Radiation Oncology, Chulolongkorn University : Diagnostic Tests

Radiation Oncology Chulolongkorn University

Diagnostic Tests

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1. µÃÇ¨ËÒÁÐàÃç§ÅÓäÊéãËè ÁÕÇÔ¸Õ¡ÒÃµÃÇ¨ 2 ÇÔ¸Õ·ÕèµÃÇ¨ËÒ¡éÍ¹ÀÒÂã¹ÅÓäÊéãËè»ÃÐ¡Íº´éÇÂ
1.1 Air Contrast Barium Enema ÃèÇÁ¡Ñº Proctosigmoidoscopy â´Â»¡µÔ¡ÒÃ·Ó Barium Enema áºº Single-Column ¨Ðä´éÀÒ¾äÁèªÑ´à¨¹ áÅÐäÁèÊÒÁÒÃ¶àËç¹ÃÍÂâÃ¤·ÕèÁÕ¢¹Ò´àÅç¡ä´é â´ÂÊÒÁÒÃ¶µÃÇ¨ÁÐàÃç§ä´éà¾ÕÂ§ 59% áÅÐµÃÇ¨ Polyps ä´éÃÒÇ 40% ¢Í§¼Ùé»èÇÂ·Ñé§ËÁ´à·èÒ¹Ñé¹26
¡ÒÃãªéà·¤¹Ô¤ Double Contrast Barium Enema à»ç¹¡ÒÃãÊèÅÁà¢éÒä»ã¹ÅÓäÊéãËèÃèÇÁ¡Ñº Contrast Media ·ÓãËéà¾ÔèÁ¤ÇÒÁáÁè¹ÂÓ¢Í§¡ÒÃµÃÇ¨¢Öé¹¨Ò¡ÇÔ¸Õà´ÔÁ 15-20%27 ¨Ò¡¡ÒÃÈÖ¡ÉÒã¹¼Ùé»èÇÂ 460 ÃÒÂ ¾ºÇèÒÊÒÁÒÃ¶µÃÇ¨ Polyps ä´éµÑé§áµè 40-90%28 à¹×èÍ§¨Ò¡¡ÒÃ·Ó Barium Enema µéÍ§ãÊè·èÍ·ÕèÁÕÅÙ¡â»è§à¢éÒä»·Ò§ÃÙ·ÇÒÃË¹Ñ¡ à¾×èÍ»éÍ§¡Ñ¹äÁèãËé Contrast Media ÃÑèÇÍÍ¡ÁÒ¨Ò¡ÅÓäÊéãËè ·ÓãËéº´ºÑ§ºÃÔàÇ³ Rectum áÅÐ Sigmoid Colon «Öè§à»ç¹µÓáË¹è§·Õè¾ºÁÐàÃç§ÅÓäÊéãËèä´éºèÍÂ ¨Ö§¤ÇÃ·Ó
Proctosigmoidoscopy ÃèÇÁ´éÇÂ à¾×èÍµÃÇ¨ÊÍººÃÔàÇ³´Ñ§¡ÅèÒÇ
1.2 Colonoscopy with Biopsy ¡ÒÃãªé Colonoscopy ã¹¡ÒÃµÃÇ¨ÊÍºËÒÁÐàÃç§ÅÓäÊé-ãËèáÅÐ Polyps ¨Ðà¾ÔèÁ¤ÇÒÁáÁè¹ÂÓã¹¡ÒÃµÃÇ¨ÁÒ¡¡ÇèÒÇÔ¸ÕÍ×è¹ æ â´Âà©¾ÒÐ¶éÒ¡éÍ¹ÁÐàÃç§ËÃ×Í
