Accuracy of Endoscopic Ultrasound to Diagnose Nodal Invasion by Rectal Cancers: A Meta-Analysis and Systematic Review

Puli, Srinivas R.; Reddy, Jyotsna Batapati Krishna; Bechtold, Matthew L.; Choudhary, Abhishek; Antillon, Mainor R.; Brugge, William R.

doi:10.1245/s10434-009-0337-4

Cited by 139 publications

(70 citation statements)

References 69 publications

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“…It could explain why the results of radiological imaging in this field are somewhat disappointing. 24 When comparing radiological and histopathological measurements, one has to keep in mind that lymph nodes are prone to shrink during the histological processing. Based on our observations, we estimate this effect to be in the range of about 10%.…”

Section: Discussionmentioning

confidence: 99%

“…[19][20][21][22][23] This might explain the relatively disappointing results of diagnosis based on radiological lymph node status assignment, which is mainly dependent upon lymph node size. 24 Moreover, one could hypothesize that lymphatic hyperplasia in colon cancer could be a prognostic marker indicating an especially effective immunological response against the cancer. [25][26][27][28] As large lymph nodes are easier to find, this could be an alternative explanation for the phenomenon that high lymph node counts are associated with a favorable outcome in stage II and even in stage III colon cancer.…”

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confidence: 99%

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The clinical significance of lymph node size in colon cancer

et al. 2012

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To date, the clinical value of lymph node size in colon cancer has been investigated only in a few studies. Only in radiological diagnosis is lymph node size routinely recognized, and nodes Z10 mm in diameter are considered pathologic. However, the few studies regarding this topic suggest that lymph node size is not a reliable indicator of metastatic disease. Moreover, we hypothesized that increasing lymph node size is associated with favorable outcome. By performing a morphometric study, we investigated the clinical significance of lymph node size in colon cancer in terms of metastatic disease and prognosis. A cohort of 237 cases with excellent lymph node harvest (mean lymph node count: 33±17) was used. The size distribution in node-positive and -negative cases was almost identical. In all, 151 out of the 305 metastases detected (49.5%) were found in lymph nodes with diameters r5 mm. Only 25% of lymph nodes 410 mm showed metastases. Minute lymph nodes r1 mm were involved only very rarely (2 of 81 cases). In 67% of the cases, the largest positive lymph node was o10 mm. The prognostic relevance of lymph node size was investigated in a subset of 115 stage I/II cases. The occurrence of Z7 lymph nodes that were 45 mm in diameter was significantly associated with better overall survival. Our data show that lymph node size is not a suitable factor for preoperative lymph node staging. Minute lymph nodes have virtually no role in correct histopathological lymph node staging. Finally, large lymph nodes in stage I/II disease might indicate a favorable outcome.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

The clinical significance of lymph node size in colon cancer

et al. 2012

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“…Die hohe Sensitivität und Spezifität der Endosonografie konnte in einer neueren Metaanalyse bestätigt werden [687]. Das MRT mit endorektaler Spule stellt eine mögliche Alternative zum EUS dar, ist aber mit höheren Kosten verbunden und wird von den Patienten als unangenehm empfunden und ist an sehr wenigen Standorten etabliert.…”

Section: Level Of Evidence 2bunclassified

“…Bei der Beurteilung der Lymphknoten sind Sensitivität (55 -73 %) und Spezifität (74 -78 %) aller Verfahren derzeit unbefriedigend [686,687]. Dies ist u. a. dadurch bedingt, dass einerseits eine reaktive Lymphknotenvergrößerung auftritt, andererseits auch Lymphknoten von 5 mm und kleiner Metastasen enthalten können.…”

Section: Level Of Evidence 2bunclassified

S3-Leitlinie – Kolorektales Karzinom

Schmiegel

Buchberger

Follmann³

et al. 2017

Z Gastroenterol

131

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“…Clinical exam and radiologic studies provide important but imperfect data. Meta-analysis of endorectal ultrasound found a sensitivity and specificity of 73.2 and 75.8 % for lymph node involvement 36 and 87.8 and 97.8 %, respectively, for staging T1 tumors. 37 MRI specificity was 75 % for tumor stage and 71 % for lymph node involvement.…”

Section: Patient Selectionmentioning

confidence: 99%

Sphincter-Sparing Surgery in Patients with Low-Lying Rectal Cancer: Techniques, Oncologic Outcomes, and Functional Results

Bordeianou

Maguire

Alavi

et al. 2014

Journal of Gastrointestinal Surgery

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Background Rectal cancer management has evolved into a complex multimodality approach with survival, local recurrence, and quality of life parameters being the relevant endpoints. Surgical treatment for low rectal cancer has changed dramatically over the past 100 years. Discussion Abdominoperineal resection, once the standard of care for all rectal cancers, has become much less frequently utilized as surgeons devise and test new techniques for preserving the sphincters, maintaining continuity, and performing oncologically sound ultra-low anterior or local resections. Progress in rectal cancer surgery has been driven by improved understanding of the anatomy and pathophysiology of the disease, innovative surgical technique, improved technology, multimodality approaches, and increased appreciation of the patient's quality of life. The patient with a low rectal cancer, once almost universally destined for impotence and a colostomy, now has the real potential for improved survival, avoidance of a permanent stoma, and preservation of the normal route of defecation.Keywords Rectal cancer . Sphincter preservation . Total mesorectal excision . Anterior resection . Intersphincteric resection . Local excision rectal cancer Historical BackgroundThe modern era of rectal cancer surgery began with the description of the abdominoperineal resection (APR) by Miles in 1908. Prior perineal and sacral approaches (e.g., Kraske approach) to rectal cancer resection produced high rates of complications, cancer recurrence, poor quality of life (QOL), and poor overall survival. Miles' operation reflected greater understanding of the natural history of rectal cancer that was based on postmortem examination of his patients after perineal resection. He observed cancerous implants in the pelvic peritoneum, mesorectum, and affected nodes of the left common iliac bifurcation. These findings led him to develop a "cylindrical concept" of the spread of rectal cancer to upward, downward, and lateral zones. 1 The original operation included resection of the rectum, sigmoid, mesorectum, nodes of the iliac bifurcation, and a perineal component to include the anus and levator ani muscles. Postoperative mortality was high initially, but local recurrence decreased

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Accuracy of Endoscopic Ultrasound to Diagnose Nodal Invasion by Rectal Cancers: A Meta-Analysis and Systematic Review

Cited by 139 publications

References 69 publications

The clinical significance of lymph node size in colon cancer

The clinical significance of lymph node size in colon cancer

S3-Leitlinie – Kolorektales Karzinom

Sphincter-Sparing Surgery in Patients with Low-Lying Rectal Cancer: Techniques, Oncologic Outcomes, and Functional Results

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