Value of Endorectal Ultrasonography in Preoperative Staging of Rectal Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHONG Guangxi ¹ , DAI Qing ¹ , JIANG Yuxin ¹ , XIAO Yi ² , QIU Huizhong ²

1.Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China;;
2.Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China;

Corresponding author：

Keywords：

Rectal cancer; Endorectal ultrasonography; Preoperative staging

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Objective To determine the accuracy of endorectal ultrasonography (ERUS) in preoperative staging of rectal cancer and investigate the limitations and pitfalls of ERUS.
Methods Ninety-four patients with rectal cancer were examined preoperatively by ERUS between September 2008 and November 2009 in this hospital. The size, shape, echo pattern, infiltration depth, and extra-rectal invasion of lesions were observed. The results of ERUS staging were compared with histopathology findings of the resected specimens.
Results The overall accuracy of ERUS in T staging was 63.8% (60/94). The accuracies of ERUS for pT1, pT2, pT3, and pT4 tumor were 87.2% (82/94), 76.6% (72/94), 76.6% (72/94), and 97.9% (92/94), respectively. The sensitivity, specificity, and accuracy of ERUS for advanced rectal cancer (pT3+pT4) were 70.8% (34/48), 78.3% (36/46), and 74.5% (70/94), respectively. The sensitivity, specificity, and accuracy of ERUS in lymph node metastasis were 75.0% (42/56), 42.1% (16/38), and 61.7% (58/94), respectively. There was no significant difference of accuracy among various tumor locations above anocutaneous line (P＝0.495). The accuracy of ERUS for T staging improved with experience, the T staging accuracy improved from 40.0% after assessment of 30 cases to 81.3% after 94 cases were examined (P＝0.026).
Conclusions The ERUS provides a good accuracy rate for assessment of the depth of tumor invasion and lymph node metastasis of rectal cancer, and has become an important imaging tool for preoperative staging rectal cancer. The operator experience, peritumoral inflammation mainly influences the accuracy of ERUS.

Citation： ZHONG Guangxi ,DAI Qing,JIANG Yuxin,XIAO Yi,QIU Huizhong. Value of Endorectal Ultrasonography in Preoperative Staging of Rectal Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(9): 901-905. doi: Copy

