|
1
|
Rafaelsen SR, Vagn-Hansen C, Sørensen T, Pløen J, Jakobsen A. Transrectal ultrasound and magnetic resonance imaging measurement of extramural tumor spread in rectal cancer. World J Gastroenterol 2012; 18:5021-6. [PMID: 23049209 PMCID: PMC3460327 DOI: 10.3748/wjg.v18.i36.5021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 07/26/2012] [Accepted: 07/29/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the agreement between transrectal ultrasound (TRUS) and magnetic resonance imaging (MRI) in classification of ≥ T3 rectal tumors.
METHODS: From January 2010 to January 2012, 86 consecutive patients with ≥ T3 tumors were included in this study. The mean age of the patients was 66.4 years (range: 26-91 years). The tumors were all ≥ T3 on TRUS. The sub-classification was defined by the penetration of the rectal wall: a: 0 to 1 mm; b: 1-5 mm; c: 6-15; d: > 15 mm. Early tumors as ab (≤ 5 mm) and advanced tumors as cd (> 5 mm). All patients underwent TRUS using a 6.5 MHz transrectal transducer. The MRI was performed with a 1.5 T Philips unit. The TRUS findings were blinded to the radiologist performing the interpretation of the MRI images and measuring the depth of extramural tumor spread.
RESULTS: TRUS found 51 patients to have an early ≥ T3 tumors and 35 to have an advanced tumor, whereas MRI categorized 48 as early ≥ T3 tumors and 38 as advanced tumors. No patients with tumors classified as advanced by TRUS were found to be early on MRI. The kappa value in classifying early versus advanced T3 rectal tumors was 0.93 (95% CI: 0.85-1.00). We found a kappa value of 0.74 (95% CI: 0.63-0.86) for the total sub-classification between the two methods. The mean maximal tumor outgrowth measured by TRUS, 5.5 mm ± 5.63 mm and on MRI, 6.3 mm ± 6.18 mm, P = 0.004. In 19 of the 86 patients the following CT scan or surgery revealed distant metastases; of the 51 patients in the ultrasound ab group three (5.9%) had metastases, whereas 16 (45.7%) of 35 in the cd group harbored distant metastases, P = 0.00002. The odds ratio of having distant metastases in the ultrasound cd group compared to the ab group was 13.5 (95% CI: 3.5-51.6), P = 0.00002. The mean maximal ultrasound measured outgrowth was 4.3 mm (95% CI: 3.2-5.5 mm) in patients without distant metastases, while the mean maximal outgrowth was 9.5 mm (95% CI: 6.2-12.8 mm) in the patients with metastases, P = 0.00004. Using the MRI classification three (6.3%) of 48 in the MRI ab group had distant metastases, while 16 (42.1%) of the 38 in the MRI cd group, P = 0.00004. The MRI odds ratio was 10.9 (95% CI: 2.9-41.4), P = 0.00008. The mean maximal MRI measured outgrowth was 4.9 mm (95% CI: 3.7-6.1 mm) in patients without distant metastases, while the mean maximal outgrowth was 11.5 mm (95% CI: 7.8-15.2 mm) in the patients with metastases, P = 0.000006.
CONCLUSION: There is good agreement between TRUS and MRI in the pretreatment sub-classification of ≥ T3 tumors. Distant metastases are more frequent in the advanced group.
Collapse
|
|
2
|
Bipat S, Zwinderman AH, Bossuyt PMM, Stoker J. Multivariate random-effects approach: for meta-analysis of cancer staging studies. Acad Radiol 2007; 14:974-84. [PMID: 17659244 DOI: 10.1016/j.acra.2007.05.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Revised: 05/08/2007] [Accepted: 05/08/2007] [Indexed: 12/12/2022]
Abstract
RATIONALE AND OBJECTIVES Meta-analyses of diagnostic accuracy studies produce summary estimates of sensitivity and specificity. Cancer staging relies on staging systems and meta-analysis is often performed after dichotomization of the staging results. For each dichotomization, summary estimates of sensitivity and specificity can be calculated by repeated bivariate random-effects analyses. In this process, staging information is lost and under- and overstaging can not be adequately expressed. MATERIALS AND METHODS We propose a new multivariate random-effects approach, which is an extension of the bivariate random-effects approach. To illustrate the principles and outcomes of both approaches, we used data from a meta-analysisevaluating endoluminal ultrasonography in staging of rectal cancer. In the multivariate approach, results on correct staging and under- and overstaging were calculated. In addition, the results from this analysis were used to calculate sensitivity and specificity estimates for each dichotomization and these estimates were compared with the results of the repeated bivariate analyses. RESULTS By the multivariate analysis, results on correct staging and under- and overstaging were obtained. The sensitivity and specificity estimates for the dichotomizations, calculated from the results of this multivariate approach, were also comparable with the sensitivity and specificity estimates obtained by the repeated bivariate analyses. CONCLUSIONS The multivariate random-effects approach can be a useful meta-analytic method for summarizing cancer staging data presented in diagnostic accuracy studies.
