectal T1 carcinomas. EUS is a unique diagnostic modality that allows us to observe cross-sectional images of a lesion. Use of an ultrasound probe, HFUP(high-frequency ultrasound probe), is recommended rather than conventional EUS that can easily proceed during colonoscopy. The accuracy of invasion depth diagnosis will be improved with intensive scanning of the suspicious invasive portion of the lesion by colonoscopy. In cases of polypoid lesions that are 6mm or more in height, it is difficult to obtain good HFUP images of the deepest parts of the lesion because of deep attenuation. In such cases, pushing the probe against the top or base of the lesion and use of low frequency probes(12 or 7.5MHz)may help in obtaining satisfactory images.

 In both polypoid, flat- and depressed-type early carcinomas, invasion depth diagnosis is used to determine the choice of therapy(i.e., endoscopic resection or surgery), and the depth of T1b carcinomas was significantly higher than Tis・T1a carcinomas(p<0.05). We believe that HFUP will be useful for diagnosing invasion depth, particularly in patients with T1b carcinomas. As for the polypoid type early carcinomas, HFUP is not useful for the diagnosis of invasion depth in Ip- and Isp-type carcinomas(accuracy rate ; 65.3%, no significant differences between Tis・T1a ca. and T1b ca.) ; however, the accuracy was significantly higher in T1b, than in Tis・T1a carcinomas(p<0.05). HFUP is useful for diagnosing the invasion depth of sessile type early colorectal carcinomas, particularly suspected for T1b carcinomas.

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