Polyps ÁÕ¢¹Ò´àÅç¡àÁ×èÍà»ÃÕÂºà·ÕÂºÃÐËÇèÒ§ Barium Enema áÅÐ Colonoscopy ã¹¼Ùé»èÇÂÃÒÂà´ÕÂÇ¡Ñ¹
¨Ð¾ºÇèÒ Barium Enema ãËé¤ÇÒÁäÇ (Sensitivity) ã¹¡ÒÃµÃÇ¨ 67% ã¹¢³Ð·Õè Colonoscopy µÃÇ¨
ä´é 97%29 »ÃÐâÂª¹ì¢Í§ Colonoscopy ¹Í¡¨Ò¡¤ÇÒÁäÇã¹¡ÒÃµÃÇ¨ÁÒ¡¡ÇèÒ Barium Enema áÅéÇ
ÂÑ§ÊÒÁÒÃ¶µÑ´ªÔé¹à¹×éÍÁÒµÃÇ¨·Ò§¾ÂÒ¸ÔÊÀÒ¾ä´é áÅÐ¶éÒ¾º Polyps ¡çÊÒÁÒÃ¶·ÓÒ¡ÒÃÃÑ¡ÉÒ´éÇÂ¡ÒÃ
µÑ´ÍÍ¡ (Polypectomy) ä´éÍÕ¡´éÇÂ ¹Í¡¨Ò¡¹Õéã¹¼Ùé»èÇÂÁÐàÃç§ÅÓäÊéãËè·Õèà¤Â¼èÒµÑ´ÅÓäÊéãËèä»áÅéÇ
¨ÐÁÕ¡ÒÃà»ÅÕèÂ¹á»Å§¢Í§ÅÑ¡É³Ð·Ò§¡ÒÂÇÔÀÒ¤ä»¨Ò¡»¡µÔ ¡ÒÃ·Ó Barium Enema ã¹ºÒ§¤ÃÑé§
á»Å¼ÅÅÓºÒ¡ã¹¡ÒÃ·Õè¨ÐºÍ¡ÇèÒ¼Ùé»èÇÂÁÕ¡ÒÃ¡ÅÑºà»ç¹«éÓà©¾ÒÐ·Õè¢Í§âÃ¤ËÃ×ÍäÁè ¡ÒÃ·Ó
Colonoscopy ã¹ÃÒÂàªè¹¹Õé¨ÐÁÕ»ÃÐâÂª¹ìÁÒ¡¡ÇèÒ Barium Enema ã¹¡ÒÃÇÔ¹Ô¨©ÑÂâÃ¤
¼ÅàÊÕÂ¢Í§ Colonoscopy ÁÕËÅÒÂ»ÃÐ¡ÒÃ »ÃÐ¡Íº´éÇÂàÃ×èÍ§¢Í§¤èÒãªé¨èÒÂ«Öè§¨Ðá¾§¡ÇèÒ Double Contrast Barium Enema ¼Ùé»èÇÂÁÑ¡¨ÐÃÙéÊÖ¡·ÃÁÒ¹¨Ò¡¡ÒÃ·Ó Colonoscopy ÁÒ¡¡ÇèÒ¡ÒÃ·Ó
Barium Enema ÃÇÁ·Ñé§á¼Åá·Ã¡«éÍ¹¢Í§ Endoscopy ¨ÐÁÒ¡¡ÇèÒ¡ÒÃ·Ó Barium Enema ¡ÅèÒÇ¤×Í
¾º¡ÒÃµ¡àÅ×Í´áÅÐ¡ÒÃ·ÐÅØ¢Í§ÅÓäÊéãËè»ÃÐÁÒ³ 0.1-0.2% ¨Ò¡¡ÒÃ·Ó Colonoscopy ã¹¢³Ð·Õè
Barium Enema ¾ºà¾ÕÂ§ 0.02%30-32
