The learning curve for endorectal ultrasonography in rectal cancer staging

Li, Jimmy C. M.; Liu, Shirley Y.W.; Lo, Anthony W.I.; Hon, Sophie S. F.; Ng, Simon; Lee, Janet F. Y.; Leung, Ka Lau

doi:10.1007/s00464-010-1085-z

Cited by 19 publications

(11 citation statements)

References 27 publications

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“…In addition, endorectal US has a learning curve for beginners (22). Endorectal US is an operator-dependent examination, and accuracy is closely related to the experience level of the sonologist.…”

Section: Discussionmentioning

confidence: 99%

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Assessment of Rectal Tumors with Shear-Wave Elastography before Surgery: Comparison with Endorectal US

Chen

Wang

et al. 2017

Radiology

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Purpose To compare the value of endorectal ultrasonography (US) with shear-wave elastography (SWE) in staging rectal tumors before surgery. Materials and Methods This prospective study was approved by the institutional review board and written informed consent was obtained. In a pilot cohort from April 2015 to January 2016, 70 patients with rectal adenocarcinomas and/or adenomas confirmed with histopathologic examination underwent both endorectal US and SWE. Tumor stiffness and three regions of reference backgrounds, as well as tumor stiffness ratios (SRs) versus these backgrounds, were analyzed. The optimal staging feature was selected by using receiver operating characteristic analysis, and the concordance rate with pathologic stage was analyzed and compared with endorectal US. The results were validated in an independent cohort of 30 patients from February 2016 to July 2016. Results In the pilot study, from rectal adenoma to stage T3 cancers, the tumor stiffness, stiffness of peritumoral fat, tumor SR versus distant perirectal fat, and tumor SR versus normal rectal wall were significantly increased (all P < .05, correlation coefficients between SWE features and pathologic T stages were 0.589-0.853). Receiver operating characteristic analysis of tumor staging demonstrated that tumor stiffness was the optimal feature with the highest area under the receiver operating characteristic curve (AUC = 0.991-1.000). The cutoff values of stage T1, T2, and T3 cancers were 26.9 kPa, 70.3 kPa, and 112.0 kPa, respectively. For SWE, the diagnostic concordance rate with pathologic stage (95.7%, weighted κ = 0.962) was higher than that of endorectal US (75.7%, weighted κ = 0.756). In the validation cohort, similar findings were revealed for diagnostic concordance rate (93.3% vs 76.7%; weighted κ = 0.927 vs 0.651) and diagnostic performance of tumor staging (AUC = 0.950-1.000 vs 0.700-0.833). Conclusion By using the feature of tumor stiffness at SWE, the accuracy of preoperative staging for rectal tumors was improved compared with endorectal US in the pilot study, but was not significantly different in the validation cohort, potentially due to small sample size. RSNA, 2017 Online supplemental material is available for this article.

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Section: Discussionmentioning

confidence: 99%

“…Considering endorectal US was used as a routine clinical practice instead of as research in a clinical trial, their results were potentially more representative of clinical practice. In addition, a well-recognized learning curve exists for the technique because endorectal US is heavily operator dependent (22).…”

Section: Patientsmentioning

confidence: 99%

Assessment of Rectal Tumors with Shear-Wave Elastography before Surgery: Comparison with Endorectal US

Chen

Wang

et al. 2017

Radiology

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“…Another limiting factor of ERUS is its operator-dependency. At the same time, this also means that in the hands of an experienced diagnostician it is a reliable method providing a great amount of information [ 21 , 22 ]. According to our results, the learning curve is relatively short; after 30 examinations it is possible to evaluate the depth invasion of rectal cancers with confidence.…”

Section: Discussionmentioning

confidence: 99%

Rectal Tumour Staging with Endorectal Ultrasound: Is There Any Difference between Western and Eastern European Countries?

Fábián

Bor

Farkas

et al. 2016

Gastroenterology Research and Practice

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Background. Rectal tumour management depends highly on locoregional extension. Rectal endoscopic ultrasound (ERUS) is a good alternative to computed tomography and magnetic resonance imaging. However, in Hungary only a small amount of rectal tumours is examined with ERUS. Methods. Our retrospective study (2006–2012) evaluates the diagnostic accuracy of ERUS and compares the results, the first data from Central Europe, with those from Western Europe. The effect of neoadjuvant therapy, rectal probe type, and investigator's experience were also assessed. Results. 311 of the 647 ERUS assessed locoregional extension. Histological comparison was available in 177 cases: 67 patients underwent surgery alone; 110 received neoadjuvant chemoradiotherapy (CRT); ERUS preceded CRT in 77 and followed it in 33 patients. T-staging was accurate in 72% of primarily operated patients. N-staging was less accurate (62%). CRT impaired staging accuracy (64% and 59% for T- and N-staging). Rigid probes were more accurate (79%). At least 30 examinations are needed to master the technique. Conclusions. The sensitivity of ERUS complies with the literature. ERUS is easy to learn and more accurate in early stages but unnecessary for restaging after CRT. Staging accuracy is similar in Western and Central Europe, although the number of examinations should be increased.