Collapse
Affiliation(s)
- Shandra Bipat
- Department of Radiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
| | | | | | | |
Collapse
|
|
3
|
Lahaye MJ, Engelen SME, Nelemans PJ, Beets GL, van de Velde CJH, van Engelshoven JMA, Beets-Tan RGH. Imaging for Predicting the Risk Factors—the Circumferential Resection Margin and Nodal Disease—of Local Recurrence in Rectal Cancer: A Meta-Analysis. Semin Ultrasound CT MR 2005; 26:259-68. [PMID: 16152740 DOI: 10.1053/j.sult.2005.04.005] [Citation(s) in RCA: 196] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The aim of the present study was to conduct a meta-analysis of English literature on the accuracy of preoperative imaging in predicting the two most important risk factors for local recurrence in rectal cancer, the circumferential resection margin (CRM) and the nodal status (N-status). Articles published between 1985 and August 2004 that report on the diagnostic accuracy of endoluminal ultrasound (EUS), computed tomography (CT), or magnetic resonance imaging (MRI) in the evaluation of lymph node involvement were included. A similar search was done for the assessment of the circumferential resection margin in rectal cancer in the period from January 1985 till January 2005. The inclusion criteria were as follows: (1) more than 20 patients with histologically proven rectal cancer were included, (2) histology was used as the gold standard, and (3) results were given in a 2 x 2 contingency table or this table could otherwise be extracted from the article by two independent readers. Based on the results summary receiver operating characteristic (ROC) curves were constructed. Only 7 articles matching inclusion criteria were found concerning the CRM. The meta-analysis shows that MRI is rather accurate in diagnosing a close or involved CRM. For nodal status 84 articles could be included. The diagnostic odds ratio of EUS is estimated at 8.83. For MRI and CT, the diagnostic odds ratio are 6.53 and 5.86, respectively. The results show that EUS is slightly, but not significantly, better than MRI or CT for identification of nodal disease. There is no significant difference between the different modalities with respect to staging nodal status. At present, MRI is the only modality that predicts the circumferential resection margin with good accuracy, making it a good tool to identify high and low risk patients. Predicting the N-status remains a problem for the radiologist for every modality, although considering the new developments in MR imaging, this may change in the near future.
Collapse
Affiliation(s)
- M J Lahaye
- University Hospital Maastricht, Department of Radiology, P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
|
4
|
Davila RE, Rajan E, Adler D, Hirota WK, Jacobson BC, Leighton JA, Qureshi W, Zuckerman MJ, Fanelli R, Hambrick D, Baron TH, Faigel DO. ASGE guideline: the role of endoscopy in the diagnosis, staging, and management of colorectal cancer. Gastrointest Endosc 2005; 61:1-7. [PMID: 15672048 DOI: 10.1016/s0016-5107(04)02391-0] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This is one of a series of statements discussing the utilization of GI endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy prepared this text. In preparing this guideline, a MEDLINE literature search was performed, and additional references were obtained from the bibliographies of the identified articles and from recommendations of experts. When little or no data exist from well-designed prospective trials, emphasis is given to results from large series and reports from recognized experts. Guidelines for appropriate utilization of endoscopy are based on a critical review of the available data and expert consensus. Further controlled clinical studies are needed to clarify aspects of this statement and revision needed to clarify aspects of this statement and revision may be necessary as new data appear. Clinical consideration may justify a course of action at variance to the recommendations.
