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Viktil E, Hanekamp BA, Nesbakken A, Løberg EM, Sjo OH, Negård A, Dormagen JB, Schulz A. Early rectal cancer: The diagnostic performance of MRI supplemented with a rectal micro-enema and a modified staging system to identify tumors eligible for local excision. Acta Radiol Open 2024; 13:20584601241241523. [PMID: 38645439 PMCID: PMC11027598 DOI: 10.1177/20584601241241523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2024] [Accepted: 03/08/2024] [Indexed: 04/23/2024] Open
Abstract
Background In staging early rectal cancers (ERC), submucosal tumor depth is one of the most important features determining the possibility of local excision (LE). The micro-enema (Bisacodyl) induces submucosal edema and may hypothetically improve the visualization of tumor depth. Purpose To test the diagnostic performance of MRI to identify ERC suitable for LE when adding a pre-procedural micro-enema and concurrent use of a modified classification system. Material and Methods In this prospective study, we consecutively included 73 patients with newly diagnosed rectal tumors. Two experienced radiologists independently interpreted the MRI examinations, and diagnostic performance was calculated for local tumors eligible for LE (Tis-T1sm2, n = 43) and non-local tumors too advanced for LE (T1sm3-T3b, n = 30). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were registered for each reader. Inter- and intra-reader agreements were assessed by kappa statistics. Lymph node status was derived from the clinical MRI reports. Results Reader1/reader2 achieved sensitivities of 93%/86%, specificities of 90%/83%, PPV of 93%/88%, and NPV of 90%/81%, respectively, for identifying tumors eligible for LE. Rates of overstaging of local tumors were 7% and 14% for the two readers, and kappa values for the inter- and intra-reader agreement were 0.69 and 0.80, respectively. For tumors ≤T2, all metastatic lymph nodes were smaller than 3 mm on histopathology. Conclusion MRI after a rectal micro-enema and concurrent use of a modified staging system achieved good diagnostic performance to identify tumors suitable for LE. The rate of overstaging of local tumors was comparable to results reported in previous endorectal ultrasound (ERUS) studies.
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Affiliation(s)
- Ellen Viktil
- Department of Radiology and Nuclear Medicine, Oslo University Hospital – Ullevål Hospital, Oslo, Norway
- Institution of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bettina Andrea Hanekamp
- Department of Radiology and Nuclear Medicine, Oslo University Hospital – Ullevål Hospital, Oslo, Norway
- Institution of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Arild Nesbakken
- Institution of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Gastrointestinal Surgery, Oslo University Hospital – Ullevål Hospital, Oslo, Norway
| | - Else Marit Løberg
- Institution of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Pathology, Oslo University Hospital – Ullevål Hospital, Oslo, Norway
| | - Ole Helmer Sjo
- Department of Gastrointestinal Surgery, Oslo University Hospital – Ullevål Hospital, Oslo, Norway
| | - Anne Negård
- Institution of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Radiology, Akershus University Hospital, Lørenskog, Norway
| | - Johann Baptist Dormagen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital – Ullevål Hospital, Oslo, Norway
| | - Anselm Schulz
- Department of Radiology and Nuclear Medicine, Oslo University Hospital – Ullevål Hospital, Oslo, Norway
- Institution of Clinical Medicine, University of Oslo, Oslo, Norway
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Tang XP, Chen JF, Liu AQ, Shen YH, Huang YL. Clinical application of endoscopic ultrasonography in evaluation of colorectal and peri-colorectal lesions. Shijie Huaren Xiaohua Zazhi 2022; 30:647-654. [DOI: 10.11569/wcjd.v30.i14.647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endoscopic ultrasonography (EUS) has the functions of both endoscopy and ultrasound. Due to the complex anatomical structure of the intestine, there are few studies on EUS in colorectal lesions.
AIM To explore the clinical application value of EUS in the diagnosis of colorectal and peri-colorectal lesions.
METHODS We retrospectively analyzed the examination results of 95 patients detected by endoscopic miniprobe sonography (MPS) and linear EUS from September 2018 to July 2021, which were then compared to postoperative pathology. The kappa test was used in statistical analysis.
