Efficacy of 3-Dimensional Endorectal Ultrasound for Staging Early Extraperitoneal Rectal Neoplasms

Pinto, Rodrigo Ambar; Neto, Iran Eduardo Lima; Nahas, Sérgio Carlos; Nahas, C.; Marques, Carlos Frederico Sparapan; Ribeiro, Ulysses; Kawaguti, Fábio S.; Cecconello, Ivan

doi:10.1097/dcr.0000000000000781

Cited by 5 publications

(8 citation statements)

References 37 publications

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“…The good outcomes in the ESD group were also associated with fact that the lesions in this group were staged using magnifying chromoendoscopy, while the lesions in the TEM group were staged by ERUS. ERUS is considered a good method for evaluating early rectal cancer and has been increasingly adopted, 26 but recent studies suggest that it might not be so precise, with accuracy ranging from 36% to 78% 27–30 . On the other hand, accuracy of magnifying chromoendoscopy for predicting depth of invasion of early colorectal cancer is reported to be higher than 80%, 31–36 reaching 96.4% in our experience 37 .…”

Section: Discussionmentioning

confidence: 57%

Long‐term outcomes of endoscopic submucosal dissection and transanal endoscopic microsurgery for the treatment of rectal tumors

Kimura

Kawaguti

Nahas

et al. 2020

J of Gastro and Hepatol

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Background and Aim Endoscopic submucosal dissection and transanal endoscopic microsurgery are good options for the treatment of rectal adenomas and early rectal carcinomas, but whether long‐term outcomes of these procedures are comparable is not known. The aim of this study was to address this question. Methods A retrospective single‐center study evaluating 98 consecutive procedures between June 2008 and December 2017 was performed in a tertiary cancer center. Consecutive patients who had undergone either endoscopic submucosal resection or transanal endoscopic microsurgery for rectal adenomas and early rectal carcinomas were evaluated, and long‐term recurrence and complication rates were compared. Results Both groups were similar regarding sex, age, preoperative surgical risk, and en bloc resection rate (95.7% in the endoscopic and 100% in the surgical group, P = 0.81). Mean follow‐up period was 37.6 months. Lesions resected endoscopically were significantly larger (68.5 mm) than those resected by transanal resection (44.5 mm), P = 0.003. Curative resections occurred in 97.2% of endoscopic resections and 85.2% of the surgical ones (P = 0.04). Comparing resections that fulfilled histologic curative criteria, there were no recurrences in the endoscopic group (out of 69 cases) and two recurrences in the transanal group (8.3% of 24 cases), P = 0.06. Late complications occurred in 12.7% of endoscopic procedures and 25.9% of surgical procedures (P = 0.13). Conclusions In our experience, endoscopic submucosal resection seems to have advantages over transanal endoscopic microsurgery, with similar en bloc resection rate and lower rate of late complications and recurrences. Multicenter randomized controlled trials are needed to support our findings.

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Section: Discussionmentioning

confidence: 57%

Long‐term outcomes of endoscopic submucosal dissection and transanal endoscopic microsurgery for the treatment of rectal tumors

Kimura

Kawaguti

Nahas

et al. 2020

J of Gastro and Hepatol

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“…A study showed that the sensitivity and specificity of ERUS were 57 and 80%, respectively, while the values of CT were 79 and 76%. 9 The 3D-ERUS can automatically capture and store high-resolution images of the rectal wall and cancer. [19][20][21] Thus, we used 3D-ERUS to evaluate lymph node metastasis.…”

Section: Discussionmentioning

confidence: 99%

“…The sensitivity and specificity of CT and ERUS were 79 and 76%, and 58 and 80%, respectively. 9 Therefore, meta-analyses and population data demonstrate that clinical nodal staging, even with the combination of ERUS, CT, and MRI, is unreliable. 10 Machine learning (ML) algorithms have been widely used in the medical field for outcome prediction, diagnosis, treatment management, and prognosis.…”

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confidence: 99%

Utility of Machine Learning Algorithms in Predicting Preoperative Lymph Node Metastasis in Patients With Rectal Cancer Based on Three‐Dimensional Endorectal Ultrasound and Clinical and Laboratory Data

Huang

Lin

et al. 2023

J of Ultrasound Medicine

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BackgroundWe aimed to investigate the value of a machine learning (ML) algorithm in the preoperative prediction of lymph node metastasis in patients with rectal cancer.MethodsBased on the histopathological results, 126 rectal cancer patients were divided into two groups: lymph node metastasis‐positive and metastasis‐negative groups. We collected clinical and laboratory data, three‐dimensional endorectal ultrasound (3D‐ERUS) findings, and parameters of the tumor for between‐group comparisons. We constructed a clinical prediction model based on the ML algorithm, which demonstrated the best diagnostic performance. Finally, we analyzed the diagnostic results and processes of the ML model.ResultsBetween the two groups, there were significant differences in serum carcinoembryonic antigen (CEA) levels, tumor length, tumor breadth, circumferential extent of the tumor, resistance index (RI), and ultrasound T‐stage (P < 0.05). The extreme gradient boosting (XGBoost) model had the best comprehensive diagnostic performance for predicting lymph node metastasis in patients with rectal cancer. Compared with experienced radiologists, the XGBoost model showed significantly higher diagnostic value in predicting lymph node metastasis; the area under curve (AUC) value of the receiver operating characteristic (ROC) curve of the XGBoost model and experienced radiologists was 0.82 and 0.60, respectively.ConclusionsPreoperative predictive utility in lymph node metastasis was demonstrated by the XGBoost model based on the 3D‐ERUS finding and related clinical information. This could be useful in guiding clinical decisions on the selection of different treatment strategies.

