Perirectal lymph nodes in rectal cancer: in vitro correlation of sonographic parameters and histopathologic findings.

Hulsmans, F J; Bosma, Astrid; Mulder, P. J. J.; Reeders, Jacques W. A. J.; Tytgat, G. N. J.

doi:10.1148/radiology.184.2.1620864

Cited by 55 publications

(28 citation statements)

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“…The study of the images was made with no knowledge of the anatomo-pathological results. After analyzing the bibliography (11)(12)(13)(14) and in accordance with the study's purpose, in addition to the maximum and minimum diameter in each ganglion, we analyzed 8 morphological data cited as significant discriminators of tumor invasion (Table I).…”

Section: Methodsmentioning

confidence: 99%

Predictive ultrasound factors of lymphatic invasion in rectal cancer: "extra-corporeal" study

Ramírez-Rodríguez

Palacios-Fanlo

Ortego-Fernández-de-Retana

et al. 2011

Rev. esp. enferm. dig.

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Objective: the accuracy of preoperative endorectal ultrasound in the status evaluation of lymph nodes is around 50-70%, with a lack of eco-morphological patterns of clinical use. Since, accurate local staging is of great value in prognosis and decision-making we decided to analyze the referenced eco-morphological parameters in an attempt to find a proper predictive tool of clinical help that could improve the accuracy of rectal ultrasound.Material and method: the resected specimens of 24 patients that were operated on by radical surgery because rectal cancer, without preoperative radiotherapy, were suspended in warm water and ultrasound scanned (360° circular probe with a transducer of 10 MHz). All suspicious nodes were recorded and marked for the definitive histological report.Results: from the 24 specimens, 318 nodes were imaged (210 benign and 100 involved). All ultrasound parameters analyzed were significant but only lobulation, echogenicity and hilar reflection were independent values. An score system was design with the addition of all parameters that showed a sensitivity of 98% and specificity of 99,1%.Conclusions: our study shows that a careful study of ultrasound lymph node images can get a high level of accuracy and better help in tailoring the treatment of any particular case.Key words: Rectal cancer. Endorectal ultrasound. Lymph node. INTRODUCTIONColo-rectal carcinoma is the most common malign digestive neoplasm in countries with comparable geographical and socio-economic conditions to ours. Half of these tumors are located in the rectum and the recto-sigmoid junction. Rectal cancer is understood at this time as a differentiated oncologic entity due to the peculiar characteristics of its diagnosis and treatment. In these last few years, a multi-disciplinary approach to this entity, with individualized treatment, has achieved substantial improvement in terms of local recurrence, quality of life and survival (1). In this sense, the optimal results of this treatment are directly connected to the precision with which the preoperative study is made (2).In rectal cancer, this loco-regional preoperative evaluation refers us both to the state of the primary tumor as well as to the situation of the meso-rectal lymph nodes, which are important in the prognosis of the patient and are influential in the taking of decisions (3).Although in the last few decades diagnostic imaging techniques have improved greatly -e.g. magnetic resonance (MR) or computerized tomography (CT)-, endorectal ultrasound (E-R U/S) continues to be the most effective loco-regional pre-operative evaluation for cancer of the rectum (4,5). Even though this is the case, the efficiency of evaluating lymph nodes is between 50 and 70% in most studies (6,7). Since it has great negative predictive value, these results are due mostly to the inability of E-R U/S to differentiate metastatic from inflammatory nodes. There are no generally accepted echo-morphological patterns for lymphatic invasion and those which do exist are difficult to put into pract...

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Section: Methodsmentioning

confidence: 99%

Predictive ultrasound factors of lymphatic invasion in rectal cancer: "extra-corporeal" study

Ramírez-Rodríguez

Palacios-Fanlo

Ortego-Fernández-de-Retana

et al. 2011

Rev. esp. enferm. dig.

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“…In most patients with bile duct obstruction or with a bile duct endoprosthesis, enlarged lymph nodes were seen in the hepatoduodenal ligament, especially adjacent to the hepatic artery. In most patients, these were not biopsied because of their location (within resection margins) or because of a benign appearance; However, as reported in the literature, there is some overlap between benign and malignant US features of lymph nodes, and in many patients no certain characterization of enlarged lymph nodes was possible by LUS [11].…”

Section: Lymph Nodesmentioning

confidence: 99%

Laparoscopic ultrasonography for abdominal tumor staging: technical aspects and imaging findings

et al. 1997

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Since 1992 diagnostic laparoscopy combined with laparoscopic ultrasonography has been performed in our center in more than 300 patients for staging of tumors of the liver, bile ducts, pancreas, esophagus, and gastric cardia. In this article our experience with laparoscopic ultrasonography for abdominal tumor staging is described, with particular attention for the technical aspects, imaging findings, limitations, and pitfalls.