RESULTS Using postoperative pathology as the golden standard, the accuracy of linear EUS in diagnosing the depth of rectal cancer invasion (T stage) was 73.9% (17/23 cases), including T1 (2/4 cases), T2 (4/6 cases), T3 (6/7 cases) , and T4 (5/ 5 cases) stages. The accuracy of linear EUS in diagnosing regional lymph node metastasis (N stage) was 91.3% (21/23 cases), including N0 (14/15 cases) and N1 (7/8 cases) stages. The consistency was high (kappa value = 0.782, P < 0.01). During preoperative evaluation of colorectal adenoma or early cancer before endoscopic submucosal dissection (ESD), the accuracy of MPS in diagnosing the depth of tumor invasion was 87.1% (27/31 cases), and the consistency was moderate (kappa value = 0.665, P < 0.01). The accuracy of MPS in diagnosing the origin and type of colorectal submucosal lesions was 95.5% (21/22 cases), and the consistency was high (kappa value = 0.919, P < 0.01). The accuracy of endoscopic ultrasonography-guided fine-needle aspiration in determining rectal and peri-rectal lesions was 70.0% (7/10 cases), and the consistency was moderate (kappa value = 0.565, P < 0.01).
CONCLUSION According to the specific location and size of colorectal and peri-colorectal lesions, selective use of the MPS and linear EUS is of great value with regard to T/N staging of rectal cancer, preoperative evaluation of ESD, determination of the characteristics of colorectal-submucosal bulging lesions, and acquisition of lesion tissue of rectal and peri-rectal lesions.
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Affiliation(s)
- Xi-Ping Tang
- Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Jin-Feng Chen
- Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Ai-Qun Liu
- Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Yan-Hua Shen
- Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Yue-Li Huang
- Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi Zhuang Autonomous Region, China
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3
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Jensen DRK, Jaensch C, Madsen AH. The accuracy of trans rectal ultrasonography (TRUS) in early-stage rectal cancer or benign adenomas. Scand J Gastroenterol 2019; 54:603-608. [PMID: 31090476 DOI: 10.1080/00365521.2019.1614662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Screening for colorectal cancer in Denmark has resulted in more patients being diagnosed with benign adenomas and early-stage rectal cancer. In general, TRUS is accepted as a good modality for evaluating the above mentioned before deciding on surgery. Objective: To investigate the accuracy of TRUS in a clinical setting at the Region Hospital in Herning, Denmark. Study design: Retrospective cohort study from January 2016 to June 2018. Methods: Quantitative method. The cohort (117 patients) was recruited by searching for specific procedure codes. Data were collected by going through the electronic patient files. Results: TRUS predicted T0, T1, T2 and T3 with an accuracy of 91%, 35%, 43% and 20% respectively and an overall accuracy of 68%. A weighted Cohens kappa value of 0.30 (p ≤ .05). TRUS differentiated between T0/T1 with a sensitivity of 70%, specificity of 85% and an accuracy of 85% and kappa value of 0.44 (p ≤ .05). Conclusion: TRUS can with great precision establish whether the tumor is benign so correct local treatment can be instituted.
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Affiliation(s)
| | - Claudia Jaensch
- a Department of Surgery , Herning Regional Hospital , Herning , Denmark
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4
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Nuernberg D, Saftoiu A, Barreiros AP, Burmester E, Ivan ET, Clevert DA, Dietrich CF, Gilja OH, Lorentzen T, Maconi G, Mihmanli I, Nolsoe CP, Pfeffer F, Rafaelsen SR, Sparchez Z, Vilmann P, Waage JER. EFSUMB Recommendations for Gastrointestinal Ultrasound Part 3: Endorectal, Endoanal and Perineal Ultrasound. Ultrasound Int Open 2019; 5:E34-E51. [PMID: 30729231 PMCID: PMC6363590 DOI: 10.1055/a-0825-6708] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 11/23/2018] [Accepted: 12/01/2018] [Indexed: 02/07/2023] Open
Abstract
This article represents part 3 of the EFSUMB Recommendations and Guidelines for Gastrointestinal Ultrasound (GIUS). It provides an overview of the examination techniques recommended by experts in the field of endorectal/endoanal ultrasound (ERUS/EAUS), as well as perineal ultrasound (PNUS). The most important indications are rectal tumors and inflammatory diseases like fistula and abscesses in patients with or without inflammatory bowel disease (IBD). PNUS sometimes is more flexible and convenient compared to ERUS. However, the technique of ERUS is quite well established, especially for the staging of rectal cancer. EAUS also gained ground in the evaluation of perianal diseases like fistulas, abscesses and incontinence. For the staging of perirectal tumors, the use of PNUS in addition to conventional ERUS could be recommended. For the staging of anal carcinomas, PNUS can be a good option because of the higher resolution. Both ERUS and PNUS are considered excellent guidance methods for invasive interventions, such as the drainage of fluids or targeted biopsy of tissue lesions. For abscess detection and evaluation, contrast-enhanced ultrasound (CEUS) also helps in therapy planning.