2. Fecal Occult Blood Test à¹×èÍ§¨Ò¡ÁÐàÃç§ÅÓäÊéãËèÁÑ¡¨ÐÁÕàÅ×Í´ÍÍ¡¨Ò¡¼ÔÇ¢Í§¡éÍ¹ÁÐàÃç§ÍÍ¡ÁÒ»Ð»¹¡ÑºÍØ¨¨ÒÃÐºèÍÂ æ ´Ñ§¹Ñé¹¡ÒÃµÃÇ¨àÅ×Í´ã¹ÍØ¨¨ÒÃÐ¨ÐªèÇÂã¹¡ÒÃµÃÇ¨ÁÐàÃç§ä´é (Cancer Screening Test) ¢éÍ´Õ¢Í§¡ÒÃ·Ó Fecal Occult Blood Test ¤×Í·Ó§èÒÂ ÃÒ¤Ò¶Ù¡ áµè¢éÍàÊÕÂ¤×Í¡ÒÃµÃÇ¨ÇÔ¸Õ¹Õé ÁÕ¤ÇÒÁäÇ (Sensitivity) µèÓ áÅÐ¤ÇÒÁ¨Óà¾ÒÐ (Specificity) µèÓ à¹×èÍ§¨Ò¡ÁÐàÃç§ÅÓäÊéãËèã¹ºÒ§ÃÒÂÍÒ¨äÁèÁÕàÅ×Í´ÍÍ¡ÁÒ·Ò§ÍØ¨¨ÒÃÐ ËÃ×ÍÁÕàÅ×Í´ÍÍ¡à»ç¹¤ÃÑé§¤ÃÒÇà·èÒ¹Ñé¹
¹Í¡¨Ò¡¹ÕéÂÑ§ÁÕÊÒÃÍÒËÒÃËÅÒÂÍÂèÒ§·Õè·ÓãËéà¡Ô´ False Positive ¢Í§¡ÒÃµÃÇ¨ä´é àªè¹ ¡ÒÃÃÑº»ÃÐ-
·Ò¹ÂÒºÒ§ª¹Ô´ ºÒ§¤ÃÑé§àÅ×Í´ÍÍ¡ÁÒ¨Ò¡µÓáË¹è§Í×è¹¢Í§·Ò§à´Ô¹ÍÒËÒÃ àªè¹ àÅ×Í´ÍÍ¡¨Ò¡á¼Åã¹¡ÃÐà¾ÒÐÍÒËÒÃ33 ¡ÒÃÃÑº»ÃÐ·Ò¹äÇµÒÁÔ¹«ÕÁÒ¡ æ ÍÒ¨·ÓãËéà¡Ô´¼Å False Negative ä´é24 ËÃ×Í¶éÒ»ÃÔÁÒ³àÅ×Í´·ÕèÍÍ¡ÁÕ¹éÍÂáÅÐ¡ÃÐ¨ÒÂäÁèÊÁèÓàÊÁÍã¹ÍØ¨¨ÒÃÐ àÇÅÒà¡çºÍØ¨¨ÒÃÐÁÒµÃÇ¨ÍÒ¨µÃÇ¨äÁè¾ºàÅ×Í´ã¹ÍØ¨¨ÒÃÐ35
3. Tissue Diagnosis àÁ×èÍÊ§ÊÑÂÇèÒ¼Ùé»èÇÂà»ç¹âÃ¤ÁÐàÃç§ÅÓäÊéãËè¨Óà»ç¹µéÍ§ä´éÃÑº¡ÒÃÇÔ¹Ô¨
©ÑÂ·Õèá¹è¹Í¹´éÇÂ¡ÒÃµÃÇ¨·Ò§¾ÂÒ¸ÔÊÀÒ¾ «Öè§ÍÒ¨·Óä´éâ´ÂµÑ´ªÔé¹à¹×éÍ·ÕèÊ§ÊÑÂ¨Ò¡ÅÓäÊéãËè áÅÐ/ËÃ×Í¨Ò¡ºÃÔàÇ³ÃÍÂâÃ¤·Õèá¾Ãè¡ÃÐ¨ÒÂ àªè¹·Õè Left Supraclavicular Lymph Node ¢Öé¹¡Ñº¡ÒÃ¾Ô¨ÒÃ³Ò¤ÇÒÁàËÁÒÐÊÁã¹¼Ùé»èÇÂáµèÅÐÃÒÂ¡èÍ¹àÃÔèÁ¡ÒÃ Staging áÅÐ¡ÒÃÃÑ¡ÉÒ
