Bilgisayarlı Tomografik Kolonoskopinin Kolon Tümörünü Saptama ve Evrelemesindeki Rolü

Öz

Amaç:

Bilgisayarlı tomografi (BT) kolonoskopi ile kolonun duvar yapısı, serozal yüzey, perikolik yağ dokusu, lenf nodları ve uzak organ metastazın değerlendirilebilmesi nedeniyle diğer kolon değerlendirme tekniklerine üstündür. Bu çalışmada BT kolonoskopinin kolon kitlelerini saptama ve evrelenmesindeki

rolü araştırıldı.

Gereç ve Yöntem:

Optik kolonoskopide saptanan distal tıkayıcı kolon kanseri nedeniyle proksimal kolonun değerlendirilemediği 11 olgu (2 kadın, 9 erkek, yaşları 45-71 yıl) çalışmaya dahil edildi. Bağırsak temizliğini takiben BT ile olgulara, pron ve supin pozisyonda BT kolonoskopi çekimi yapıldı. Bu kitleler “Modifiye Dukes” sınıflaması ile evrelendi. BT kolonoskopiden sonra 1-3 gün içinde ameliyat ile çıkartılan kitlelere patolojik olarak Dukes sınıflaması yapıldı. BT kolonoskopik ve patolojik Dukes sınıflaması arasındaki uyum araştırıldı.

Bulgular:

On bir kolon kitlesinin tamamı BT kolonoskopi ile gösterilebildi. Kitleler en sık (%36) sigmoid kolon yerleşimli olup, bunu transvers kolon (%18) takip etmekteydi. Olguların hepsinde kitlelerin bulunduğu düzeylerden proksimale hava geçişi sağlanarak, bu segmentlerin de değerlendirilebilmesi sağlandı. On bir olgunun 7’sinde (%63,6) kitle proksimal veya distalinde 5mm’nin üstünde bir veya bir kaç adet polip izlendi. Bunlardan birinde toplamda 10’dan fazla 1 cm’den büyük polip mevcut olup, bu olguya ameliyatta total kolektomi yapıldı. Diğer 10 olguda ise kitle segmental kolektomi ile çıkarıldı. BT kolonoskopi ile 8 olguda (%72,7) doğru, 1 olguda (%9,1) daha düşük, 2 olguda (%18,2) ise daha yüksek evreleme yapıldığı gözlendi. Kolon kanser evrelemesinde BT kolonoskopi ve patoloji bulguları arasında anlamlı ilişki saptandı (p<0.05).

Sonuç:

BT kolonoskopinin kolon tümörlerinde yüksek doğrulukta evrelemesi, proksimal ve distal kolon segmentlerini de değerlendirmeye imkan vermesi kolonun diğer görüntüleme tekniklerine olan üstünlüğüdür.

Anahtar Kelimeler

• BT kolonoskopi,kolorektal kanser,optik kolonoskopi

The Role of Computed Tomographic Colonoscopy on the Detection and Staging of Colorectal Cancer

Abstract

Purpose:

Computed tomography (CT) colonoscopy overcomes the other colon evaluation techniques due to the ability of the colon wall, serosal surface, pericolic fat tissue, lymph nodes and distant organ metastases to be evaluated. In this study, the role of CT colonoscopy in the detection and staging of colon masses was investigated.

Material and Methods:

Eleven cases (2 females, 9 males, 45- 71 years) whose proximal colon could not be evaluated due to distal obstructive colon cancer detected on optical colonoscopy were included in the study. Following bowel cleansing, CT colonography was performed in the prone and supine positions. These masses were staged with the “Modified Dukes” classification. Patients who underwent surgical excision within 1-3 days after CT colonoscopy were pathologically classified as Dukes. The agreement between CT colonoscopy and pathology classifications was investigated by Cohen’s kappa.