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Affiliation(s)
- Dieter Nuernberg
- Medical School Brandenburg Theodor Fontane, Gastroenterology, Neuruppin, Germany
| | - Adrian Saftoiu
- Research Center in Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Ana Paula Barreiros
- Deutsche Stiftung Organtransplantation, Head of Organisation Center Middle, Frankfurt, Germany
| | - Eike Burmester
- Department of Internal Medicine/Gastroenterology, Sana-Kliniken Lübeck, Lübeck, Germany
| | - Elena Tatiana Ivan
- Research Center in Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Dirk-André Clevert
- Department of Clinical Radiology, Interdisciplinary Ultrasound-Center, University of Munich-Grosshadern Campus, Munich, Germany
| | | | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Torben Lorentzen
- Ultrasound Section, Division of Surgery, Department of Gastroenterology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Giovanni Maconi
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, "L.Sacco" University Hospital, Milan, Italy
| | - Ismail Mihmanli
- Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Department of Radiology and ALKA Radyoloji Tani Merkezi, Istanbul, Turkey
| | - Christian Pallson Nolsoe
- Ultrasound Section, Division of Surgery, Department of Gastroenterology, Herlev Hospital and Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen, Denmark
| | - Frank Pfeffer
- Department of Surgery, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Søren Rafael Rafaelsen
- Colorectal Centre of Excellence, Clinical Cancer Centre, University Hospital of Southern Denmark, Vejle, Denmark
| | - Zeno Sparchez
- 3rd Medical Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Peter Vilmann
- Endoscopy Department, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Jo Erling Riise Waage
- Department of Surgery, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, Bergen, Norway
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5
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Bronzwaer MES, Musters GD, Barendse RM, Koens L, de Graaf EJR, Doornebosch PG, Schwartz MP, Consten ECJ, Schoon EJ, de Hingh IHJT, Tanis PJ, Dekker E, Fockens P. The occurrence and characteristics of endoscopically unexpected malignant degeneration in large rectal adenomas. Gastrointest Endosc 2018; 87:862-871.e1. [PMID: 29030001 DOI: 10.1016/j.gie.2017.09.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/24/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Large non-pedunculated rectal polyps are most commonly resected by endoscopic mucosal resection (EMR) or transanal endoscopic microsurgery (TEM). Despite pre-procedural diagnostics, unexpected rectal cancer is incidentally encountered within the resected specimen. This study aimed to compare the diagnostic assessment and procedural characteristics of lesions with and without unexpected submucosal invasion. METHODS A post-hoc analysis of a multicenter randomized trial (TREND study) was performed in which patients with a non-pedunculated rectal polyp of ≥3 cm without endoscopic suspicion of invasive growth were randomized between EMR and TEM. RESULTS Unexpected rectal cancer was detected in 13% (27/203) of patients; 15 after EMR and 12 after TEM. Most consisted of low-risk T1 cancers (78%, n = 18). There were no differences in the diagnostic assessment between lesions with and without unexpected submucosal invasion. Diagnostic biopsies revealed similar rates of high-grade dysplasia (28% [7/25] vs 18% [26/144]). When compared with EMR of adenomas, EMR procedures of unexpected cancers had a lower success rate of submucosal lifting (60% vs 93%, P < .001), were more often assessed as endoscopically incomplete (33% vs 10%, P = .01), and were more frequently terminated prematurely (60% vs 8%, P = .001). CONCLUSIONS Diagnostic assessment of large non-pedunculated rectal polyps revealed similar characteristics between unexpected cancers and adenomas. Unexpected cancers during EMR were non-lifting in 40%, endoscopically assessed as incomplete in 33%, and terminated prematurely in 60%. In treatment-naive patients, these factors should raise suspicion of malignancy and need discussion in a multidisciplinary team meeting for decision on further treatment strategies.
