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

Öz

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.

Anahtar Kelimeler

• CT colonoscopy,colorectal cancer,optic colonoscopy

Kaynakça

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