Results:

All of the eleven colon masses was demonstrated by CT colonoscopy. The masses were the most common (36%) sigmoid colon, followed by transverse colon (18%). In all cases, it was ensured that these segments could be assessed by providing air passage to the proximal from the levels where masses were present. Seven (63.6%) of the eleven cases had one or more polyps on the proximal or distal 5mm above the mass. There was a total of more than 10 polyps (>1cm) on one of the patient, total colectomy was done during the operation. In the other 10 cases mass was removed by segmental colectomy. CT colonoscopy revealed that 8 cases (72.7%) had a lower grade in 1 case (9.1%) and 2 cases (18.2%) had a higher grade. There was a significant correlation between CT colonoscopy and pathology findings in colon cancer stage (p <0.05).

Conclusion:

It is the superiority of CT colonoscopy to other imaging techniques of the colon, allowing high-precision staging of colon tumors, and evaluation of proximal and distal colon segments.

Keywords

• CT colonoscopy,colorectal cancer,optic colonoscopy

References

1. 1. Fletcher JG, Johnson CD, Krueger WR ve ark.ları. Contrast-enhanced CT colonography in recurrent colorectal carcinoma: feasibility of simultaneous evaluation for metastastic disease, local recurrence, and metachronous neoplasia in colorectal carcinoma. AJR 2002;178:283-290.
2. 2. Yee J, Akerkar GA, Hung RK ve ark.ları. Colorectal neoplasia: performance characteristics of CT colonography for detection in 300 patients. Radiology 2001;219:685-692.
3. 3. Filippone A, Ambrossini R, Fuschi M ve ark..ları. Preoperative T and N staging of colorectal cancer: accuracy of contrast-enhanced multi-detector row CT colonography- initial experience. Radiology 2004;231:83-90.
4. 4. Marshall JB, Barthel JS. The frequency of total colonoscopy and terminal ileal intubation in the 1990s. Gastrointest Endosc 1993;39:518-520.
5. 5. Gazelle GS, Gaa J, Saini S, Shellito P. Staging of colon carcinoma using water enema CT. J Comput Assist Tomogr 1995;19:87-91.
6. 6. Balthazar EJ, Megibow AJ, Hulnick D, Naidich DP. Carcinoma of the colon: detection and preoperative staging by CT. AJR Am J Roentgenol 1988;150:301-306.
7. 7. Morrin MM, Farrel RJ, Raptopoulos V, McGee JB, Bleday R, Kruskal JB. Role of virtual computed colonography in patients with colorectal cancers and obstructing colorectal lesions. Dis Colon Rectum 2000;43:303-311.
8. 8. Halligan S, Altman DG, Taylor SA ve ark. Ları. CT colonography in the detection of colorectal polyps and cancer: systematic review, meta-analysis, and proposed minimum data set for study level reporting. Radiology 2005;237:893-904.

9. 9. Hara AH, Johson CD, Reed JE ve ark.ları. Detection of colorectal polyps with CT colonography: initial assessment of sensitivity and spesificity. Radiol 1997;205:59- 65. 10. Royster AP, Fenlon HM, Clarke PD, Nunes DP,Ferruci JT. CT colonoscopy of colorectal neoplasms: two-dimensional and three-dimensional virtual reality techniques with colonoscopic correlaiton. AJR 1997;169:1237- 1242. 11. Morrin M, Kruskal JB, Farrell RJ ve ark.ları. Endoluminal CT colonography utility after an incomplete endoscopic colonoscopy. AJR 1999;172:913-918. 12. Mulhall BP, Veerappan GR, Jackson JL. Meta-analysis: computed tomographic colonography. Ann Intern Med;142:635-650.
10. 13. Oto A, Gebelek V, Oğuz BS ve ark. ları. CT attenuation of colorectal polypoid lesions: evaluation of contrast enhancement in CT colonography. Eur Radiol 2003;13:1657-1663.
11. 14. Zalis ME, Barish MA, Choi JR ve ark. ları. CT colonography reporting and data system: a consensus proposal. Radiology 2005;236:3-9.
12. 15. Balthazar EJ, Siegel Se, Megibow AJ, Scholes J, Gordon R. CT in patients with scirrhous carcinoma of the GI tract: imaging findings and value for tumour detection and staging. AJR 1995;165:839-845.
13. 16. Lafrate F, Hassan C, Zullo A ve ark. ları. CT colonography with reduced bowel preparation after incomplete colonoscopy in the elderly. Eur Radiol 2008;18:1385-1395.31.