Collapse
|
|
5
|
Bipat S, Glas AS, Slors FJM, Zwinderman AH, Bossuyt PMM, Stoker J. Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging--a meta-analysis. Radiology 2004; 232:773-83. [PMID: 15273331 DOI: 10.1148/radiol.2323031368] [Citation(s) in RCA: 712] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To perform a meta-analysis to compare endoluminal ultrasonography (US), computed tomography (CT), and magnetic resonance (MR) imaging in rectal cancer staging. MATERIALS AND METHODS Relevant articles published between 1985 and 2002 were included if more than 20 patients were studied, histopathologic findings were the reference standard, and data were presented for 2 x 2 tables; articles were excluded if data were reported elsewhere in more detail. Two reviewers independently extracted data on study characteristics and results. Bivariate random-effects approach was used to obtain summary estimates of sensitivity and specificity for invasion of muscularis propria, perirectal tissue, and adjacent organs and for lymph node involvement. Summary receiver operating characteristic (ROC) curves were fitted for perirectal tissue invasion and lymph node involvement. RESULTS Ninety articles fulfilled all inclusion criteria. For muscularis propria invasion, US and MR imaging had similar sensitivities; specificity of US (86% [95% confidence interval [CI]: 80, 90]) was significantly higher than that of MR imaging (69% [95% CI: 52, 82]) (P =.02). For perirectal tissue invasion, sensitivity of US (90% [95% CI: 88, 92]) was significantly higher than that of CT (79% [95% CI: 74, 84]) (P <.001) and MR imaging (82% [95% CI: 74, 87]) (P =.003); specificities were comparable. For adjacent organ invasion and lymph node involvement, estimates for US, CT, and MR imaging were comparable. Summary ROC curve for US of perirectal tissue invasion showed better diagnostic accuracy than that of CT and MR imaging. Summary ROC curves for lymph node involvement showed no differences in accuracy. CONCLUSION For local invasion, endoluminal US was most accurate and can be helpful in screening patients for available therapeutic strategies.
Collapse
Affiliation(s)
- Shandra Bipat
- Department of Radiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | | | | | | | | | | |
Collapse
|
|
6
|
Ahmad NA, Kochman ML, Ginsberg GG. Endoscopic ultrasound and endoscopic mucosal resection for rectal cancers and villous adenomas. Hematol Oncol Clin North Am 2002; 16:897-906. [PMID: 12418054 DOI: 10.1016/s0889-8588(02)00038-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
EUS is the most accurate tool for local staging of rectal carcinoma. In addition to providing accurate T- and N-stages, EUS allows assessment of the internal and external anal sphincters. Accurate endosonographic staging directs the optimal method of management of rectal carcinoma, type of resection, and candidacy for neoadjuvant therapy. EMR may be applied to large rectal adenomas as an alternative to surgical resection in selected patients. EUS is important in discriminating lesions suitable for EMR.
Collapse
Affiliation(s)
- Nuzhat A Ahmad
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania Cancer Center, University of Pennsylvania Medical School, 3 Ravdin, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | | | | |
Collapse
|
|
7
|
Segura Cabral JM, Olveira Martín A, del Valle Hernández E. [Endoanal and endorectal echography]. GASTROENTEROLOGIA Y HEPATOLOGIA 2001; 24:135-42. [PMID: 11261225 DOI: 10.1016/s0210-5705(01)70141-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- J M Segura Cabral
- Servicio de Aparato Digestivo, Unidad de Ecografía, Hospital La Paz, Madrid
| | | | | |
Collapse
|
|
8
|
Mallery S, Dam JV. Colorectal cancer staging by endoscopic ultrasonography. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2000. [DOI: 10.1053/tg.2000.5433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
|
9
|
Massari M, De Simone M, Cioffi U, Rosso L, Chiarelli M, Gabrielli F. Value and limits of endorectal ultrasonography for preoperative staging of rectal carcinoma. SURGICAL LAPAROSCOPY & ENDOSCOPY 1998; 8:438-444. [PMID: 9864111 DOI: 10.1097/00019509-199812000-00008] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2024]
Abstract
In rectal cancer, the depth of tumor infiltration and metastatic involvement of lymph nodes are important prognostic factors. Endosonography of the rectum, combining the advantages of both endoscopy and sonography, provides information not available from other imaging diagnostic techniques. From January 1989 to December 1997, 85 patients affected by rectal carcinoma were submitted to preoperative evaluation with endorectal ultrasonography. In 75 cases the results obtained with the endosonography were compared to the histology of the resected specimens. Overall accuracy in staging depth of infiltration was 90.7%. Overstaging occurred in 4% of patients, whereas understaging occurred in 5.3%. In staging lymph nodal involvement, overall accuracy was 76%, sensitivity was 69.8%, specificity was 84.4%, positive predictive value was 85.7%, and negative predictive value was 67.5%. Endorectal ultrasound is a safe and accurate diagnostic method for staging both tumor invasion and lymph node metastatic involvement, and for selecting an appropriate surgical strategy in patients affected by rectal cancer.
