Assessment of the accuracy of transrectal ultrasonography in anorectal neoplasia

Mackay, Sarah; Pager, Chet K.; Joseph, David; Stewart, Peter; Solomon, Michael J.

doi:10.1002/bjs.4042

Cited by 97 publications

(53 citation statements)

References 19 publications

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“…6,22 Some authors suggested that any visible perirectal lymph node should be considered metastatic. 13,30,31 This strategy may lead to a false-positive diagnosis of reactive lymph nodes, which eventually may cause overstaging. Therefore, better-defined criteria for sonographic N staging of rectal cancer are needed.…”

Section: Discussionmentioning

confidence: 99%

Application of Endoscopic Sonography in Preoperative Staging of Rectal Cancer

Lin

Luo

Gao

et al. 2011

Journal of Ultrasound in Medicine

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Six-Year Experience n recent years, the development of new surgical techniques and use of neoadjuvant therapy have modified the management and improved the prognosis of rectal cancer. The selection of suitable treatment strategies for rectal cancer is based on accurate staging of the lesions. Several methods have been reported for imaging rectal cancer, such as sonography, computed tomography, magnetic resonance imaging (MRI), and positron emission tomography/computed tomography. [1][2][3][4][5][6][7][8][9][10][11][12] Computed tomography and MRI have advantages of imaging distant metastases (M staging), but for locoregional invasion imaging (T and N staging), endoscopic sonography may be a better choice, especially for assessing the invasive depth of a lesion (T staging). Several studies have shown good accuracy for endoscopic sonography in rectal cancer staging. 3,4,7,8,13 These studies showed that the overall accuracy of T staging fluctuated from 72% to 90%, and the overall accuracy of N staging ranged from 69% to 80%.Shiyong Lin, PhD, Guangyu Luo, MD, Xiaoyan Gao, Hongbo Shan, MD, Yin Li, MD, Rong Zhang, MD, Jianjun Li, MD, Longjun He, PhD, Guobao Wang, PhD, Guoliang Xu, MD Received January 20, 2011, ORIGINAL RESEARCHObjectives-The aim of this study was to evaluate our experience with the application of endoscopic sonography in preoperative staging of rectal cancer. April 2004 and May 2010, 192 patients with rectal cancer first underwent endoscopic sonography and then underwent surgery at our hospital. None of the patients in this study received neoadjuvant therapy. The endoscopic sonographic staging results were compared with those of postoperative pathologic staging. Methods-BetweenResults-The accuracy of overall T staging was 86.5%, and for T1, T2, T3, and T4, the accuracy rates were 86.7%, 94.0%, 86.2%, and 65.5%, respectively. The accuracy of T staging for ulcerated lesions was significantly lower than that for nonulcerated lesions (P = .013). The accuracy of T staging between nontraversable stenotic lesions and traversable lesions was also significantly different (P = .002). The accuracy of N staging was 77.8%, and the specificity and sensitivity were 85.6% and 74.2%, respectively.Conclusions-Endoscopic sonography is safe and effective for preoperative staging of rectal cancer and should be a routine examination before surgery. As for ulcerated and nontraversable stenotic lesions, however, the results of endoscopic sonographic staging could be doubtful. Moreover, the accuracy of endoscopic sonographic N staging still needs modification by further research.

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Section: Discussionmentioning

confidence: 99%

Application of Endoscopic Sonography in Preoperative Staging of Rectal Cancer

Lin

Luo

Gao

et al. 2011

Journal of Ultrasound in Medicine

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“…A potential pitfall is overstaging of the tumor. Peritumoral inflammation, hemorrhage, and desmoplastic changes can potentially affect accuracy and result in tumor overstaging [38]. …”

Section: Discussionmentioning

confidence: 99%

Endorectal Ultrasound-Guided Fine-Needle Aspiration: A Useful Diagnostic Tool for Perirectal and Intraluminal Lesions

et al. 2012

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Objectives: Endorectal endoscopic ultrasound (ERUS) allows highly detailed assessment of the rectal wall layers and visualization of the extraluminal structures. Herein, we study the utility of ERUS fine-needle aspiration (FNA) to evaluate perirectal lesions. Study Design: Forty-nine ERUS-FNAs were retrieved from the cytopathology archives of The Johns Hopkins Hospital. The cytology slides, corresponding histology, immunohistochemistry when available, and clinical data were reviewed. Results: The aspirated material showed malignant (n = 24), benign (n = 19), atypical (n = 3), carcinoid tumor (n = 1), and nondiagnostic conditions (n = 2). The past medical history of 36 cases was significant for carcinomas. The primary site of the tumors included colorectal, urinary bladder, prostate, pancreas, gallbladder, ovary, and female lower genital tract. Statistical analysis for endoscopic ultrasonography FNA showed 87% sensitivity, 100% specificity, diagnostic accuracy of 90%, and a positive predictive value of 100% and a negative predictive value of 77%. Conclusion: ERUS-FNA can be utilized for: (1) accurate staging of colorectal adenocarcinomas by evaluation of nodal metastasis, depth of transmural tumor invasion and local tumor spread to perirectal fat, (2) prevention of aggressive surgical intervention in benign conditions, (3) providing diagnostic material for ancillary studies, and (4) evaluation of perirectal lesions with a more accurate method by combining imaging and histology.

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“…Moreover, efficacy increases when three-dimensional (3D) EUS software is used (5). The accuracy of EUS in assessing depth of invasion into the rectal wall has been found to vary with tumor stage, with higher accuracy in early (T1) and advanced (T3-T4) lesions than in T2 lesions (16,17).…”

Section: Discussionmentioning

confidence: 99%