Rectal ultrasound with fine needle aspiration: an underutilized modality for delineating and diagnosing perirectal, presacral, and pelvic lesions

Abstract

Background and study aims The merits of rectal ultrasound for rectal cancer staging are well documented. Conventional approaches to accessing perirectal and presacral lesions entail computed tomography guidance via a transgluteal approach or frank surgical exploration. We report on the safety and efficacy of performing rectal ultrasound with fine-needle aspiration (RUS-FNA) for evaluating perirectal, presacral, and pelvic abnormalities. Patients and methods Patients who underwent RUS-FNA of perirectal, presacral, or pelvic lesions between August 2005 and September 2016 were identified using an institutional database. Subjects were all individuals treated at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina, United States. Patient demographics and imaging characteristics were noted. Procedural details included lesion size, location, echo appearance, and technical information. Patients were given antibiotics prior to FNA attempt and for 3 days after. Diagnostic yield, clinical utility, and complications were noted. Results Twenty-seven patients met criteria during the specified study time period. The cohort consisted of 12 males (44.4 %) and 15 females (55.5 %). RUS-FNA was diagnostic in 24 patients (88.8 %) and obviated the need for surgery in 14 patients (51.9 %). There were four complications (14.8 %): two perirectal and two presacral abscesses. Conclusion While the diagnostic yield of RUS-FNA is high and the potential to affect clinical decision-making is substantial, risk of complication is not negligible. RUS-FNA should only be performed if the result will substantially alter clinical management, and the decision to perform RUS-FNA should be made with close consultation between the endosonographer, surgeon, and/or medical or radiation oncologist.

Risk of adverse events associated with upper and lower endoscopic ultrasound: a population-based cohort study

“…Data on lower EUS for rectal and pelvic lesions are scant. Among the few studies that have reported on lower EUS adverse events, risks have been as high as 15 %–21 % 11 12 . Many participants, however, underwent other procedures concurrently with their lower EUS with fine-needle aspiration (FNA), including colonoscopy and polypectomy 11 .…”

Intrapelvic Intestinal Leiomyoma in a Dog - Diagnostic and Therapeutic Challenges

“…Ainda que, a PAAF intra-retal seja pouco descrita em pequenos animais, e alguns autores afirmam que a citologia apresenta limitações para diagnóstico de tumores retais caninos [14], neste caso auxiliou na diferenciação da neoplasia enaltecendo sua aplicabilidade, mostrando-se de grande importância para o diagnóstico presuntivo e planejamento cirúrgico [15,17,20]. Em humanos, é reportado a utilização de PAAF guiada por UTR para coleta de amostras de massas de localização IP, sendo considerada ferramenta segura, precisa e útil para tomada de decisões, fornecendo diagnóstico eficaz em até 88% dos pacientes [5]. Em consonância, foi relatado a utilização de PAAF em cães com massas retais, e 4/5 exames foram consistentes com o diagnóstico definitivo [15].…”

“…Para a UTR, o animal foi submetido à medicação pré-anestésica [0,3 mg/kg IM de morfina (Dimorf @ ) 3 e 0,4 mg/kg IM de midazolam (Dormonid @ ) 4 ] e indução anestésica [4 mg/kg IV de propofol (Propovan @ ) 3 ]. A paciente foi mantida em plano anestésico [isoflurano (Isoforine @ ) 3 vaporizado em oxigênio à 100%] e fluidoterapia [ringer lactato 10 mL/kg/h IV], além de antibioticoprofilaxia [com 30 mg/kg IV de cefalotina sódica (Cefalotina sódica @ ) 5 ].…”