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Xia Q, Cheng W, Bi J, Ren AP, Chen X, Li T. Value of biplane transrectal ultrasonography plus micro-flow imaging in preoperative T staging and rectal cancer diagnosis in combination with CEA/CA199 and MRI. BMC Cancer 2023; 23:860. [PMID: 37700269 PMCID: PMC10496222 DOI: 10.1186/s12885-023-11370-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 09/04/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Rectal cancer is one of the most common malignant tumors and has a high incidence rate and fatality rate. Accurate preoperative T staging of rectal cancer is critical for the selection of appropriate rectal cancer treatment. Various pre-operative imaging methods are available, and the identification of the most accurate method for clinical use is essential for patient care. We investigated the value of biplane transrectal ultrasonography (TRUS) combined with MFI in preoperative staging of rectal cancer and explored the value of combining TRUS plus MFI with CEA/CA199 and MRI. METHODS A total of 87 patients from Daping Hospital with rectal cancer who underwent TRUS examination plus MFI were included. Grades of MFI were determined by Alder classification. Among the total patients, 64 underwent MRI and serum CEA/CA199 tests additionally within one week of TRUS. Pathological results were used as the gold standard for cancer staging. Concordance rates between TRUS, MRI, and CEA/CA199 for tumors at different stages were compared. RESULTS There were no significant differences between the Alder classification and pathological T staging. The concordance rate of TRUS and MFI for rectal cancer T staging was 72.4% (K = 0.615, p < 0.001). Serum CEA and CA199 levels were significantly different in tumors at different stages and increased progressively by pathological stage (p < 0.001); the accuracy rate was 71.88% (K = 0.599, p < 0.001), while that of MRI was 51.56% (K = 0.303, p < 0.001), indicating that TRUS had higher consistency in the preoperative T staging of rectal cancer. The combination of TRUS, MRI, and CEA/CA199 yielded an accuracy rate of 90.6%, which was higher than that of any method alone. CONCLUSIONS Preoperative T staging of rectal cancer from biplane TRUS plus MFI was highly consistent with postoperative pathological T staging. TRUS combined with MRI and serum CEA/CA199 had a greater value in the diagnosis of rectal cancer and a higher diagnostic rate than any examination alone.
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Affiliation(s)
- Qin Xia
- Department of Ultrasound, Daping Hospital, Army Medical University, Chongqing, 400000, China
| | - Wei Cheng
- Department of Ultrasound, Daping Hospital, Army Medical University, Chongqing, 400000, China
| | - Jie Bi
- Department of Ultrasound, Daping Hospital, Army Medical University, Chongqing, 400000, China
| | - An-Ping Ren
- Department of Ultrasound, Daping Hospital, Army Medical University, Chongqing, 400000, China
| | - Xiao Chen
- Department of Ultrasound, Daping Hospital, Army Medical University, Chongqing, 400000, China
| | - Tao Li
- Department of Ultrasound, Daping Hospital, Army Medical University, Chongqing, 400000, China.
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Hyeong S, Lee J, Kim S, Lee D, Suh GH, Choi J. Application of endoscopic ultrasound to the descending colon and rectum in normal dogs. Vet Radiol Ultrasound 2023. [PMID: 36876648 DOI: 10.1111/vru.13226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 01/23/2023] [Accepted: 01/23/2023] [Indexed: 03/07/2023] Open
Abstract
Endoscopic ultrasound (EUS) is a medical procedure in which endoscopy is combined with ultrasonography (US) to compensate for problems associated with the transabdominal US such as large penetration depths, presence of intestinal gas, and acoustic shadowing. This prospective, method comparison, pilot study was performed to assess the feasibility of applying EUS in the colorectal region and to describe the typical EUS features of the descending colon and rectum in healthy dogs. Transabdominal US and EUS with or without the hydrosonography were applied to the descending colon and rectum in 10 clinically healthy Beagle dogs and wall thickness, visibility of the wall layers, and conspicuity of the mucosal and serosal surfaces of the intestinal wall were assessed. Endoscopic ultrasound enabled circumferential evaluation of the colorectal wall and provided better visibility of the wall layers and conspicuity of the mucosal and serosal surfaces without degradation of the image, even in the far-field portion of the colorectal wall, compared to US. Moreover, EUS provided the adequate image quality of the rectum, which was difficult to evaluate with US due to deep scan depth and acoustic shadowing by the pelvis. Meanwhile, the application of hydrosonography to EUS deteriorated the visibility of the wall layers and conspicuity of the intestinal wall. The results of this study demonstrate the feasibility of EUS to assess the colorectal region and its potential application for the evaluation of rectal masses or intrapelvic lesions that are inaccessible by the transabdominal US in dogs.