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“…27 However, other studies highlight the substantial operator dependence of TRUS relative to MRI and the potential impacts on accuracy and reproducibility, especially with respect to determining nodal involvement. 28,29 Much of the evidence supporting the use of MRI in the preoperative assessment of rectal cancer was generated by the MERCURY Study Group, which found a high correlation between preoperative MRI and histopathology with respect to the extramural depth (EMD) of tumor spread. 30 Similarly, other authors have reported the high accuracy of MRI for assessing both EMD and the involvement of the mesorectal fascia.…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

Beyond Histologic Staging: Emerging Imaging Strategies in Colorectal Cancer with Special Focus on Magnetic Resonance Imaging

Fraum

Owen

Fowler

2016

Clinics in Colon and Rectal Surgery

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).Colorectal cancer (CRC) is the third most common malignancy and second most common cause of cancer mortality in the United States, with over 132,000 new diagnoses and 49,000 deaths each year. 1 As these numbers indicate, CRC is curable in a substantial percentage of cases. Accurate staging is critical to the selection of a suitable treatment strategy and, consequently, to the achievement of optimal clinical outcomes. To this point, radiologic examinations are playing an increasingly important role in both the initial staging of CRC and the evaluation of response to neoadjuvant therapy. Moreover, imaging facilitates preoperative planning by delineating relationships between tumors and the adjacent anatomy, thereby defining the best surgical approach and minimizing risk of injury to surrounding structures.The imaging and treatment of CRC can be generally divided into two main components: (1) locoregional staging and management of primary tumors; and (2) the identification and management of distant metastases, which most commonly occur in the liver. The primary goal of locoregional treatment strategies is to achieve a margin-negative surgical resection, either primarily (for colon and rectal cancer) or after neoadjuvant chemotherapy and/or radiation (for rectal cancer only). Transrectal ultrasound (TRUS), computed tomography (CT), and magnetic resonance imaging (MRI) are the main imaging modalities for locoregional staging (►Table 1) and are focused on defining the local extent of the primary tumor (T-staging) as well as the status of local and regional lymph nodes (N-staging).While locoregional tumor management is important for preventing or minimizing invasion of adjacent structures and avoiding the associated morbidity, mortality in CRC is primarily determined by the hepatic disease burden. 2 Thus, the current treatment paradigm for liver metastases from both colon cancer and rectal cancer is surgical resection, which maximizes the chances for long-term survival. 3,4 For liver metastases deemed unresectable, neoadjuvant chemotherapy and percutaneous interventions can be employed to achieve hepatic tumor control and may eventually make resection feasible by reducing metastatic disease burden. 5-7 The imaging AbstractImaging plays an increasingly important role in the staging and management of colorectal cancer. In recent years, magnetic resonance imaging (MRI) has supplanted transrectal ultrasound as the preferred modality for the locoregional staging of rectal cancer. Furthermore, the advent of both diffusion-weighted imaging and hepatobiliary contrast agents has significantly enhanced the ability of MRI to detect colorectal liver metastases. In clinical practice, MRI routinely provides prognostic information, helps to guide surgical strategy, and determines the need for neoadjuvant therapies related to both the primary tumor and metastatic disease. Expanding on these roles for MRI, positron emission tomography (PET)/MRI is the newest clinical hybrid imaging modality and combines the metabolic information of P...

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The learning curve for endorectal ultrasonography in rectal cancer staging

Abstract: ERUS was accurate in preoperative staging of rectal cancer. It was an easy-to-learn procedure for accurate tumor staging, but considerable experience was required to attain accuracy for nodal staging.

Cited by 19 publications

References 27 publications

Assessment of Rectal Tumors with Shear-Wave Elastography before Surgery: Comparison with Endorectal US

Assessment of Rectal Tumors with Shear-Wave Elastography before Surgery: Comparison with Endorectal US

Rectal Tumour Staging with Endorectal Ultrasound: Is There Any Difference between Western and Eastern European Countries?

Beyond Histologic Staging: Emerging Imaging Strategies in Colorectal Cancer with Special Focus on Magnetic Resonance Imaging

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