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©The Author(s) 2015.
World J Gastrointest Endosc. Jun 25, 2015; 7(7): 688-701
Published online Jun 25, 2015. doi: 10.4253/wjge.v7.i7.688
Published online Jun 25, 2015. doi: 10.4253/wjge.v7.i7.688
Table 1 The 2010 AJCC staging system for primary rectal cancer
Primary tumor (T) | |
TX | Primary tumor cannot be assessed |
T0 | No evidence of primary tumor |
Tis | Carcinoma in situ: Intraepithelial or invasion of lamina propria |
T1 | Tumor invades submucosa |
T2 | Tumor invades muscularis propria |
T3 | Tumor invades through the muscularis propria into pericolorectal tissues |
T4a | Tumor penetrates to the surface of the visceral peritoneum |
T4b | Tumor directly invades or is adherent to other organs or structures |
Regional lymph nodes (N) | |
NX | Regional lymph nodes cannot be assessed |
N0 | No regional nodal metastasis |
N1 | Metastasis in 1-3 regional lymph nodes |
N1a | Metastasis in one regional lymph node |
N1b | Metastasis in 2-3 regional lymph nodes |
N1c | Tumor deposit(s) in the subserosa, mesentery, or non-peritonealized pericolic or perirectal tissues without regional nodal metastasis |
N2 | Metastasis in 4 or more regional lymph nodes |
N2a | Metastasis in 4-6 regional lymph nodes |
N2b | Metastasis in 7 or more regional lymph nodes |
Distant metastasis (M) | |
M0 | No distant metastasis |
M1 | Distant metastasis |
M1a | Metastasis confined to one organ or site (i.e., liver, lung, ovary, non-regional node) |
M1b | Metastases in more than one organ/site or the peritoneum |
Table 2 Therapeutic strategy
cT1 cT2 cN0 cCRM- | Surgery alone |
Any cT cN+ cT2 cT3 cN0 cCRM+ | CRT |
cT2 cT3 cN0 cCRM- | SCRT |
Table 3 T staging (uT) of rectal cancer at endoscopic ultrasound, according to the infiltration depth
uT1 = tumor invasion limited to the mucosa and the submucosa; this is further divided into T1m, if the tumor infiltrates the mucosa, with normal muscolaris mucosa, and T1sm, when there is submucosal invasion (Figures 1 and 7) |
uT2 = tumor infiltration of the muscolaris propria, with the tumor mass extended through the first 4 layers of the rectal wall. The outer layer corresponding to the muscolaris propria is smooth, meaning that the tumor is still limited to the rectal wall (Figure 2) |
uT3 = tumor invasion of the perirectal fat, with an irregular 4th layer, which means that the tumor has spread outside the rectal wall (Figures 3 and 4) |
uT4 = tumor infiltration of adjacent structures and organs, which are strictly connected to the rectal hypoechoic mass (Figure 5) |
Table 4 Endoscopic ultrasound accuracy of T and N stage of rectal cancer
Ref. | Ptsno. | TStage | NStage | P/R | Tipe of EUS probe |
Saitoh et al[13] | 88 | 90% | 75% | - | Flexible, radial, (7 MHz) Rigid, radial (5-7.5 MHz) |
Feifel et al[14] | 79 | 89% | - | P | Rigid, linear (3-7 MHz) |
Yamashita et al[15] | 122 | 78% | - | R | Rigid, linear (5.5-7 MHz) |
Beynon et al[16] | 100 | 93% | 83% | - | Rigid |
Rifkin et al[17] | 102 | 72% | 81% | Rigid, radial (7 MHz) | |
Hildebrandt et al[18] | 113 | - | 78% | P | Rigid, radial (7 MHz) |
Tio et al[19] | 91 | 88% | - | - | Rigid |
Katsura et al[20] | 120 | 92% | - | Rigid, radial, (7 MHz) | |
Glaser et al[21] | 154 | 86% | 81% | P | Rigid, radial (7 MHz) |
Herzog et al[22] | 118 | 89% | 80% | P | Rigid, radial (7 MHz) |
Cho et al[23] | 76 | 82% | 70% | P | Flexible, radial (7 MHz) |
Thaler et al[24] | 36 | 88% | 80% | P | Rotating wall transducer IR 1510 AKTM (Kretz) (5, 7.5, 10 MHz) |
Nielson et al[25] | 100 | 85% | - | - | Probe (7 MHz) |
Sailer et al[26] | 160 | 77% | 83% | P | Rigid |
Nishimori et al[27] | 70 | 76% | 69% | Flexible | |
Norton et al[28] | 121 | 92% | 65% | P | Flexible, radial (7.5-12 MHz) |
Kim et al[29] | 89 | 81% | 63% | Rotating transducer (7.5 MHz) | |
Marone et al[30] | 63 | 81% | 70% | R | Flexible, radial (7.5-12 MHz) |
Akasu et al[31] | 154 | 96% | 72% | R | Flexible, radial (7.5-12 MHz |
Garcia-Aquilar et al[32] | 545 | 69% | 64% | P | Rigid, radial (7-10 MHz) |
Harewood et al[12] | 80 | 91% | 82% | P | Flexible, radial (7.5-12 MHz) |
Marusch et al[33] | 422 | 63% | - | P | Rigid |
Kauer et al[34] | 458 | 69% | 68% | R | Probe (7.5-10 MHz ) |
Vila et al[35] | 120 | 83% | 72% | P | Flexible, radial |
Landman et al[36] | 938 | - | 70% | P | Probe (10 MHz) |
Halefoglu et al[37] | 34 | 85% | 76% | P | Probe (7-10 MHz) |
Lin et al[38] | 192 | 86% | 78% | P | Flexible, radial (7.5-12 MHz) |
Fernández-Esparrach et al[39] | 90 | 95% | 65% | P | Flexible, radial (5-20 MHz) |
Ünsal et al[40] | 31 | 80% | 70% | R | Radial |
Zhu et al[41] | 110 | 91% | 85% | - | Rigid, radial (5-10 MHz) |
4976 | |||||
Mean | 84 | 74 | |||
Range | 63-96 | 63-85 |
Table 5 Accuracy of endoscopic ultrasound for each single T stage
Table 6 N staging at endoscopic ultrasound, according to the number of metastatic lymph nodes
uN1 = 1-3 positive nodes |
uN2 = More than 4 metastatic lymph nodes |
Table 7 Accuracy of endoscopic ultrasound in staging locally advanced rectal cancer after chemo-radiation
- Citation: Marone P, Bellis M, 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(7): 688-701
- URL: https://www.wjgnet.com/1948-5190/full/v7/i7/688.htm
- DOI: https://dx.doi.org/10.4253/wjge.v7.i7.688