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Affiliation(s)
- Maxime E S Bronzwaer
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Gijsbert D Musters
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Renée M Barendse
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Lianne Koens
- Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Eelco J R de Graaf
- Department of Surgery, IJsselland Hospital, Capelle aan de Ijssel, the Netherlands
| | - Pascal G Doornebosch
- Department of Surgery, IJsselland Hospital, Capelle aan de Ijssel, the Netherlands
| | - Matthijs P Schwartz
- Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, the Netherlands
| | - Esther C J Consten
- Department of Surgery, Meander Medical Center, Amersfoort, the Netherlands
| | - Erik J Schoon
- Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, the Netherlands
| | | | - Pieter J Tanis
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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6
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Endorectal ultrasound in the identification of rectal tumors for transanal endoscopic surgery: factors influencing its accuracy. Surg Endosc 2017; 32:2831-2838. [DOI: 10.1007/s00464-017-5988-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 11/19/2017] [Indexed: 02/07/2023]
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7
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Chen LD, Wang W, Xu JB, Chen JH, Zhang XH, Wu H, Ye JN, Liu JY, Nie ZQ, Lu MD, Xie XY. Assessment of Rectal Tumors with Shear-Wave Elastography before Surgery: Comparison with Endorectal US. Radiology 2017. [PMID: 28640694 DOI: 10.1148/radiol.2017162128] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Li-Da Chen
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou 510080, People’s Republic of China (L.D.C., W.W., J.Y.L., M.D.L., X.Y.X.); Departments of Gastrointestinal Surgery (J.B.X., J.H.C., X.H.Z., H.W., J.N.Y.) and Hepatobiliary Surgery (M.D.L.), the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; and Department of Epidemiology, Guangdong Cardiovascular
| | - Wei Wang
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou 510080, People’s Republic of China (L.D.C., W.W., J.Y.L., M.D.L., X.Y.X.); Departments of Gastrointestinal Surgery (J.B.X., J.H.C., X.H.Z., H.W., J.N.Y.) and Hepatobiliary Surgery (M.D.L.), the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; and Department of Epidemiology, Guangdong Cardiovascular
| | - Jian-Bo Xu
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou 510080, People’s Republic of China (L.D.C., W.W., J.Y.L., M.D.L., X.Y.X.); Departments of Gastrointestinal Surgery (J.B.X., J.H.C., X.H.Z., H.W., J.N.Y.) and Hepatobiliary Surgery (M.D.L.), the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; and Department of Epidemiology, Guangdong Cardiovascular
| | - Jian-Hui Chen
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou 510080, People’s Republic of China (L.D.C., W.W., J.Y.L., M.D.L., X.Y.X.); Departments of Gastrointestinal Surgery (J.B.X., J.H.C., X.H.Z., H.W., J.N.Y.) and Hepatobiliary Surgery (M.D.L.), the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; and Department of Epidemiology, Guangdong Cardiovascular
| | - Xin-Hua Zhang
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou 510080, People’s Republic of China (L.D.C., W.W., J.Y.L., M.D.L., X.Y.X.); Departments of Gastrointestinal Surgery (J.B.X., J.H.C., X.H.Z., H.W., J.N.Y.) and Hepatobiliary Surgery (M.D.L.), the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; and Department of Epidemiology, Guangdong Cardiovascular
| | - Hui Wu
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou 510080, People’s Republic of China (L.D.C., W.W., J.Y.L., M.D.L., X.Y.X.); Departments of Gastrointestinal Surgery (J.B.X., J.H.C., X.H.Z., H.W., J.N.Y.) and Hepatobiliary Surgery (M.D.L.), the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; and Department of Epidemiology, Guangdong Cardiovascular
| | - Jin-Ning Ye