Collapse
Affiliation(s)
- M Massari
- Department of General and Thoracic Surgery, University of Milan, Ospedale Maggiore Policlinico IRCCS, Italy
| | | | | | | | | | | |
Collapse
|
|
10
|
Sailer M, Leppert R, Bussen D, Fuchs KH, Thiede A. Influence of tumor position on accuracy of endorectal ultrasound staging. Dis Colon Rectum 1997; 40:1180-6. [PMID: 9336113 DOI: 10.1007/bf02055164] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
UNLABELLED Endorectal ultrasound is a well-established method of preoperative staging of rectal neoplastic lesions. PURPOSE This study was undertaken to evaluate whether tumor site (in terms of height) and position (with respect to the rectal circumference) have an influence on the reliability of endoluminal ultrasound staging. METHODS From January 1991 to May 1996, 154 consecutive patients with a total of 162 rectal tumors were examined preoperatively using endorectal ultrasound. Apart from staging all tumors using the uT/uN classification, tumor level and tumor position were recorded prospectively. Neoplasms were subdivided into low rectal (0-6 cm from the anal verge), mid rectal (7-12 cm), and higher lesions (> 12 cm). Furthermore, the lumen was divided into an anterior, left lateral, posterior, and right lateral position, and all tumors, apart from circular lesions (n = 9), were subclassified accordingly. RESULTS Overall, we found 40 (25 percent) adenomas, 15 (9 percent) T1, 29 (18 percent) T2, 67 (41 percent) T3, and 11 (7 percent) T4 lesions. Overall accuracy was 78 percent. Staging accuracy for low rectal tumors (n = 41) was 68 percent, whereas 76 and 88 percent of mid (n = 96) and high (n = 25) neoplasms were staged correctly, respectively. The difference was not statistically significant. With regard to position, 47 tumors were situated anteriorly (77 percent accuracy), 42 in the left lateral position (69 percent accuracy), 33 posteriorly (73 percent accuracy), and 31 in the right lateral position (81 percent accuracy). Differences did not reach statistical significance. CONCLUSION Endorectal ultrasound is currently the best method for preoperative assessment of the depth of infiltration of rectal tumors. However, rectal anatomy seems to affect staging accuracy in the lower rectum because the structure of the ampulla recti renders endosonographic examination more difficult. In addition, endosonographic layers are less well defined at this level. Both factors contribute to a lower reliability and predictive value of endorectal ultrasound staging in the lower rectum, although statistical significance was not reached in this study. On the other hand, tumor position with respect to rectal circumference does not influence the predictive value of endorectal ultrasound.
Collapse
Affiliation(s)
- M Sailer
- Surgical Department, University School of Medicine, Würzburg, Germany
| | | | | | | | | |
Collapse
|
|
11
|
Nielsen MB, Qvitzau S, Pedersen JF, Christiansen J. Endosonography for preoperative staging of rectal tumours. Acta Radiol 1996; 37:799-803. [PMID: 8915296 DOI: 10.1177/02841851960373p273] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim of this study was to evaluate the use of rectal endosonography for preoperative staging of tumour extension and lymph node involvement in rectal tumours. MATERIAL AND METHODS Over a 4-year period 100 patients with rectal tumours were studied with sonography using 7 MHz endoprobes. Tumour spread was assessed according to the TNM classification, and the number and maximum size of perirectal lymph nodes were registered. The sonographic findings were compared with the surgical and histological findings. RESULTS The overall accuracy of endosonography in assessing local tumour extension was 85% (76-91%; 95 percent confidence limits). T4 tumours with a large contact surface to an adjacent organ tended to be nonresectable. Lymph node assessment could be made in 81 patients who underwent radical resection: sonography showed lymph nodes in 49 patients, 30 of whom had nodal metastases; the histological examination showed lymph nodes in the remaining 32 patients, 8 of whom had nodal metastases. The number of lymph nodes at the histological examination was markedly higher than the number depicted by preoperative ultrasound. CONCLUSION This study confirmed the use of endoluminal ultrasound in the preoperative evaluation of local tumour spread. However, endosonographic assessment of perirectal nodal involvement seems to be too unreliable to be used for the preoperative selection of patients.
