Endorectal ultrasound in the preoperative staging of rectal tumors

Orrom, W. J.; Wong, W. Douglas; Rothenberger, David A.; Jensen, Linda L.; Goldberg, Stanley M.

doi:10.1007/bf02150740

Cited by 239 publications

(97 citation statements)

References 24 publications

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“…One of the most essential prerequisites for applying local excision for curative surgery in patients with rectal carcinoma is excluding those cases that have regional lymph node metastases. Endorectal ultrasound is the most widely used modality for this purpose, but its accuracy for the evaluation of regional lymph node metastases is known to be only 64～88% (24,25). From this standpoint, evaluating the intensity of tumor budding may be a useful surrogate marker to determine if an additional radical resection is indicated for the cases where the surgical specimens are not available for determining the nodal status, such as for locally excised rectal carcinomas.…”

Section: Discussionmentioning

confidence: 99%

Intensity of Tumor Budding as an Index for the Malignant Potential in Invasive Rectal Carcinoma

Choi

Park

et al. 2005

Cancer Res Treat

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Purpose: The aim of this study was to quantitatively assess the intensity of tumor budding in rectal carcinoma and to determine how it correlates with the malignant potential.Materials and Methods: Intensities of the tumor budding at the invasive front of the surgical specimens from 90 patients (male, 51) with well-or moderately-differentiated rectal carcinoma were investigated. Differences in the budding intensity among pathologic variables were compared, and recurrences and survivals were analyzed in accordance with degree of the budding intensity. The patients ranged in age from 33 to 75 years (mean, 55.4) with the median follow-up being 43 months (range, 12～ 108).Results: Tumor budding was identified in 89 patients (98.9%) with a mean intensity of 7.5±5.3. The budding intensity was significantly higher in tumors with lymphatic invasion (p=0.0081), blood vessel invasion (p＜ 0.0001), and perineural invasion (p=0.0013) than in those tumor without these findings. It became significantly higher with the increase in nodal stage (p＜0.0001). The intensity of tumor budding in patients with relapse (29 patients) was significantly higher than that in patients without relapse (6.2±5.0 vs. 10.2±4.9; p=0.0005), but this difference in the intensity was observed only for the node-positive patients (8.0±3.4 vs. 11.9±5.1; p=0.0064). W hen the patients were stratified into two groups on either side of the mean of the intensity, the higher intensity group showed a significantly less favorable diseasefree (DFS) and overall survival (OS) (p=0.0026 and 0.0205, respectively). Based on the multivariate analysis, the nodal stage and the intensity of budding proved to be the independent variables associated with DFS (p=0.023 and 0.03, respectively).Conclusion: Tumor budding at the invasive margin is a reliable pathologic index that indicates a higher malignant potential and a less favorable prognosis for patients with advanced rectal carcinoma. (Cancer Res Treat. 2005; 37:177-182)

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Section: Discussionmentioning

confidence: 99%

Intensity of Tumor Budding as an Index for the Malignant Potential in Invasive Rectal Carcinoma

Choi

Park

et al. 2005

Cancer Res Treat

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“…Due to inaccurate staging by clinical examination, several imaging methods have been proposed that use computed tomography (CT), transrectal ultrasonography (TRUS), or, more recently, magnetic resonance imaging (MRI) with transrectal coils. Despite several articles reporting TRUS as the most accurate imaging method for the local staging of rectal tumors [2][3][4], a recent article [5] reported a trend toward overstaging the degree of tumor penetration within the bowel wall. The reported accuracy of CT has been variable, depending on patient selection (early or advanced neoplasia) and, most importantly, on the technical conditions of the examination (presence or absence of rectal distention) [6][7][8][9][10][11].…”

mentioning

confidence: 99%

Water enema computed tomography (WE-CT) in the local staging of low colorectal neoplasms: comparison with transrectal ultrasound

