Preoperative assessment of mesorectal lymph node involvement in rectal cancer

Beynon, J.; Mortensen, N. J. McC.; Foy, D. M. A.; Channer, J. L.; Rigby, H.S.; Virjee, J.

doi:10.1002/bjs.1800760320

Cited by 198 publications

(66 citation statements)

References 34 publications

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“…As was the case 20 years ago, most examiners continue to base their echographic prediction of lymph node invasion on the identification of circular or oval hypoechoic lesions in the meso-rectal zone (10,11). This discriminatory simplicity has led to numerous diagnostic errors (7,20), so that when there is a possibility of error in the form of false negatives (infra-staging), and the conviction that it is better to over-treat then under-treat a cancer patient, most echographers tend to declare all nodes detected during the exploration to be neoplastic.…”

Section: Discussionmentioning

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: Discussionmentioning

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 the study of Rifkin et al (18), 81 patients underwent CT and ERUS for staging purposes of rectal cancer; the accuracy of CT in assessing depth of rectal wall invasion was 53%, compared with 72% for ERUS. Beynon et al (40) compared ERUS to CT for the evaluation of mesorectal nodal status; they found that the accuracy of CT was only 57%, compared with 87% for ERUS. More recently Herzog et al (41) examined 87 patients who underwent both CT and ERUS; they found accuracy of CT to be 74.7%, whereas ERUS had an accuracy of 90.,8%.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Staging of Rectal Cancer: Role of Endorectal Ultrasound

A.G.F.¹,

Grobler²,

Santoro³

2011

Rectal Cancer - A Multidisciplinary Approach to Management

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“…Endoscopy and biopsy allow to determine the histological grade of malignancy (high-or low-risk histolo gy)-Endorectal sonography enables to assess the depth of invasion with 90% accuracy [15], It is crucial to deter mine whether or not the tumor penetrates through the muscularis propria [16]. Considering the lymph node involvement, the accuracy is about 83% [17], CT and Y. Mason's Operation DigSurg 1997:14:304-306 MRI are optional. According to our experience, MR1 is characterized by an accuracy rate of 82 and 60% in assess ing the depth of invasion and lymph node metastases, respectively [18], To sum up, the following features of the tumor are con sidered 'ideal' for local excision with the transsphincteric technique: (1) distance from the anal verge not >11-12 cm; (2) diameter <3 cm; (3) low-risk histology, and (4) infiltration limited to the mucosa or submucosa.…”

Section: Discussionmentioning

confidence: 99%

Local Excision of Rectal Cancer: The Operation of Y. Mason

1997

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Thirty-two patients with rectal cancer underwent local excision according to Y. Mason’s procedure. Since local excision does not remove lymph nodes, the risk of metastases must be minimal and therefore the selection of patients careful. Preoperative selection is performed by rectal digital examination, endoscopy, rectal endosonography and sometimes by magnetic resonance imaging. The validity of the local excision can only be established by the definitive postoperative histological assessment. In case of pT1 tumors with ‘low-risk’ histology, results show that survival and local recurrence rate are comparable to those obtained with radical resection.

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Preoperative assessment of mesorectal lymph node involvement in rectal cancer

Cited by 198 publications

References 34 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

Preoperative Staging of Rectal Cancer: Role of Endorectal Ultrasound

Local Excision of Rectal Cancer: The Operation of Y. Mason

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