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“…A ultra-sonografia endorretal é viável (em termos de ser exeqüível, mas não de ser universalmente disponível), para quase todos os tipos de lesões, exceto as muito extensas e invasivas 44,46 ; para as estenosantes 46 e as que estão muito altas ou as que ocupam o extremo distal do reto [47][48][49] . Outro aspecto limitante é a experiência do examinador 47,50 , e eventual uso de irradiação antes do exame ultrasonográfico 51,52 .…”

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Câncer ano-reto-cólico: aspectos atuais III - câncer de reto - terapêutica neoadjuvante

Santos¹

2008

Rev bras. colo-proctol.

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RESUMO: O tratamento cirúrgico do câncer de reto era feito por meio de operação via abdominal se o tumor estivesse no terço superior ou abdominoperineal, se o tumor estivesse no terço médio ou inferior, era associado à radioterapia e/ou a quimioterapia. A preservação do esfíncter anal, pelos princípios cirúrgicos vigentes, era limitada e destinava-se aos tumores que estavam acima do alcance do toque digital. As anastomoses baixas, ensaiadas em doenças benignas, foram introduzidas para o câncer, mas somente ganharam destaques com grampeadores mecânicos. Avanços posteriores incorporaram novas concepções sobre a anatomia cirúrgica do reto e seus aspectos oncológicos, provocando alterações operatórias cujos resultados promoveram revisão de conceitos e emancipação da terapêutica. O arsenal farmacológico foi tão ampliado e enriquecido, que o embaraço atual está em escolher e testar as drogas oncológicas disponíveis. Paralelamente aos aceleradores lineares, os avanços na área de computação e produção de imagens radiológicas possibilitaram o planejamento tridimensional do segmento anatômico a ser atingido, com ganhos valorosos para a radioterapia. O maior desafio no tratamento do câncer de reto, superado os aspectos físicos e cirúrgico-anatômicos, continua sendo o controle da recidiva local, ainda que bem inferiores aos observados no passado. Esse progresso ocorreu graças ao avanço tecnológico das imagens ultra-sonográficas e da ressonância magnética que, no campo propedêutico, vêm aprimorando o estadiamento do tumor; à maior definição do uso da terapêutica neo-adjuvante, à técnica cirúrgica de excisão total do mesorreto e ao apuro manual dos cirurgiões. Descritores: câncer de reto, recidiva local, excisão total do mesorreto (ETM), terapia neo-adjuvante. A abordagem terapêutica de uma doença, qualquer que seja ela, pode ser sintetizada num único objetivo -a cura -independentemente do tipo de esforço desprendido e da multiplicidade da equipe que desenvolve os meios para a satisfação plena do objetivo almejado. Contudo, nem todas as doenças podem ser assim enquadradas, e a meta se torna em objetivos dispersos que fundamentam os estudos para as continuadas buscas dos melhores resultados terapêuticos para aquela doença. Trabalho realizado no Hospital Maternidade Frei Galvão deO câncer de reto está enquadrado no item em que os "objetivos são dispersos" e, nesse caso, a mola propulsora dos centros de pesquisas e da indústria que se afinam e potencializam seus recursos, na impossibilidade de curar, buscam atender, com indiscutíveis benefícios para os doentes, os seguintes objetivos: a. controle local da doença b. maior sobrevida c. preservação esfincteriana e d. melhor qualidade de vida. A base em que se fundamentam esses objetivos, quase que na totalidade das vezes, é expressa por classificações em que o parâmetro principal é a chance de sobrevida do paciente, a qual depende do tamanho do tumor e de suas características histológicas, em termos de maior ou menor diferenciação.

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Perirectal lymph nodes in rectal cancer: in vitro correlation of sonographic parameters and histopathologic findings.

Cited by 55 publications

References 0 publications

Predictive ultrasound factors of lymphatic invasion in rectal cancer: "extra-corporeal" study

Predictive ultrasound factors of lymphatic invasion in rectal cancer: "extra-corporeal" study

Laparoscopic ultrasonography for abdominal tumor staging: technical aspects and imaging findings

Câncer ano-reto-cólico: aspectos atuais III - câncer de reto - terapêutica neoadjuvante

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