The role of EUS and MRI in rectal cancer staging

Rovera, Francesca; Dionigi, Gianlorenzo; Boni, Luigi; Cutaia, Sofia; Diurni, Mario; Dionigi, Renzo

doi:10.1016/j.suronc.2007.10.038

Cited by 20 publications

(21 citation statements)

References 14 publications

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“…18 The different results of these studies may have been related to many factors, such as the number of cases, operator experience, nontraversable stenoses caused by tumors, postbiopsy peritumoral inflammation, hemorrhage, microscopic tumor infiltration, and pathologic techniques. [19][20][21][22] Our study showed overall T-staging accuracy of 86.5% and overall N-staging accuracy of 77.8%.…”

Section: Discussionsupporting

confidence: 49%

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: Discussionsupporting

confidence: 49%

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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“…It cannot be placed in stenosing cancers and may not reach the tumors in the upper rectum or sigmoid colon. The evaluation of the mesorectal fascia and lymph nodes outside the mesorectum is limited because endorectal coil provides adequate signal-to-noise only within 3 cm around the coil (18). Pelvic phased-array coils provide evaluation of the entire pelvis, but its spatial resolution may not be sufficient to differentiate rectal wall layers or identify extension of early cancers into the mesorectal fat, and its use may be limited in low-lying rectal cancers and obese patients (19).…”

Section: Mri Protocolmentioning

confidence: 99%

MRI in local staging of rectal cancer: an update

Tapan

Ozbayrak²,

Tatlı³

2014

Diagn Interv Radiol

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Preoperative imaging for staging of rectal cancer has become an important aspect of current approach to rectal cancer management, because it helps to select suitable patients for neoadjuvant chemoradiotherapy and determine the appropriate surgical technique. Imaging modalities such as endoscopic ultrasonography, computed tomography, and magnetic resonance imaging (MRI) play an important role in assessing the depth of tumor penetration, lymph node involvement, mesorectal fascia and anal sphincter invasion, and presence of distant metastatic diseases. Currently, there is no consensus on a preferred imaging technique for preoperative staging of rectal cancer. However, high-resolution phased-array MRI is recommended as a standard imaging modality for preoperative local staging of rectal cancer, with excellent soft tissue contrast, multiplanar capability, and absence of ionizing radiation. This review will mainly focus on the role of MRI in preoperative local staging of rectal cancer and discuss recent advancements in MRI technique such as diffusion-weighted imaging and dynamic contrast-enhanced MRI. Colorectal cancer is the second most common cancer in women and the third most common cancer in men with 570 100 and 663 600 estimated new cases per year worldwide, respectively (1). Rectal cancer accounts for approximately 42% of colorectal cancers with 45 000 estimated new cases per year in the United States (2). Prognosis of rectal cancer is determined by depth of invasion, number of involved lymph nodes, and involvement of circumferential resection margin. Management of rectal cancer has evolved over the years with preoperative imaging playing an increasingly prominent role. Initial strategy of clinical diagnosis followed by surgery and postoperative chemotherapy had a high local recurrence rate (27%) and poor survival (48% 5-year survival) (3). Later studies showed that neoadjuvant chemoradiation improves survival and decreases local recurrence rates significantly (4). In addition, it reduces tumor size, facilitates curative resection (5), and may enable sphincter sparing surgery in cancers close to the anorectal junction (6). Neoadjuvant chemoradiotherapy is not indicated in stage I tumors (confined to rectal wall with no nodal involvement), but is recommended for stage II (extends beyond the rectal wall, no nodal involvement) and stage III tumors (regional lymph node involvement). Therefore, in order to avoid unnecessary chemoradiation in stage I cancers, a reliable imaging modality is crucial to precisely define depth of invasion and to identify lymph node involvement (7). Current approach in the management of rectal cancer includes preoperative staging with different imaging modalities followed by neoadjuvant chemoradiotherapy (for stage II/III cancers). This approach has lowered the local recurrence rate (11%) and improved survival (58% 5-year survival) (3).Preoperative imaging for rectal cancer staging is also useful to determine which surgical technique would be more appropriate: recently-developed lo...

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“…After RT-CT, EUS and MRI might be useful to demonstrate tumor shrinkage and down-staging in responsive tumors, which might occasionally disappear completely [17,18,[20][21][22][23] . Increasing reflectivity and signal changes indicate fibrosis, but unless significant tumor bulk remains, neither modality seems to be able to exclude the persistence of tumor cells within fibrosis [24][25][26][27][28] . Finally, EUS-FNA (endoscopic ultrasound-guided fine-needle aspiration) was proposed for N staging of rectal cancer following neoadjuvant chemoradiation [29] .…”

Section: Mezzi G Et Al Eus and Mri In Rectal Cancermentioning

confidence: 99%

Endoscopic ultrasound and magnetic resonance imaging forre-staging rectal cancer after radiotherapy

Mezzi¹,

Arcidiacono²,

Carrara³

et al. 2009

WJG

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AIM:To compare the sensitivity and specificity of two imaging techniques, endoscopic ultrasound (EUS) and magnetic resonance imaging (MRI), in patients with rectal cancer after neoadjuvant chemoradiation therapy. And we compared EUS and MRI data with histological findings from surgical specimens. METHODS:Thirty-nine consecutive patients (51.3% Male; mean age: 68.2 ± 8.9 years) with histologically confirmed distal rectal cancer were examined for staging. All patients underwent EUS and MRI imaging before and after neoadjuvant chemoradiation therapy. RESULTS:After neoadjuvant chemoradiation, EUS and MRI correctly classified 46% (18/39) and 44% (17/39) of patients, respectively, in line with their histological T stage (P > 0.05). These proportions were higher for both techniques when nodal involvement was considered: 69% (27/39) and 62% (24/39). When patients were sorted into T and N subgroups, the diagnostic accuracy of EUS was better than MRI for patients with T0-T2 (44% vs 33%, P > 0.05) and N0 disease (87% vs 52%, P = 0.013). However, MRI was more accurate than EUS in T and N staging for patients with more advanced disease after radiotherapy, though these differences did not reach statistical significance.CONCLUSION: EUS and MRI are accurate imaging techniques for staging rectal cancer. However, after neoadjuvant RT-CT, the role of both methods in the assessment of residual rectal tumors remains uncertain.

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The role of EUS and MRI in rectal cancer staging

Cited by 20 publications

References 14 publications

Application of Endoscopic Sonography in Preoperative Staging of Rectal Cancer

Application of Endoscopic Sonography in Preoperative Staging of Rectal Cancer

MRI in local staging of rectal cancer: an update

Endoscopic ultrasound and magnetic resonance imaging forre-staging rectal cancer after radiotherapy

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