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Affiliation(s)
- Seongjae Hyeong
- College of Veterinary Medicine, Chonnam National University, Gwangju, South Korea
| | - Juryeong Lee
- College of Veterinary Medicine, Chonnam National University, Gwangju, South Korea
| | - Soyeon Kim
- Department of Veterinary Medical Imaging, College of Veterinary medicine, Seoul National University, Seoul, South Korea
| | - Dongjae Lee
- Department of Veterinary Medical Imaging, College of Veterinary medicine, Seoul National University, Seoul, South Korea
| | - Guk-Hyun Suh
- College of Veterinary Medicine, Chonnam National University, Gwangju, South Korea
| | - Jihye Choi
- Department of Veterinary Medical Imaging, College of Veterinary medicine, Seoul National University, Seoul, South Korea
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Ghoneem E, Shabana ASA, El Sherbini M, Zuhdy M, Eldamshety O, Gouda M, El Shamy A, Saleh GA, Saleh AAG. Endoluminal ultrasound versus magnetic resonance imaging in assessment of rectal cancer after neoadjuvant therapy. BMC Gastroenterol 2022; 22:542. [PMID: 36575373 PMCID: PMC9793528 DOI: 10.1186/s12876-022-02628-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Accurate rectal tumor staging guides the choice of treatment options. EUS and MRI are the main modalities for staging. AIM OF THE WORK To compare the performance of EUS and MRI for loco-regional staging of anorectal cancer after neo-adjuvant therapy. METHODS Seventy-three (37 male, 36 female) patients with rectal cancer after neo-adjuvant chemoradiotherapy were enrolled. Histopathological staging after surgery were used as reference for comparing the yield of loco-regional staging for EUS and MRI. EUS and MRI were done 1 month after completion of neo-adjuvant therapy. RESULTS Regarding post-surgical T staging, eight patients had early tumor (T2 = 16 and T1 = 9) and thirty six were locally advanced (T3 = 36), while N staging, forty patients with negative nodes and 33 were positive (N1 = 22 and N2 = 11). Comparing EUS to MRI, it showed a higher sensitivity (95.7% vs. 78.7%), specificity (84.6% vs. 68.0%) and accuracy (91.8% vs. 75.3%) for staging early and locally advanced tumor. Also, it had a higher sensitivity (78.8% vs. 69.7%), specificity (75.0% vs. 65.0%) and accuracy (76.7% vs. 67.1%) for detection of lymph nodes. CONCLUSION EUS appears to be more accurate than MRI in loco-regional staging of rectal carcinoma after neo-adjuvant therapy.
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Affiliation(s)
- Elsayed Ghoneem
- grid.10251.370000000103426662Department of Internal Medicine, Hepatology and Gastroenterology Unit, Specialized Medical Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt ,Egyptian Liver Research Institute and Hospital, Sherbin, Mansoura, Egypt
| | - Ahmed Shekeib Abdein Shabana
- grid.10251.370000000103426662Department of Internal Medicine, Hepatology and Gastroenterology Unit, Specialized Medical Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed El Sherbini
- grid.10251.370000000103426662Department of Internal Medicine, Hepatology and Gastroenterology Unit, Specialized Medical Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohammad Zuhdy
- grid.10251.370000000103426662Department of Surgical Oncology, Oncology Center Mansoura University (OCMU), Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Osama Eldamshety
- grid.10251.370000000103426662Department of Surgical Oncology, Oncology Center Mansoura University (OCMU), Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Gouda
- grid.420091.e0000 0001 0165 571XTheodor Bilharz Research Institute, Cairo, Egypt
| | - Ahmed El Shamy
- grid.10251.370000000103426662Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Gehad Ahmad Saleh
- grid.10251.370000000103426662Department of Diagnostic Radiology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed Abdel Ghafar Saleh
- grid.10251.370000000103426662Department of Internal Medicine, Hepatology and Gastroenterology Unit, Specialized Medical Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Castro-Pocas FM, Dinis-Ribeiro M, Rocha A, Santos M, Araújo T, Pedroto I. Colon carcinoma staging by endoscopic ultrasonography miniprobes. Endosc Ultrasound 2017; 6:245-251. [PMID: 28663528 PMCID: PMC5579910 DOI: 10.4103/2303-9027.190921] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background and Objectives: Due to the increasing use of endoscopic techniques for colon cancer resection, pretreatment locoregional staging may gain critical interest. The use of endoscopic ultrasonography (EUS) miniprobes in this context has been seldom reported. Our aim was to determine the accuracy of EUS miniprobes for colon cancer staging. Materials and Methods: Forty patients with colon cancer (2 in the cecum, 9 in the ascending colon, 5 in the transverse colon, 5 in the descending colon, and 19 in the sigmoid colon) were submitted to staging using 12 MHz EUS miniprobes. EUS and the anatomopathological results were compared with regard to the T and N stages. It was assessed if the location, longitudinal extension, or circumferential extension of the tumor had any influence on the accuracy in EUS staging. Results: Tumor staging was feasible in 39 (98%) patients except in one case with a stenosing tumor (out of 6). Globally, T stage was accurately determined in 88% of the cases. In the assessment of the presence or absence of lymph node metastasis, miniprobes presented an accuracy of 82% with a sensitivity of 67%. These results were neither affected by the location nor by the longitudinal or circumferential extension of the tumor. Conclusions: EUS miniprobes may play an important role in assessing T and N stages in colon cancer and may represent an incentive to the research of new therapeutic areas for this disease.
