Modified Wong's Classification Improves the Accuracy of Rectal Cancer Staging by Endorectal Ultrasound and MRI

Muñoz, Elena; Granero-Castro, Pablo; Frasson, Matteo; Escartín, Jorge; Esclapez, Pedro; Campos, Salvador; Flor-Lorente, Blas; García‐Granero, Eduardo

doi:10.1097/dcr.0b013e3182a69a3b

Cited by 11 publications

(10 citation statements)

References 28 publications

(27 reference statements)

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“…In another study, good agreement was found between ultrasound and MRI in classifying extramural spread into early and advanced using a cut‐off of 5 mm . More recently a maximum tumour thickness with a cut‐off of 19 mm, detected by ultrasound, has been suggested as a more realistic prognostic parameter than the measurement of the radial extension into the mesorectal fat . Owing to the limitation of ultrasound in imaging tissue lying 10 mm or more beyond the rectal wall, it is mostly used in the assessment of early tumours for local treatment.…”

Section: Resultsmentioning

confidence: 99%

The degree of extramural spread of T3 rectal cancer: an appeal to the American Joint Committee on Cancer

et al. 2017

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The T3 category of the TNM classification includes over 60% of all rectal tumours and encompasses the greatest variance in cancer-specific end-points than any other T category. The most recent edition of the cancer staging handbook of the American Joint Committee on Cancer (AJCC) dated 2010 does not divide T3 tumours into subgroups which reflect cancer-specific outcome more sensitively. The original aim of the present study was to review the literature to assess the influence of the degree of extramural extent of T3 rectal cancer on local recurrence and survival. An article written by the authors was accepted for publication but was withdrawn immediately after they became aware of the publication of the 4th edition of the TNM Supplement by the Union for International Cancer Control dated 2012, which was not accessible by the search system used. This article dealt with the subdivision of the T3 category although this was not included in the most up-to-date AJCC guidelines and was stated to be 'entirely optional'. Medline, PubMed and Cochrane Library searches were performed to identify all studies that investigated the degree of extramural spread and its relationship to survival and local recurrence. Twenty-two studies were identified of which 12 assessed the degree of histopathological extramural spread measured in millimetres. In 18 of the 22 studies the degree of extramural spread was a statistically significant prognostic factor for survival and local recurrence. Analysis of the studies indicated that the subdivision of category T3 rectal cancer into two subgroups of extramural spread ≤ 5 mm or more than 5 mm resulted in markedly different survival and local recurrence rates. The data were insufficient to allow validation of any greater subdivision. Measurement of the extent of extramural spread by MRI before any treatment agreed with the histopathological measurement in the surgical specimen to within 1 mm. The extent of extramural spread in T3 rectal cancer measured in millimetres is a powerful prognostic factor. A subdivision of T3 into T3a and T3b of less than or equal to or more than 5 mm appears to give the greatest discrimination of local recurrence and survival. Preoperative T3 subdivision by MRI has the same sensitivity as histopathological examination of the resected specimen. Given the clinical need for the pretreatment classification of the T3 category for oncological management planning, the evidence strongly indicates that the subdivision of the T3 category by MRI should be formally considered as part of the TNM staging system for rectal cancer.

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Section: Resultsmentioning

confidence: 99%

The degree of extramural spread of T3 rectal cancer: an appeal to the American Joint Committee on Cancer

et al. 2017

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“…Kocaman et al [32] found overstaging in overall 8/50 cases, with 4/15 patients staged from T2 to T3/4 (26.7%). In a prospective study comparing standard local TN classification and a modified Wong's classification, MRI overstaging was revealed to be therapy-relevant in 16/42 cases (38%) [33]. The N category was not evaluated.…”

Section: Discussionmentioning

confidence: 99%

Overstaging: A Challenge in Rectal Cancer Treatment

et al. 2018

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Background: Preoperative staging, including computed tomography (CT), magnetic resonance imaging (MRI), and endoscopic ultrasound (EUS), is decisive to envisage the therapeutic concept for rectal cancer (RC). Overstaging may subject the patient to neoadjuvant therapy that does not improve survival but may lead to therapy-associated morbidity. Methods: This study retrospectively compares and values EUS, CT, and MRI in Union Internationale Contre le Cancer (UICC) stage I-III RC with a focus on overstaging. RC patients receiving primary operation only at the University Clinic Ulm were analyzed. The therapeutic relevance of preoperative staging was determined by comparison with postoperative pathological workup. Results: 244 examinations in 184 RC patients (EUS: n = 63, CT: n = 143, MRI: n = 38) revealed therapy-relevant overstaging into the T3/4 category in 10 (16%) EUS, 18 (13%) CT, and 10 (26%) MRI cases. Patients were upgraded to the N+ category in 13 (21%) EUS, 29 (20%) CT, and 11 (29%) MRI cases. As a result, UICC stages II and III turned out to be overstaged in 13 (21%) EUS, 18 (13%) CT, and 10 (26%) MRI cases. Conclusion: More than 10% therapy-relevant overstaging by any method represents a major challenge for modern RC therapy. Physicians should scrupulously consider this fact in their treatment considerations to avoid overtreatment.

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“…[5][6][7][8] this explains the oncologic inferiority of le, with local recurrence as the most common pattern of failure, ranging from 20% to 30% as reported by several authors. the accuracy of endorectal ultrasound (eRus) and/or mRi is 60% to 80% at its best, with an inability to find lymph nodes <5 mm in size, which have the potential to harbor metastasis.…”

Section: Outcomes Of Salvage Surgery For Cure In Patients With Locallmentioning

confidence: 99%

Outcomes of Salvage Surgery for Cure in Patients With Locally Recurrent Disease After Local Excision of Rectal Cancer

Bikhchandani

Ong

Dozois

et al. 2015

Diseases of the Colon &Amp; Rectum

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Modified Wong's Classification Improves the Accuracy of Rectal Cancer Staging by Endorectal Ultrasound and MRI

Cited by 11 publications

References 28 publications

The degree of extramural spread of T3 rectal cancer: an appeal to the American Joint Committee on Cancer

The degree of extramural spread of T3 rectal cancer: an appeal to the American Joint Committee on Cancer

Overstaging: A Challenge in Rectal Cancer Treatment

Outcomes of Salvage Surgery for Cure in Patients With Locally Recurrent Disease After Local Excision of Rectal Cancer

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