4. Serum Tumor Markers ÁÕ Markers 3 ª¹Ô´·Õè·Óä´éã¹âÃ§¾ÂÒºÒÅ¨ØÌÒÅ§¡Ã³ì áÅÐÁÕ»ÃÐâÂª¹ìã¹¡ÒÃµÔ´µÒÁ¡ÒÃ¡ÅÑºà»ç¹«éÓ¢Í§âÃ¤ËÅÑ§¡ÒÃÃÑ¡ÉÒ áÅÐà¾×èÍµÃÇ¨´Ù¼Å¡ÒÃÃÑ¡ÉÒ (Monitoring of Therapy) »ÃÐ¡Íº´éÇÂ CEA36, CA19-937, áÅÐ CA5038
5. Metastatic Work-up ¡ÒÃ«Ñ¡»ÃÐÇÑµÔáÅÐµÃÇ¨ÃèÒ§¡ÒÂ¨ÐªèÇÂªÕéºè§¶Ö§ÃÐÂÐ¢Í§âÃ¤ä´é¤ÃèÒÇ æ ¶éÒÁÕÍÒ¡ÒÃ·Ò§¤ÅÕ¹Ô¤·Õè·ÓãËé¤Ô´¶Ö§ÃÍÂâÃ¤¢Í§¡ÒÃá¾Ãè¡ÃÐ¨ÒÂ ¤ÇÃµÃÇ¨à¾ÔèÁàµÔÁµÒÁ·ÕèÊ§ÊÑÂ àªè¹ µÃÇ¨¾ºÇèÒµÑºâµ¤ÇÃ·Ó Liver Function Test â´Âà©¾ÒÐ Alkaline Phosphatase áÅÐ
Ultrasonography ËÃ×Í CT/MRI ¢Í§µÑºà¾×èÍµÃÇ¨àªç¤ÇèÒ¼Ùé»èÇÂÁÕ Liver Metastasis ËÃ×ÍäÁè ã¹¡Ã³Õ·Õè¼Ùé»èÇÂÁÕÍÒ¡ÒÃ»Ç´¡ÃÐ´Ù¡áÅÐÁÕ¤èÒ Alkaline Phosphatase ÊÙ§¼Ô´»¡µÔ ¤ÇÃ¾Ô¨ÒÃ³Ò·Ó Bone X-ray ËÃ×Í Bone Scan ÃèÇÁ´éÇÂ ã¹¼Ùé»èÇÂ·Ø¡ÃÒÂ·ÕèäÁèÁÕÍÒ¡ÒÃ¤ÇÃ·Ó Liver Function Test â´Âà©¾ÒÐ
Alkaline Phosphatase áÅÐ Chest x-ray à¾×èÍµÃÇ¨´ÙÇèÒÁÕ¡ÒÃá¾Ãè¡ÃÐ¨ÒÂ¢Í§âÃ¤ÁÐàÃç§ä»·Õè»Í´áÅÐµÑº «Öè§à»ç¹µÓáË¹è§·Õè¾º Metastatic Disease ä´éºèÍÂ Abdominal and Pelvic CT Scan ÁÕ
»ÃÐâÂª¹ìã¹¡ÒÃÇÔ¹Ô¨©ÑÂáÅÐµÃÇ¨ËÒÃÐÂÐ¢Í§âÃ¤ â´Âà©¾ÒÐã¹ÃÒÂ¢Í§ÁÐàÃç§ÅÓäÊéãËèÊèÇ¹
Rectum

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Last modified on 25 October 1996