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Affiliation(s)
- Fernando M Castro-Pocas
- Department of Ultrasound, Service of General Surgery, Santo António Hospital, Porto Hospital Center; Institute of Ciências Biomédicas Abel Salazar, Faculty of Medicine, University of Porto; Department of Gastroenterology, Santo António Hospital, Porto Hospital Center, Porto, Portugal
| | - Mário Dinis-Ribeiro
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Anabela Rocha
- Institute of Ciências Biomédicas Abel Salazar, Faculty of Medicine, University of Porto; Unit of Digestive Surgery, Service of General Surgery, Santo António Hospital, Porto Hospital Center, Porto, Portugal
| | - Marisa Santos
- Institute of Ciências Biomédicas Abel Salazar, Faculty of Medicine, University of Porto; Unit of Digestive Surgery, Service of General Surgery, Santo António Hospital, Porto Hospital Center, Porto, Portugal
| | - Tarcísio Araújo
- Department of Gastroenterology, Santo António Hospital, Porto Hospital Center, Porto, Portugal
| | - Isabel Pedroto
- Institute of Ciências Biomédicas Abel Salazar, Faculty of Medicine, University of Porto; Department of Gastroenterology, Santo António Hospital, Porto Hospital Center, Porto, Portugal
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Marone P, Bellis MD, D’Angelo V, Delrio P, Passananti V, Girolamo ED, Rossi GB, Rega D, Tracey MC, Tempesta AM. Role of endoscopic ultrasonography in the loco-regional staging of patients with rectal cancer. World J Gastrointest Endosc 2015; 7:688-701. [PMID: 26140096 PMCID: PMC4482828 DOI: 10.4253/wjge.v7.i7.688] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 11/26/2014] [Accepted: 03/20/2015] [Indexed: 02/05/2023] Open
Abstract
The prognosis of rectal cancer (RC) is strictly related to both T and N stage of the disease at the time of diagnosis. RC staging is crucial for choosing the best multimodal therapy: patients with high risk locally advanced RC (LARC) undergo surgery after neoadjuvant chemotherapy and radiotherapy (NAT); those with low risk LARC are operated on after a preoperative short-course radiation therapy; finally, surgery alone is recommended only for early RC. Several imaging methods are used for staging patients with RC: computerized tomography, magnetic resonance imaging, positron emission tomography, and endoscopic ultrasound (EUS). EUS is highly accurate for the loco-regional staging of RC, since it is capable to evaluate precisely the mural infiltration of the tumor (T), especially in early RC. On the other hand, EUS is less accurate in restaging RC after NAT and before surgery. Finally, EUS is indicated for follow-up of patients operated on for RC, where there is a need for the surveillance of the anastomosis. The aim of this review is to highlight the impact of EUS on the management of patients with RC, evaluating its role in both preoperative staging and follow-up of patients after surgery.
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Luz LP, Cote GA, Al-Haddad MA, McHenry L, LeBlanc JK, Sherman S, Moreira DM, El Hajj II, McGreevy K, DeWitt J. Utility of EUS following endoscopic polypectomy of high-risk rectosigmoid lesions. Endosc Ultrasound 2015; 4:137-44. [PMID: 26020049 PMCID: PMC4445172 DOI: 10.4103/2303-9027.156744] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 08/21/2014] [Indexed: 12/17/2022] Open
Abstract
Background: The utility of endoscopic ultrasound (EUS) compared with standard white light endoscopy (WLE) following recent polypectomy of high-risk colorectal polyps is unknown. Objective: To assess the incremental yield of EUS after endoscopic polypectomy of a high-risk rectal lesion. Design: Retrospective cohort. Setting: Tertiary referral center. Materials and Methods: Patients referred for EUS following attempted endoscopic resection of a high-risk rectal neoplasm, defined as a tubulovillous adenoma, tubular adenoma with high-grade dysplasia, carcinoid, carcinoma in-situ or adenocarcinoma (CA). Interventions: Sigmoidoscopy ± mucosal biopsy and EUS ± fine-needle aspiration (FNA) to evaluate for: (1) Residual polyp/tumor in the rectal wall or (2) peritumoral adenopathy. Main Outcome: Sensitivity and specificity for detection of residual neoplasia for WLE ± biopsy (WLE/BX) and EUS ± FNA for cancer (CA group) or benign disease (non-CA group). The incremental yield of EUS defined as: (1) Residual intramural neoplasia not present on WLE ± BX and; (2) abnormal peritumoral adenopathy. Results: A total of 70 patients (mean age 64 ± 11 years, 61% male) with a final diagnosis of CA (n = 38) and non-CA (n = 32) were identified. There was no difference between the sensitivity and specificity of WLE alone (65% and 84%), WLE with biopsy (71% and 95%), and EUS (59% and 84%), for the detection of residual neoplasia (P > 0.05 for all). EUS identified 3 masses missed by WLE, all in the CA group. A malignant (n = 2) or benign (n = 3) node was identified in 5 (13%) CA patients; EUS-FNA in two showed residual malignancy in one and a reactive lymph node (LN) in one. No LNs were identified in the non-CA patients. Limitations: Retrospective design, incomplete follow-up in some patients. Conclusion: Following endoscopic polypectomy of high-risk rectal neoplasia, the incremental yield of EUS compared with WLE/BX for evaluation of residual disease appears limited, especially in patients with benign disease.