Collapse
Affiliation(s)
- M B Nielsen
- Department of Radiology and Ultrasound, Glostrup Hospital, University of Copenhagen, Denmark
| | | | | | | |
Collapse
|
|
12
|
Hünerbein M, Below C, Schlag PM. Three-dimensional endorectal ultrasonography for staging of obstructing rectal cancer. Dis Colon Rectum 1996; 39:636-42. [PMID: 8646949 DOI: 10.1007/bf02056942] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Preoperative staging of advanced carcinoma of the rectum by conventional endorectal ultrasonography is often impossible because of the presence of obstruction, which does not allow passage of the endoprobe. In a prospective study, we investigated the value of three-dimensional endorectal ultrasonography for staging of obstructing rectal cancer. This technique permits examination of obstructing rectal tumors because scan planes can be chosen deliberately within a scanned volume. METHODS Overall obstructing tumors not accessible for conventional endoprobes were found in 26 of 94 patients who were subjected to endorectal ultrasonography for staging of rectal cancer. Three-dimensional volume scanning was performed using a three-dimensional frontfire transducer or a three-dimensional bifocal multiplane transducer (7.5/10 MHz). Data of the three-dimensional scans were stored on a hard disk for subsequent evaluation with a combison 530 processor. RESULTS Three-dimensional transrectal endosonography enabled visualization of local tumor spread in all 26 patients. In 18 patients, obstruction was caused by advanced primary rectal carcinoma. Endosonography accurately determined the tumor infiltration depth in three T2 tumors, eight T3 tumors, and three T4 tumors. Overall accuracy for assessment of infiltration depth was 78 percent. Accuracy for assessment of perirectal lymph node involvement was 75 percent. In eight patients, the obstruction was attributable to extramural regrowth of rectal cancer after surgery. Diameter of the lesions ranged between 3 and 6 cm. Although all lesions were clearly depicted by three-dimensional endosonography, only five lesions (62 percent) were detected by computed tomography. CONCLUSIONS Three-dimensional endorectal ultrasonography provides previously unattainable scan planes and enables accurate staging of obstructing rectal tumors. This technique may improve therapy planning in advanced rectal cancer by selecting patients who require preoperative adjuvant therapy.
Collapse
Affiliation(s)
- M Hünerbein
- Department of Surgery, Robert-Rössle Hospital and Tumor Institute, Virchow Hospital, Humboldt University, Berlin, Germany
| | | | | |
Collapse
|
|
13
|
TAZUMA S, FUJITAKA T, TERAMEN K, KAWAGUCHP H, TSUCHIMOTO D, MIYAKE H, OKAJIMA M, ASAHARA T, KAJIYAMA G, DOHI K, ITO K. Efficacy of Endoscopic Ultrasonography in the Diagnosis of Lateral Lymphatic Spread in Rectal Cancer. Dig Endosc 1996. [DOI: 10.1111/j.1443-1661.1996.tb00407.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- Susumu TAZUMA
- Department of Radiology, Hiroshima University School of Medicine, Hiroshima, Japan
- First Department of Internal Medicine, Hiroshima University School of Medicine, Hiroshima, Japan
| | - Tsuguo FUJITAKA
- Second Department of Surgery, Hiroshima University School of Medicine, Hiroshima, Japan
| | - Kazushi TERAMEN
- First Department of Internal Medicine, Hiroshima University School of Medicine, Hiroshima, Japan
| | - Hiroyuki KAWAGUCHP
- Department of Radiology, Hiroshima University School of Medicine, Hiroshima, Japan
- First Department of Internal Medicine, Hiroshima University School of Medicine, Hiroshima, Japan
| | - Denya TSUCHIMOTO
- First Department of Internal Medicine, Hiroshima University School of Medicine, Hiroshima, Japan
| | - Hiroaki MIYAKE
- First Department of Internal Medicine, Hiroshima University School of Medicine, Hiroshima, Japan
| | - Masazumi OKAJIMA
- Second Department of Surgery, Hiroshima University School of Medicine, Hiroshima, Japan
| | - Toshimasa ASAHARA
- Second Department of Surgery, Hiroshima University School of Medicine, Hiroshima, Japan
| | - Goro KAJIYAMA
- First Department of Internal Medicine, Hiroshima University School of Medicine, Hiroshima, Japan
| | - Kiyohiko DOHI
- Second Department of Surgery, Hiroshima University School of Medicine, Hiroshima, Japan
| | - Katsuhide ITO
- Department of Radiology, Hiroshima University School of Medicine, Hiroshima, Japan
| |
Collapse
|
|
14
|
Fedyaev EB, Volkova EA, Kuznetsova EE. Transrectal and transvaginal ultrasonography in the preoperative staging of rectal carcinoma. Eur J Radiol 1995; 20:35-8. [PMID: 7556250 DOI: 10.1016/0720-048x(95)00616-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
To evaluate the diagnostic ability of transrectal and transvaginal ultrasonography (TRUS and TVUS), 132 patients with rectal carcinoma were examined. Analysis of the data obtained has shown that the high quality of endosonographic imaging allows the performance of detailed staging of rectal carcinoma. In the great majority of patients (91%) the staging was carried out correctly. Neoplastic invasion was overstaged in only five cases and understaged in another five cases. Altered pararectal lymph nodes could be visualized by endosonographic examination in 54.5% of patients.