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“…The anatomical relationship between the rectum and surrounding tissues and organs was more clearly displayed as a five-layered rectal wall. In addition, the image could be viewed from different angles, which was convenient for preservation and repeated observations, and overcame the weakness of two-dimensional ultrasound of poor repeatability (25). It was reported in the literature that rectal 3D-TRUS had advantages over traditional two-dimensional ultrasound in determining the T and N stages of tumors, and the accuracy was higher, reaching 72%-95% (26)(27)(28)(29).…”

Section: Discussionmentioning

confidence: 99%

“…Postoperative pathological examination was performed on all of the surgical specimens. In the patients who underwent watchand-wait, 2 (6.9%) relapsed within 12 months, and the other 27 patients (93.1%) maintained a cCR status for a median of 32 [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] months.…”

Section: Baseline Characteristicsmentioning

confidence: 99%

Association Between Three-Dimensional Transrectal Ultrasound Findings and Tumor Response to Neoadjuvant Chemoradiotherapy in Locally Advanced Rectal Cancer: An Observational Study

et al. 2021

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BackgroundThere is a significant demand for the development of non-surgical methods for the evaluation of complete response to tumor therapy. Predicting ability and image quality of routine imaging has not been satisfactory. To avoid the deficiencies, we assessed the capability of three-dimensional transrectal ultrasound in predicting the response to neoadjuvant chemoradiotherapy in rectal cancer patients.MethodsThe inclusion criteria were patients with locally advanced rectal adenocarcinoma, receiving capecitabine-based neoadjuvant chemoradiotherapy, distance from anal verge (≤6 cm), clinical stage T3-4 and/or N+ without evidence of distant metastasis, and restaging ycT0-3a (T3a <5 mm) after the end of neoadjuvant chemoradiotherapy. Three-dimensional transrectal ultrasound was performed 7 weeks after neoadjuvant chemoradiotherapy to discern the patients with complete response from the others. Eight main parameters were obtained from three-dimensional transrectal ultrasound: thickness of muscularis on the residual side, thickness of contralateral muscularis, angle of residual arc, regularity of the shape, integrity of the mucosal layer, blurring of the margin, internal echo, and posterior echo. The association between tumor response and three-dimensional transrectal ultrasound parameters was analyzed, and a model was developed by logistic regression.ResultsBetween 2014 and 2019, 101 patients were recruited; 72 cases received total mesorectal excision, and 29 cases underwent watch-and-wait. Among the three-dimensional transrectal ultrasound parameters, the adjusted-thickness of the muscularis (P<0.01), angle of the residual arc (P<0.01), and regularity of the residual shape (P<0.01) were strongly associated with tumor response. In the dataset with total mesorectal excision cases (TME dataset), the residual adjusted-thickness (odds ratio [OR]=4.88, 95% confidence interval [CI]=1.44–16.6, P=0.01) and regularity of the residual shape (OR=5.00, 95% CI=1.13–22.2, P=0.03) were kept in the final logistic model. The area under the curve of the logistic model was 0.84. Among these parameters, residual adjusted-thickness correlated significantly with tumor response. Additionally, we observed similar results in the whole population of 101 cases (whole dataset) and in the cross-validation.ConclusionThree-dimensional transrectal ultrasound model is a valuable method for predicting tumor response in rectal cancer patients undergoing neoadjuvant chemoradiotherapy, which should be included as a factor for evaluating clinical complete response.Trial RegistrationThis trial was registered with ClinicalTrials.gov, number NCT02605265. Registered 9 November 2015 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/record/NCT02605265

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Efficacy of 3-Dimensional Endorectal Ultrasound for Staging Early Extraperitoneal Rectal Neoplasms

Abstract: Three-dimensional endorectal ultrasound was effective for determining rectal wall invasion and lesion extension in tumors <5 cm and with <50% of rectal wall invasion but was limited for detecting lymph node involvement in early rectal lesions.

Cited by 5 publications

References 37 publications

Long‐term outcomes of endoscopic submucosal dissection and transanal endoscopic microsurgery for the treatment of rectal tumors

Long‐term outcomes of endoscopic submucosal dissection and transanal endoscopic microsurgery for the treatment of rectal tumors

Utility of Machine Learning Algorithms in Predicting Preoperative Lymph Node Metastasis in Patients With Rectal Cancer Based on Three‐Dimensional Endorectal Ultrasound and Clinical and Laboratory Data

Association Between Three-Dimensional Transrectal Ultrasound Findings and Tumor Response to Neoadjuvant Chemoradiotherapy in Locally Advanced Rectal Cancer: An Observational Study

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