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Affiliation(s)
- Leticia P Luz
- Medicine Service, Division of Gastroenterology, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA ; Department of Internal Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Gregory A Cote
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mohammad A Al-Haddad
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lee McHenry
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Julia K LeBlanc
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Stuart Sherman
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Ihab I El Hajj
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kathleen McGreevy
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - John DeWitt
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
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7
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Laghi A, Bellini D, Petrozza V, Piccazzo R, Santoro GA, Fabbri C, van der Paardt MP, Stoker J. Imaging of colorectal polyps and early rectal cancer. Colorectal Dis 2015; 17 Suppl 1:36-43. [PMID: 25511860 DOI: 10.1111/codi.12820] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- A Laghi
- Department of Radiological Sciences, Oncology and Pathology, "SAPIENZA" University of Rome, I.C.O.T. Hospital, Latina, Italy
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8
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Kim MJ. Transrectal ultrasonography of anorectal diseases: advantages and disadvantages. Ultrasonography 2014; 34:19-31. [PMID: 25492891 PMCID: PMC4282231 DOI: 10.14366/usg.14051] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 11/17/2014] [Accepted: 11/19/2014] [Indexed: 12/17/2022] Open
Abstract
Transrectal ultrasonography (TRUS) has been widely accepted as a popular imaging modality for evaluating the lower rectum, anal sphincters, and pelvic floor in patients with various anorectal diseases. It provides excellent visualization of the layers of the rectal wall and of the anatomy of the anal canal. TRUS is an accurate tool for the staging of primary rectal cancer, especially for early stages. Although magnetic resonance imaging is a modality complementary to TRUS with advantages for evaluating the mesorectum, external sphincter, and deep pelvic inflammation, three-dimensional ultrasonography improves the detection and characterization of perianal fistulas and therefore plays a crucial role in optimal treatment planning. The operator should be familiar with the anatomy of the rectum and pelvic structures relevant to the preoperative evaluation of rectal cancer and other anal canal diseases, and should have technical proficiency in the use of TRUS combined with an awareness of its limitations compared to magnetic resonance imaging.
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Affiliation(s)
- Min Ju Kim
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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Fuccio L, Attili F, Larghi A. Forward-viewing linear echoendoscope: a new option in the endoscopic ultrasound armamentarium (with video). JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2014; 22:27-34. [PMID: 25345848 DOI: 10.1002/jhbp.181] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The forward-viewing linear echoendoscope (FV-EUS) has been developed with the aim of overcoming limitations of standard curved linear-array echoendoscopes (CLA-EUS) and to further expand interventional applications of EUS. The main characteristic of the FV-EUS is a shifting in the orientation of both endoscopic and ultrasound views from oblique to forward, with the exit of the working channel at the tip of the instrument. This allows exit of the devices parallel to the longitudinal axis of the endoscope, thus resulting in a more direct and stable access to the lesion while increasing the precision and force applied to the target. Accumulating evidence has shown that the FV-EUS can be used instead of the standard CLA-EUS scope for routine fine needle aspiration, with extremely good performance for subepithelial lesions and for difficult to reach locations. Several areas of use of this echoendoscope are yet to be better defined, such as its potential for therapeutic and interventional procedures, as well as for natural orifice transluminal endoscopic surgery. The current report provides an updated overview of the available evidence for both diagnostic and interventional uses of the FV-EUS.
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Affiliation(s)
- Lorenzo Fuccio
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Nardi PD, Carvello M. How reliable is current imaging in restaging rectal cancer after neoadjuvant therapy? World J Gastroenterol 2013; 19:5964-5972. [PMID: 24106396 PMCID: PMC3785617 DOI: 10.3748/wjg.v19.i36.5964] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 05/21/2013] [Accepted: 07/17/2013] [Indexed: 02/06/2023] Open
Abstract
In patients with advanced rectal cancer, neoadjuvant chemo radiotherapy provides tumor downstaging and downsizing and complete pathological response in up to 30% of cases. After proctectomy complete pathological response is associated with low rates of local recurrence and excellent long term survival. Several authors claim a less invasive surgery or a non operative policy in patients with partial or clinical complete response respectively, however to identify patients with true complete pathological response before surgical resection remains a challenge. Current imaging techniques have been reported to be highly accurate in the primary staging of rectal cancer, however neoadjuvant therapy course produces deep modifications on cancer tissue and on surrounding structures such as overgrowth fibrosis, deep stroma alteration, wall thickness, muscle disarrangement, tumor necrosis, calcification, and inflammatory infiltration. As a result, the same imaging techniques, when used for restaging, are far less accurate. Local tumor extent may be overestimated or underestimated. The diagnostic accuracy of clinical examination, rectal ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography using 18F-fluoro-2'-deoxy-D-glucose ranges between 25% and 75% being less than 60% in most studies, both for rectal wall invasion and for lymph nodes involvement. In particular the ability to predict complete pathological response, in order to tailor the surgical approach, remains low. Due to the radio-induced tissue modifications, combined with imaging technical aspects, low rate accuracy is achieved, making modern imaging techniques still unreliable in restaging rectal cancer after chemo-radiotherapy.