Collapse
Affiliation(s)
- E B Fedyaev
- Research Institute of Medical Radiology, Russian Academy Medical Sciences, Obninsk
| | | | | |
Collapse
|
|
15
|
Solomon MJ, McLeod RS, Cohen EK, Simons ME, Wilson S. Reliability and validity studies of endoluminal ultrasonography for anorectal disorders. Dis Colon Rectum 1994; 37:546-51. [PMID: 8200232 DOI: 10.1007/bf02050988] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Endoluminal ultrasonography (ELUS) is accurate in the assessment of penetration through the rectal wall by carcinoma. Clinical studies were performed to determine the reliability and validity of ELUS. METHODS The interobserver reliability among four observers with varying experience with ELUS was determined for staging the penetration of rectal cancer through the rectal wall. The ability of ELUS to change the clinical management of the referring clinician (comprehensiveness) was assessed on all referrals over a six-month period. RESULTS The reliability of ELUS for staging rectal cancer demonstrated only fair to moderate correlation (weighted kappa range, 0.22-0.47). The accuracy of ELUS compared with surgical pathology demonstrated a learning curve proportional to the experience of the observer. In 45 percent of referrals, ELUS changed the clinical management of patients and in 76 percent of referrals the clinician's confidence in the diagnosis and management of patients was altered. ELUS was more likely to change the management of patients with pelvic pouch sepsis (70 percent) and early neoplastic lesions (57 percent) than in more advanced neoplastic lesions (40 percent), perianal Crohn's disease (40 percent), complex noninflammatory bowel disease sepsis (33 percent), and incontinence (31 percent). CONCLUSIONS ELUS has the ability to change the clinical management of a variety of anorectal conditions. However, for neoplasia the interobserver reliability is only moderate and a learning curve exists.
Collapse
Affiliation(s)
- M J Solomon
- Department of Surgery, University of Toronto, Canada
| | | | | | | | | |
Collapse
|
|
16
|
Buhre LM, Mulder NH, Oldhoff J, Szabó BG, Grond AJ, Verschueren RC. The clinical staging of rectal cancer in patients treated by preoperative radiotherapy. Clin Oncol (R Coll Radiol) 1994; 6:157-61. [PMID: 7522036 DOI: 10.1016/s0936-6555(94)80054-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We describe the results of clinical and (or) surgical staging used by the same surgeon to select a group of 41 patients with advanced rectal cancer for preoperative radiotherapy. Fifteen patients with resectable but advanced rectal cancer were subjected to a short course of radiotherapy (30 Gy in 10 days), immediately followed by resection. High dose preoperative radiotherapy (50-56 Gy in 5 weeks) was administered to 26 patients with borderline resectable or fixed cancer. Adequate resection of the tumour was possible in 21 of these 26 patients 4 weeks after the end of the radiotherapy. A total of 36 patients thus underwent resection after preoperative radiotherapy. No radiotherapy related acute or late morbidity was seen. On 31 December 1992 the results were investigated retrospectively. The median time since entering into the study was 87 months (range 27-141). During the follow-up, pelvic recurrence was detected in six patients; one patient had concomitant distant metastases. The local recurrence free survival at 5 years calculated by the Kaplan-Meier method was 72% (95% CI 58-85). Distant metastases without local recurrence developed in 11 patients. The calculated survival at 5 years was 45% (95% CI 30.5-59).
Collapse
Affiliation(s)
- L M Buhre
- Department of Surgery, University Hospital, Groningen, The Netherlands
| | | | | | | | | | | |
Collapse
|