1.	De Graaf EJ, Doornebosch PG, Tollenaar RA, et al. Transanal endoscopic microsurgery versus total mesorectal excision of T1 rectal adenocarcinomas with curative intention [J]. Eur J Surg Oncol, 2009; 35(12): 12801285.
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3.	Canda AE, Terzi C, Gorken IB, et al. Effects of preoperative chemoradiotherapy on anal sphincter functions and quality of life in rectal cancer patients [J]. Int J Colorectal Dis, 2010; 25(2): 197204.
4.	Brown G, Davies S, Williams GT, et al. Effectiveness of preoperative staging in rectal cancer: digital rectal examination, endoluminal ultrasound or magnetic resonance imaging? [J]. Br J Cancer, 2004; 91(1): 2329.
5.	Siddiqui AA, Fayiga Y, Huerta S. The role of endoscopic ultrasound in the evaluation of rectal cancer [J]. Int Semin Surg Oncol, 2006; (3): 3642.
6.	Beynon J, Foy DM, Roe AM, et al. Endoluminal ultrasound in the assessment of local invasion in rectal cancer [J]. Br J Surg, 1986; 73(6): 474477.
7.	Sobin LH, Wittekind C. International Union Against Cancer (UICC) TNM classification of malignant tumours [M]. 6th Ed. New York: WileyLiss, 2002: 99103.
8.	Zammit M, Jenkins JT, Urie A, et al. A technically difficult endorectal ultrasound is more likely to be inaccurate [J]. Colorectal Dis, 2005; 7(5): 486491.
9.	Badger SA, Devlin PB, Neilly PJ, et al. Preoperative staging of rectal carcinoma by endorectal ultrasound: is there a learning curve? [J]. Int J Colorectal Dis, 2007; 22(10): 12611268.
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11.	GarciaAguilar J, Pollack J, Lee SH, et al. Accuracy of endorectal ultrasonography in preoperative staging of rectal tumors [J]. Dis Colon Rectum, 2002; 45(1): 1015.
12.	Yamashita Y, Machi J, Shirouzu K, et al. Evaluation of endorectal ultrasound for the assessment of wall invasion of rectal cancer. Report of a case [J]. Dis Colon Rectum, 1988; 31(8): 617623.
13.	Maier AG, Barton PP, Neuhold NR, et al. Peritumoral tissue reaction at transrectal US as a possible cause of overstaging in rectal cancer: histopathologic correlation [J]. Radiology, 1997; 203(3): 785789.
14.	Sentovich SM, Blatchford GJ, Falk PM, et al. Transrectal ultrasound of rectal tumors [J]. Am J Surg, 1993; 166(6): 638641.
15.	Herzog U, von Flüe M, Tondelli P, et al. How accurate is endorectal ultrasound in the preoperative staging of rectal cancer? [J]. Dis Colon Rectum, 1993; 36(2): 127134.
16.	Sailer M, Leppert R, Bussen D, et al. Influence of tumor position on accuracy of endorectal ultrasound staging [J]. Dis Colon Rectum, 1997; 40(10): 11801186.
17.	Puli SR, Reddy JB, Bechtold ML, et al. Accuracy of endoscopic ultrasound to diagnose nodal invasion by rectal cancers: a metaanalysis and systematic review [J]. Ann Surg Oncol, 2009; 16(5): 12551265.
18.	陈晓靖, 兰凯, 汪晓东, 等. 多层螺旋CT和经直肠超声在直肠癌术前分期中价值 [J]. 中国普外基础与临床杂志, 2009; 16(9): 702705.
19.	Heriot AG, Grundy A, Kumar D. Preoperative staging of rectal carcinoma [J]. Br J Surg, 1999; 86(1): 1728.
20.	Hulsmans FH, Bosma A, Mulder PJ, et al. Perirectal lymph nodes in rectal cancer: in vitro correlation of sonographic parameters and histopathologic findings [J]. Radiology, 1992; 184(2): 553560.
21.	Carmody BJ, Otchy DP. Learning curve of transrectal ultrasound [J]. Dis Colon Rectum, 2000; 43(2): 193197.
22.	Mackay SG, Pager CK, Joseph D, et al. Assessment of the accuracy of transrectal ultrasonography in anorectal neoplasia [J]. Br J Surg, 2003; 90(3): 346350.
23.	Radovanovic Z, Breberina M, Petrovic T, et al. Accuracy of endorectal ultrasonography in staging locally advanced rectal cancer after preoperative chemoradiation [J]. Surg Endosc, 2008; 22(11): 24122415.
24.	Tankova L, Hadjieva T, Kovatchki D, et al. Endosonographic assessment of the response of rectal cancer to preoperative radiotherapy [J]. Hepatogastroenterology, 2009; 56(96): 16451650.