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Use of a convex probe-endobronchial US endoscope in EUS of the rectum and FNA. Gastrointest Endosc 2013; 77:157-9. [PMID: 23261110 DOI: 10.1016/j.gie.2012.08.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 08/27/2012] [Indexed: 12/11/2022]
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Du P, Duan WM, Jin HQ, Liu D. Role of endoscopic ultrasonography in the staging and treatment of colorectal carcinoma. Shijie Huaren Xiaohua Zazhi 2012; 20:2638-2641. [DOI: 10.11569/wcjd.v20.i27.2638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the use of endoscopic ultrasonography (EUS) in the staging and treatment of colorectal carcinoma.
METHODS: Fifty-six patients who were diagnosed with colorectal cancer by endoscopic biopsy in our department underwent EUS staging (TN). According to the results of EUS staging, the patients were treated with surgery. After postoperative pathologic staging, the patients with stage 2 and stage 3 disease were given adjuvant chemotherapy. Using postoperative pathology as a gold standard, the accuracy of EUS staging was calculated. The patients were followed for over two years and the rate of recurrence was calculated.
RESULTS: The accuracy rates of uT staging for colorectal cancer were 88.89% (T1), 83.33% (T2), 85.71% (T3), and 75.00% (T4), and the total accuracy rate of uT staging for colorectal cancer is 83.23%. The accuracy rates of uN staging were 81.25% (uN(+)) and 80% (uN(-)), and the total accuracy rate of uN staging is 80.63%. Six (10.71%) patients had recurrence.
CONCLUSION: EUS is useful for the staging and treatment of colorectal cancer.
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Fernández-Esparrach G, Ayuso-Colella JR, Sendino O, Pagés M, Cuatrecasas M, Pellisé M, Maurel J, Ayuso-Colella C, González-Suárez B, Llach J, Castells A, Ginès A. EUS and magnetic resonance imaging in the staging of rectal cancer: a prospective and comparative study. Gastrointest Endosc 2011; 74:347-54. [PMID: 21802588 DOI: 10.1016/j.gie.2011.03.1257] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 03/30/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND Accurate locoregional staging is crucial in rectal cancer for deciding patient management because the administration of neoadjuvant therapy depends on it. EUS and magnetic resonance imaging (MRI) are used indistinctly in the pretherapeutic workup of rectal cancer. OBJECTIVE To prospectively compare the performance of EUS and MRI in the locoregional staging of rectal cancer in a large series of patients. DESIGN Prospective and comparative study. SETTING Tertiary center. PATIENTS Patients with histologically proven rectal cancer. INTERVENTIONS EUS and MRI were performed in all patients by a different operator unaware of the results of the other procedure. MAIN OUTCOME MEASUREMENTS Epidemiological, clinical, radiological, and echographic variables were evaluated. Pathological examination of the surgical specimen was used as the criterion standard. RESULTS Ninety patients (54 men and 36 women with a mean age of 68 ± 12 years; range 33-87 years) constitute the final sample of this study. Most of the tumors were stages T2-T3 (85%; 95% CI, 77%-92%). Twenty of them (22%; 95% CI, 14%-32%) were stenotic and 24 (27%; 95% CI, 18%-37%) had polypoid morphology. The accuracy of T staging was very similar for EUS and MRI for stage T2 (76%; 95% CI, 65%-84% and 77%; 95% CI, 67%-85%, respectively; P = not significant) and stage T3 (76%; 95% CI, 65%-84% and 83%, 95% CI, 73%-90%, respectively; P = not significant). MRI was not able to visualize any T1 tumor, whereas EUS understaged all T4 tumors. The univariate analysis showed that the polypoid morphology of the tumor inversely correlated with T staging on MRI. The accuracy of MRI for N staging was higher than that of EUS, although the difference did not reach statistical significance (79%; 95% CI, 65%-88% and 65%; 95% CI, 51%-78%, respectively). When performing the univariate analysis to assess the reasons for this difference, the presence of a stenotic tumor was the only parameter significantly related to a poorer performance of EUS in N staging. LIMITATIONS The small number of early and locally advanced lesions. CONCLUSIONS EUS and MRI have similar accuracy in the T and N staging in rectal cancer. The presence of stenosis and polypoid morphology is inversely associated with accuracy for either EUS or MRI.
