Pre-Operative assessment of local invasion in rectal cancer: Digital examination, endoluminal sonography or computed tomography?

Abstract

Forty-four patients with primary rectal cancers and six patients with benign rectal lesions were examined pre-operatively digitally, with endorectal sonography (ELU) and also computed tomography (CT). Digital examination of the rectal cancers had an overall accuracy of 68 per cent and predicted invasion beyond the muscularis propria with a sensitivity of 68 per cent, specificity of 83 per cent, positive predictive value of 100 per cent and negative predictive value of 46 per cent. In comparison CT had an accuracy of 82 per cent, sensitivity of 86 per cent, specificity of 62 per cent, positive predictive value of 91 per cent and negative predictive value of 50 per cent. ELU was the most reliable indicator of local invasion in rectal cancer when compared with postoperative histopathology with an accuracy of 91 per cent, sensitivity of 94 per cent, specificity of 87 per cent, positive predictive value of 97 per cent and negative predictive value of 78 per cent.

Role of Transrectal Ultrasound in Preoperative Local Staging of Carcinoma Rectum and It’s Histopathological Correlation

“…Beynon et al have reported an accuracy of 83 % with a sensitivity of 88 % and specificity of 79 % [2]. This technique is considerably more accurate than CT scanning, digital examination, or magnetic resonance imaging.…”

“…Tio and Tytgat first described the hypoechoic pattern of the metastatic lymph node. Later on, Beynon et al [2] and Hildebrandt and Feifel [1] applied Tio and Tytgat's observation to the rectum. At present, an accuracy of 72-83 % with ultrasonic diagnosis of nodal involvement is reported.…”

“…The TNM (tumor, node, and metastasis) classification is used with a u-modifier to describe the depth of invasion and the presence or absence of metastatic lymph nodes as described by Beynon and coworkers [2] (Table 1 and Figs. 1 and 2).…”

Estudo retrospectivo de 47 complicações em 380 pacientes operados de câncer retal

“…Os fatores relacionados com o tumor são altura da localização, aspecto macroscópico, envolvimento circunferencial, fixação aos planos profundos retais e extrarretais, aspecto microscópico, DNA celular, invasão parietal no reto e adenopatia pré-sacra - Beynon (1986) 6 , Kewenter et al (1994) 57 e Wolmark et al (1986) 100 -. Os fatores relacionados com o paciente são biótipo, idade, sexo, presença de doença metastática, presença de doenças sistêmicas e condições mórbidas afins.…”

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

“…A limitação do método, quando se pretende comparar com a viabilidade do mesmo para o tumor, prende-se ao fato de que nem sempre é fácil localizar a massa tumoral diminuta dentro do nódulo. Os fatores de referência são a hipoecogenicidade do nódulo, a aparência com maior ou menor regularidade de forma, e o tamanho, em geral maior que 1 cm, mas com a consideração de que os nódulos maiores que 0,5 cm têm de 50-70% de probabilidade de conter invasão metastática 45,51,57,58 e os menores que 0,4 cm, cerca de 20% 58 . Nesses casos, alguns autores dão maior ênfase para a ressonância magnética 46 .…”