Rectal carcinoma: Preoperative staging and detection of postoperative local recurrence with transrectal and transvaginal ultrasound

Abstract

Transrectal ultrasound (TRUS) was performed preoperatively in 35 patients with rectal carcinoma and the results were compared to histologic findings. In the same group, postoperative studies were performed in 22 patients; in women, transvaginal ultrasound (TVUS) was added to the transrectal study. According to Duke's classification modified by Astler-Coller, in relation to the "T" parameter, TRUS correctly staged 33 of 35 neoplasms (accuracy, 94.3%); one was overstaged and one was understaged. In detection of lymph node involvement, accuracy was 74% (sensitivity 69%, specificity 73.9%). Recurrent local tumors, histologically confirmed, developed in two of 22 postoperative patients who had undergone curative anterior resection. This study demonstrates that TRUS is an accurate method in preoperative staging of rectal carcinoma. In the prospective study, the role of follow-up TRUS and TVUS in detection of local recurrences is evaluated.

Clinical implications of quantification of mesorectal tumor invasion by endoscopic ultrasound: All T3 rectal cancers are not equal

“…The introduction of transrectal endoscopic ultrasound (EUS) has enhanced the ability to delineate the layers of the rectal wall, thereby improving treatment allocation by achieving more accurate T staging 8–19 . The literature demonstrates the accuracy of EUS in the T staging of rectal carcinoma to range from 80 to 95%, 20,21 compared to CT (65–75%) and MRI (75–85%) 22–26 .…”

MR colonography for the assessment of colonic anastomoses

“…In addition to assessing colonic anastomoses, diagnostic imaging can be used to perform a general body screening to assess pericolic fat tissue and extraintestinal organs, including the liver and lymph nodes. Endoluminal sonogra- phy (ES), virtual CT, MRI, and positron emission tomography (PET)/CT have also been used for these purposes (33)(34)(35)(36)(37)(38)(39)(40). Transrectal or transvaginal ES for the assessment of rectal anastomosis has shown an accuracy of 94% (36).…”

“…ES is advantageous because it can directly assess the colonic wall; however, not all colonic anastomoses can be assessed with ES. In addition, ES has a low sensitivity and specificity for the detection of lymph nodes or extracolonic metastases (33).…”

Rectal imaging and cancer

“…EUS can be used to determine the depth of tumor invasion, extension into the perirectal fat or adjacent organs, and possibly, metastatic involvement in perirectal lymph nodes [20,21]. The accuracy of EUS for staging primary tumors varies from 64% to 93%, but more commonly is reported between 80% and 90% [22].…”

“…Although EUS can identify small perirectal lymph nodes, the accuracy for determining their involvement by tumor ranges from 52% to 83% [21]. Several criteria have been devised to characterize the malignant potential of lymph nodes, such as changes in echotexture and morphology, but EUS remains imprecise in determining the malignant potential of lymph nodes [24].…”