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Affiliation(s)
- Glòria Fernández-Esparrach
- Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, IDIBAPS, CIBERehd, Hospital Clínic, University of Barcelona, Barcelona, Spain
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Uchida N, Galasso D, Seerden TC, Carnuccio A, Zachariah K, Costamagna G, Larghi A. EUS-FNA of extracolonic lesions by using the forward-viewing linear echoendoscope. Gastrointest Endosc 2010; 72:1321-3. [PMID: 20579992 DOI: 10.1016/j.gie.2010.03.1068] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 03/12/2010] [Indexed: 01/16/2023]
MESH Headings
- Adenocarcinoma/diagnosis
- Adenocarcinoma/pathology
- Adenocarcinoma/surgery
- Adult
- Aged
- Biopsy, Fine-Needle/instrumentation
- Cecal Neoplasms/diagnosis
- Cecal Neoplasms/pathology
- Cecal Neoplasms/surgery
- Colonic Diseases/diagnosis
- Colonic Diseases/pathology
- Colonic Diseases/surgery
- Colostomy
- Diagnosis, Differential
- Endometriosis/diagnosis
- Endometriosis/pathology
- Endometriosis/surgery
- Endoscopes, Gastrointestinal
- Endosonography/instrumentation
- Female
- Hodgkin Disease/diagnosis
- Hodgkin Disease/pathology
- Hodgkin Disease/surgery
- Humans
- Lymph Nodes/pathology
- Lymphatic Metastasis/pathology
- Mediastinal Neoplasms/diagnosis
- Mediastinal Neoplasms/pathology
- Mediastinal Neoplasms/surgery
- Neoplasm Recurrence, Local/diagnosis
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/surgery
- Neoplasms, Multiple Primary/diagnosis
- Neoplasms, Multiple Primary/pathology
- Neoplasms, Multiple Primary/surgery
- Rectal Neoplasms/diagnosis
- Rectal Neoplasms/pathology
- Rectal Neoplasms/surgery
- Tomography, X-Ray Computed
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Affiliation(s)
- Naohito Uchida
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
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15
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Nguyen-Tang T, Shah JN, Sanchez-Yague A, Binmoeller KF. Use of the front-view forward-array echoendoscope to evaluate right colonic subepithelial lesions. Gastrointest Endosc 2010; 72:606-10. [PMID: 20561620 DOI: 10.1016/j.gie.2010.03.1126] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Accepted: 03/25/2010] [Indexed: 02/08/2023]
Abstract
BACKGROUND Endosonographic evaluation and sampling of right colonic subepithelial lesions is technically difficult. OBJECTIVE To evaluate the feasibility, safety, and tissue yield of a prototype front-view, forward-array, curved linear array echoendoscope in the evaluation and sampling of right colonic subepithelial lesions. SETTING Tertiary referral center. DESIGN Procedural and outcome data on all patients undergoing EUS evaluation of right-sided colonic and pericolonic lesions were collected during a 1-year study period. MAIN OUTCOME MEASUREMENTS Patient demographics, clinical indication, EUS findings, EUS-FNA yield, technical success, and procedural complications. RESULTS A total of 15 patients underwent EUS examination of right-sided colonic lesions with the prototype echoendoscope. The lesions were located in the cecum (n = 12) and the ascending colon (n = 3). The cecum was reached in all examinations within 10 minutes. Twelve patients had subepithelial lesions detected during colonoscopy. Findings included 6 extrinsic compressions from an adjacent normal structure, 1 calcified lymph node, 1 ovarian cyst, 1 prolapsed appendiceal orifice, 1 GI stromal tumor, 1 appendiceal mucocele, and 1 lymphoma. Two patients were evaluated for a pericolonic lesion seen on CT; findings included focal diverticulitis and a metastatic lymph node. In the patient evaluated for an infiltrative mass with previous nondiagnostic biopsies, colonic histoplasmosis was diagnosed. FNA was performed in 6 patients and provided diagnostic samples in 5 (83%). No procedure- or FNA-related complications were reported. CONCLUSIONS Endosonographic evaluation and sampling of right-sided colonic subepithelial lesions with the prototype front-view, forward-array, curved linear array echoendoscope is feasible and safe. The yield of FNA is high, consistent with applications in the upper GI tract.
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Affiliation(s)
- Thai Nguyen-Tang
- Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California 94115, USA
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16
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Safety, feasibility, and usefulness of rectal endoscopic ultrasonography for pediatric anal and perianal complaints. J Pediatr Gastroenterol Nutr 2010; 51:93-5. [PMID: 20410843 DOI: 10.1097/mpg.0b013e3181c2c125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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17
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Edelman BR, Weiser MR. Endorectal ultrasound: its role in the diagnosis and treatment of rectal cancer. Clin Colon Rectal Surg 2010; 21:167-77. [PMID: 20011415 DOI: 10.1055/s-2008-1080996] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
With development over the past 25 years of new surgical techniques and neoadjuvant therapy regimens for rectal cancer, physicians now have a range of treatment options that minimize morbidity and maximize the potential for cure. Accurate pretreatment staging is critical, ensuring adequate therapy and preventing overtreatment. Many options exist for staging primary rectal cancer. However, endorectal ultrasound (ERUS) remains the most attractive modality. It is an extension of the physical examination, and can be performed easily in the office. It is cost effective and is generally well tolerated by the patient, without need for general anesthesia. The authors discuss the data currently available on ERUS, including its accuracy and limitations, as well as the technical aspects of performing ERUS and interpreting the results. They also discuss new ultrasound technologies, which may improve rectal cancer staging in the future.