1. De Graaf EJ, Doornebosch PG, Tollenaar RA, et al. Transanal endoscopic microsurgery versus total mesorectal excision of T1 rectal adenocarcinomas with curative intention [J]. Eur J Surg Oncol, 2009; 35(12): 12801285.
2. Ferenschild FT, Dawson I, de Wilt JH, et al. Total mesorectal excision for rectal cancer in an unselected population: quality assessment in a low volume center [J]. Int J Colorectal Dis, 2009; 24(8): 923929.
3. Canda AE, Terzi C, Gorken IB, et al. Effects of preoperative chemoradiotherapy on anal sphincter functions and quality of life in rectal cancer patients [J]. Int J Colorectal Dis, 2010; 25(2): 197204.
4. Brown G, Davies S, Williams GT, et al. Effectiveness of preoperative staging in rectal cancer: digital rectal examination, endoluminal ultrasound or magnetic resonance imaging? [J]. Br J Cancer, 2004; 91(1): 2329.
5. Siddiqui AA, Fayiga Y, Huerta S. The role of endoscopic ultrasound in the evaluation of rectal cancer [J]. Int Semin Surg Oncol, 2006; (3): 3642.
6. Beynon J, Foy DM, Roe AM, et al. Endoluminal ultrasound in the assessment of local invasion in rectal cancer [J]. Br J Surg, 1986; 73(6): 474477.
7. Sobin LH, Wittekind C. International Union Against Cancer (UICC) TNM classification of malignant tumours [M]. 6th Ed. New York: WileyLiss, 2002: 99103.
8. Zammit M, Jenkins JT, Urie A, et al. A technically difficult endorectal ultrasound is more likely to be inaccurate [J]. Colorectal Dis, 2005; 7(5): 486491.
9. Badger SA, Devlin PB, Neilly PJ, et al. Preoperative staging of rectal carcinoma by endorectal ultrasound: is there a learning curve? [J]. Int J Colorectal Dis, 2007; 22(10): 12611268.
10. Puli SR, Bechtold ML, Reddy JB, et al. How good is endoscopic ultrasound in differentiating various T stages of rectal cancer? Metaanalysis and systematic review [J]. Ann Surg Oncol, 2009; 16(2): 254265.
11. GarciaAguilar J, Pollack J, Lee SH, et al. Accuracy of endorectal ultrasonography in preoperative staging of rectal tumors [J]. Dis Colon Rectum, 2002; 45(1): 1015.
12. Yamashita Y, Machi J, Shirouzu K, et al. Evaluation of endorectal ultrasound for the assessment of wall invasion of rectal cancer. Report of a case [J]. Dis Colon Rectum, 1988; 31(8): 617623.
13. Maier AG, Barton PP, Neuhold NR, et al. Peritumoral tissue reaction at transrectal US as a possible cause of overstaging in rectal cancer: histopathologic correlation [J]. Radiology, 1997; 203(3): 785789.
14. Sentovich SM, Blatchford GJ, Falk PM, et al. Transrectal ultrasound of rectal tumors [J]. Am J Surg, 1993; 166(6): 638641.
15. Herzog U, von Flüe M, Tondelli P, et al. How accurate is endorectal ultrasound in the preoperative staging of rectal cancer? [J]. Dis Colon Rectum, 1993; 36(2): 127134.
16. Sailer M, Leppert R, Bussen D, et al. Influence of tumor position on accuracy of endorectal ultrasound staging [J]. Dis Colon Rectum, 1997; 40(10): 11801186.
17. Puli SR, Reddy JB, Bechtold ML, et al. Accuracy of endoscopic ultrasound to diagnose nodal invasion by rectal cancers: a metaanalysis and systematic review [J]. Ann Surg Oncol, 2009; 16(5): 12551265.
18. 陈晓靖, 兰凯, 汪晓东, 等. 多层螺旋CT和经直肠超声在直肠癌术前分期中价值 [J]. 中国普外基础与临床杂志, 2009; 16(9): 702705.
19. Heriot AG, Grundy A, Kumar D. Preoperative staging of rectal carcinoma [J]. Br J Surg, 1999; 86(1): 1728.
20. Hulsmans FH, Bosma A, Mulder PJ, et al. Perirectal lymph nodes in rectal cancer: in vitro correlation of sonographic parameters and histopathologic findings [J]. Radiology, 1992; 184(2): 553560.
21. Carmody BJ, Otchy DP. Learning curve of transrectal ultrasound [J]. Dis Colon Rectum, 2000; 43(2): 193197.
22. Mackay SG, Pager CK, Joseph D, et al. Assessment of the accuracy of transrectal ultrasonography in anorectal neoplasia [J]. Br J Surg, 2003; 90(3): 346350.
23. Radovanovic Z, Breberina M, Petrovic T, et al. Accuracy of endorectal ultrasonography in staging locally advanced rectal cancer after preoperative chemoradiation [J]. Surg Endosc, 2008; 22(11): 24122415.
24. Tankova L, Hadjieva T, Kovatchki D, et al. Endosonographic assessment of the response of rectal cancer to preoperative radiotherapy [J]. Hepatogastroenterology, 2009; 56(96): 16451650.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Value of Endorectal Ultrasonography in Preoperative Staging of Rectal Cancer

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