et al. 1998

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Background: To determine the accuracy of computed tomography performed with a water enema application (WE-CT) in the local staging of low colorectal neoplasms and to compare the results with those of transrectal ultrasonography (TRUS). Methods: Forty patients with low colorectal tumors were evaluated prospectively by CT with the simultaneous administration of a lukewarm rectal enema (0.5-1.5 L). Thin slices (5 mm) and intravenous application of iodinated contrast media were routinely used. TRUS was performed in 18 patients. Tumor size, location, and staging according to the TNM classification of the UICC were registered. Tumors were classified as õT3 (T1 or T2) or as T3 or T4. For staging peritumoral lymph node metastases on WE-CT, two criteria of positivity were tested: N/ if at least one peritumoral node ¢5 mm in diameter was seen (reading A); N/ if at least one peritumoral node ¢5 mm or three peritumoral nodes õ5 mm were identified (reading B). Results: For the tumor staging, WE-CT showed a sensitivity of 90%, a specificity of 73%, a positive predictive value (PPV) of 90%, a negative predictive value (NPV) of 73%, and an accuracy of 85%. For TRUS, the results were sensitivity of 73%, specificity of 29%, PPV of 62%, NPV of 40%, and an accuracy of 39%. Concerning nodal staging with WE-CT, results were superior when reading A was used: sensitivity Å 84%, specificity Å 83%, PPV Å 73%, NPV Å 91%, and accuracy Å 84%. TRUS showed a sensitivity of 29%, specificity of 100%, PPV of 100%, NPV of 67%, and an accuracy of 71%.Correspondence to: F. Caseiro-Alves Conclusion: WE-CT is a reliable technique for the local staging of low colorectal tumors that can be superior to TRUS. For diagnosis of peritumoral metastatic lymph nodes on WE-CT, the 5-mm diameter cutoff value is the most appropriate size criterion.

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“…The entire rectal wall thickness was increased in 13 patients with a mean (SEM) of5.7 (0.4) mm for the 15 patients and a maximal thickness of 8.0 mm. In all these patients the muscularis propria was enlarged, in eight ofthem the mucosal layer was enlarged too.…”

Section: Rectal Wall Thicknessmentioning

confidence: 96%

Transrectal ultrasound study of the pathogenesis of solitary rectal ulcer syndrome.

Outryve

Pelckmans

Fierens

et al. 1993

Gut

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Transrectal ultrasonography is ofclinical value in anorectal carcinoma and in inflammatory diseases of the anorectum. In this study a rigid linear endorectal probe was used to examine 15 patients with endoscopically and biopsy proved diagnosis of solitary rectal ulcer syndrome. In 13 of the 15 patients the rectal wall was thicker (mean (SEM) 5.7 (0.4) mm; normal values: 2-8 (0.1) mm) near the rectal ulcer. In all these cases the muscularis propia layer exceeded the maximum normal diameter of 2 mm. In nine of the 15 patients the normal rectal wail echostructure, with five distinct layers, was disturbed and there was fading of the borders between the mucosa and the muscularis propria. Poor relaxation ofthe puborectalis muscle during straining was seen on ultrasound in 11 patients, as was intussusception of the rectal wall. The obvious enlargement of the muscularis propria points to a chronic mechanical load on the rectal wail. The ulcerative lesions are formed in this area of overloaded rectal wail. The direct visualisation ofthe puborectalis muscle during dynamic transrectal ultrasonography indicates that the fact that it does not relax is an important element in the pathogenesis of solitary rectal ulcer syndrome.

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Endorectal ultrasound in the preoperative staging of rectal tumors

Cited by 239 publications

References 24 publications

Intensity of Tumor Budding as an Index for the Malignant Potential in Invasive Rectal Carcinoma

Intensity of Tumor Budding as an Index for the Malignant Potential in Invasive Rectal Carcinoma

Water enema computed tomography (WE-CT) in the local staging of low colorectal neoplasms: comparison with transrectal ultrasound

Transrectal ultrasound study of the pathogenesis of solitary rectal ulcer syndrome.

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