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Affiliation(s)
- Bret R Edelman
- Colorectal Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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18
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Endoscopic balloon dilation for obstructive colorectal cancer: a basic study on morphologic and pathologic features associated with perforation. Gastrointest Endosc 2010; 71:799-805. [PMID: 20363422 DOI: 10.1016/j.gie.2009.10.059] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2009] [Accepted: 10/27/2009] [Indexed: 02/08/2023]
Abstract
BACKGROUND The use of endoscopic dilation and a self-expandable stent for colorectal cancer (CRC) presenting with a stricture or obstruction, either prior to surgery or as a palliative measure (an alternative to colostomy), causes perforation with relative high incidence (1%-17%). OBJECTIVE To experimentally investigate risk factors associated with perforation in excised CRC specimens. DESIGN Experimental study. SETTING Ex vivo experiment on freshly excised human colon cancer specimens at an academic hospital. PATIENTS This study involved 47 patients with strictured CRCs of <15 mm in internal diameter as assessed by a preoperative contrast enema. INTERVENTION Immediately after surgical resection, a balloon with a diameter of 18 mm was placed in the stricture. The balloon was inflated slowly with hydrostatic pressure over 1 minute and kept at the maximum diameter for 1 minute. MAIN OUTCOME MEASUREMENTS Correlations between macroscopic perforation and 20 items, including morphological and histopathological characteristics. RESULTS Perforation occurred in 8 of 47 (17.0%) CRC specimens. Four items showed statistically significant (P < .05) correlations with perforation: peritumoral proliferation of collagen fibers (relative area > or =23.9% in the visual field), annularity of the tumor, severe stricture (<7.9 mm), and fewer residual smooth muscle cells in the muscularis propria, reflecting tumor encroachment. The best predictor of perforation was a combination of severe stricture and pronounced peritumoral proliferation of collagen fibers. LIMITATIONS An uncontrolled study with a small number of patients. CONCLUSION Histopathological and morphological items associated with a decrease in elastic compliance were more important as predictors of perforation than dilation procedure parameters, such as balloon pressure.
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19
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Abstract
It is essential in treating rectal cancer to have adequate preoperative imaging, as accurate staging can influence the management strategy, type of resection, and candidacy for neoadjuvant therapy. In the last twenty years, endorectal ultrasound (ERUS) has become the primary method for locoregional staging of rectal cancer. ERUS is the most accurate modality for assessing local depth of invasion of rectal carcinoma into the rectal wall layers (T stage). Lower accuracy for T2 tumors is commonly reported, which could lead to sonographic overstaging of T3 tumors following preoperative therapy. Unfortunately, ERUS is not as good for predicting nodal metastases as it is for tumor depth, which could be related to the unclear definition of nodal metastases. The use of multiple criteria might improve accuracy. Failure to evaluate nodal status could lead to inadequate surgical resection. ERUS can accurately distinguish early cancers from advanced ones, with a high detection rate of residual carcinoma in the rectal wall. ERUS is also useful for detection of local recurrence at the anastomosis site, which might require fine-needle aspiration of the tissue. Overstaging is more frequent than understaging, mostly due to inflammatory changes. Limitations of ERUS are operator and experience dependency, limited tolerance of patients, and limited range of depth of the transducer. The ERUS technique requires a learning curve for orientation and identification of images and planes. With sufficient time and effort, quality and accuracy of the ERUS procedure could be improved.
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20
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The use of endoscopic ultrasonography and other imaging modalities in the preoperative staging of rectal villous tumours: a case of overstaging by magnetic resonance imaging. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2009; 23:639-41. [PMID: 19816630 DOI: 10.1155/2009/750979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
A case of a 60-year-old man with recurrent rectal villous adenoma is described. Preoperative staging with endoscopic ultrasound (EUS) and magnetic resonance imaging (MRI) revealed very discordant results. EUS showed a tumour present in the mucosa with no submucosal invasion, while MRI revealed invasion of the muscularis propria consistent with an invasive stage T2 carcinoma. Based on the MRI findings, the patient underwent a low anterior resection of the tumour. The surgical pathology specimen revealed a villous adenoma with lowgrade dysplasia but no carcinoma and no extension into the muscularis propria. The present case highlights the uncertainty that currently exists as to which imaging modality provides the greatest accuracy in the staging of rectal cancer and in guiding the type of surgical procedure performed. Two recent meta-analyses and a systematic review of the literature point to EUS as the imaging modality of choice for determining muscularis propria and perirectal tissue invasion, as well as nodal involvement.
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21
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Abstract
PURPOSE Radial transrectal ultrasound is the most frequently used method for preoperative staging of rectal cancer. Accuracy rates of transrectal ultrasound have fallen significantly to 64% and 70% for tumor and node staging, respectively. The use of a frontal probe may overcome the drawbacks of radial transrectal ultrasound. This study was designed to compare the accuracy of frontal transrectal ultrasound performed with a frontal probe with the classic procedure, which uses a radial probe, in the preoperative T and N staging of rectal cancer. METHODS Seventy-four patients with rectal adenocarcinoma underwent both techniques. Thirty patients had a neoadjuvant treatment. The staging accuracy of both methods was determined by comparing the results of each with the findings of surgical histopathologic evaluation. RESULTS Forty-six men and 28 women were recruited. Frontal transrectal ultrasound was performed in all patients. Staging was amenable in only 58 patients with the radial transrectal ultrasound because the tumors were either stenotic or too proximal. Frontal transrectal ultrasound was accurate in the T staging of 89% of the tumors, whereas radial transrectal ultrasound was accurate in only 69% (P = 0.004). The difference was even more significant when we compared accuracy among the 58 patients in whom both examinations were completed (P = 0.002). Both methods had similar accuracy for lymph node staging. Neoadjuvant treatment had no influence on accuracy. No overstaging of the tumor occurred with the frontal transrectal ultrasound. Understaging was more frequently encountered with radial transrectal ultrasound than with frontal transrectal ultrasound (26% vs. 11%, respectively; P = 0.036). CONCLUSION Compared with radial transrectal ultrasound, frontal transrectal ultrasound has a better accuracy for T staging of rectal cancer. Its advantage in overcoming the drawbacks of radial transrectal ultrasound may make this procedure the method of choice for rectal cancer staging.
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22
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Rovera F, Dionigi G, Boni L, Cutaia S, Diurni M, Dionigi R. The role of EUS and MRI in rectal cancer staging. Surg Oncol 2007; 16 Suppl 1:S51-2. [PMID: 18032030 DOI: 10.1016/j.suronc.2007.10.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Rectal cancer continues to be one of the most common tumors worldwide. Its prognosis mainly depends on early diagnosis and precise stage evaluation in order to choose the most effective treatment. In recent years, new and promising technologies have been proposed and are now available in daily practice. Each rectal cancer patient should be considered individually, choosing the diagnostic pretreatment exams that are appropriate for that single clinical case mainly related to the tumor and the available instruments. Clinicians must be informed about the efficacy of these technologies and be aware of any cause of mistake in tumor staging in order to reduce the risk of both improper use and inaccurate staging.
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Affiliation(s)
- F Rovera
- Department of Surgical Sciences, University of Insubria, 21100 Varese, Italy.
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23
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Abstract
At present, several modalities exist for the preoperative staging of rectal lesions, including computed tomography (CT), body coil or endorectal coil magnetic resonance imaging (MRI), endoscopic ultrasonography (EUS) done by rigid or flexible probes, and positron emission tomography (PET). Staging accuracy for CT ranges from 53% to 94% for T-stage accuracy and from 54% to 70% for N-stage accuracy. Improved CT accuracy is observed at higher disease stages. Body coil MRI has shown T- and N-stage accuracy ranging from 59% to 95% and 39% to 95%, respectively. Endorectal coil MRI has shown improved T- and N-stage accuracy, with rates of 66% to 91% and 72% to 79%, respectively. The development of phased-array MRI, combining high spatial resolution with a larger field of view, offers promise to improve on these rates. EUS, considered the current gold standard, has shown T-stage accuracy ranging from 75% to 95%, with N-stage accuracy ranging from 65% to 80%. Flexible EUS probes have the advantage of being able to access and sample iliac nodes. Recent studies also suggest that three-dimensional EUS may provide greater accuracy than conventional two-dimensional EUS. Limited studies exist on the use of PET in primary tumor staging. PET may upstage disease in 8% to 24% of patients and has also been used in posttreatment restaging and surveillance. Postradiation edema, necrosis, and fibrosis seem to decrease restaging accuracy in all modalities. This article reviews the current literature about the staging accuracy of the various modalities and suggests a staging algorithm for rectal cancer.
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Affiliation(s)
- V Raman Muthusamy
- H H Chao Comprehensive Digestive Disease Center, Chao Family Comprehensive Cancer Center, Department of Medicine, University of California, Irvine Medical Center, Orange, CA 92868, USA
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24
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Wu MH, Pan HA, Chang FM. Three-dimensional and Power Doppler Ultrasonography in Infertility and Reproductive Endocrinology. Taiwan J Obstet Gynecol 2007; 46:209-14. [DOI: 10.1016/s1028-4559(08)60022-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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25
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Rovera F, Dionigi G, Iosca S, Carrafiello G, Recaldini C, Boni L, Carcano G, Diurni M, Dionigi R. Preoperative assessment of rectal cancer stage: state of the art. Expert Rev Med Devices 2007; 4:517-22. [PMID: 17605687 DOI: 10.1586/17434440.4.4.517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Rectal cancer is one of the most common tumors worldwide; it accounts for approximately 25-30% of cancers arising in the large bowel. Owing to greater distribution of screening programs and better attention from both patients and General Practitioners to this disease, in recent years we have observed an increasing number of cases diagnosed in the early stages, with a consequent better prognosis. The improved 5-year survival is also partially due to better, and more accurate, diagnostic techniques and to more curative treatments. In this review, the authors analyze and discuss the more recent diagnostic techniques for an accurate preoperative staging of rectal cancer, highlighting each method's advantages and limits for their routine use in clinical practice.
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Affiliation(s)
- Francesca Rovera
- Clinical Lecturer, Department of Surgical Sciences, University of Insubria, Azienda Ospedaliero-Universitaria, Fondazione Macchi, Viale Borri 57, 21100 Varese, Italy.
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