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou 510080, People’s Republic of China (L.D.C., W.W., J.Y.L., M.D.L., X.Y.X.); Departments of Gastrointestinal Surgery (J.B.X., J.H.C., X.H.Z., H.W., J.N.Y.) and Hepatobiliary Surgery (M.D.L.), the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; and Department of Epidemiology, Guangdong Cardiovascular
| | - Jin-Ya Liu
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou 510080, People’s Republic of China (L.D.C., W.W., J.Y.L., M.D.L., X.Y.X.); Departments of Gastrointestinal Surgery (J.B.X., J.H.C., X.H.Z., H.W., J.N.Y.) and Hepatobiliary Surgery (M.D.L.), the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; and Department of Epidemiology, Guangdong Cardiovascular
| | - Zhi-Qiang Nie
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou 510080, People’s Republic of China (L.D.C., W.W., J.Y.L., M.D.L., X.Y.X.); Departments of Gastrointestinal Surgery (J.B.X., J.H.C., X.H.Z., H.W., J.N.Y.) and Hepatobiliary Surgery (M.D.L.), the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; and Department of Epidemiology, Guangdong Cardiovascular
| | - Ming-De Lu
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou 510080, People’s Republic of China (L.D.C., W.W., J.Y.L., M.D.L., X.Y.X.); Departments of Gastrointestinal Surgery (J.B.X., J.H.C., X.H.Z., H.W., J.N.Y.) and Hepatobiliary Surgery (M.D.L.), the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; and Department of Epidemiology, Guangdong Cardiovascular
| | - Xiao-Yan Xie
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou 510080, People’s Republic of China (L.D.C., W.W., J.Y.L., M.D.L., X.Y.X.); Departments of Gastrointestinal Surgery (J.B.X., J.H.C., X.H.Z., H.W., J.N.Y.) and Hepatobiliary Surgery (M.D.L.), the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; and Department of Epidemiology, Guangdong Cardiovascular
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Valero M, Robles-Medranda C. Endoscopic ultrasound in oncology: An update of clinical applications in the gastrointestinal tract. World J Gastrointest Endosc 2017; 9:243-254. [PMID: 28690767 PMCID: PMC5483416 DOI: 10.4253/wjge.v9.i6.243] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 04/10/2017] [Accepted: 05/05/2017] [Indexed: 02/06/2023] Open
Abstract
An accurate staging is necessary to select the best treatment and evaluate prognosis in oncology. Staging usually begins with noninvasive imaging such as computed tomography, magnetic resonance imaging or positron emission tomography. In the absence of distant metastases, endoscopic ultrasound plays an important role in the diagnosis and staging of gastrointestinal tumors, being the most accurate modality for local-regional staging. Its use for tumor and nodal involvement in pre-surgical evaluation has proven to reduce unnecessary surgeries. The aim of this article is to review the current role of endoscopic ultrasound in the diagnosis and staging of esophageal, gastric and colorectal cancer.
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9
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Dorez H, Sablong R, Canaple L, Saint-Jalmes H, Gaillard S, Moussata D, Beuf O. Endoluminal high-resolution MR imaging protocol for colon walls analysis in a mouse model of colitis. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2016; 29:657-69. [PMID: 26965510 DOI: 10.1007/s10334-016-0539-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/03/2016] [Accepted: 02/18/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE An endoluminal magnetic resonance (MR) imaging protocol including the design of an endoluminal coil (EC) was defined for high-spatial-resolution MR imaging of mice gastrointestinal walls at 4.7 T. MATERIALS AND METHODS A receive-only radiofrequency single-loop coil was developed for mice colon wall imaging. Combined with a specific protocol, the prototype was first characterized in vitro on phantoms and on vegetables. Signal-to-noise ratio (SNR) profiles were compared with a quadrature volume birdcage coil (QVBC). Endoluminal MR imaging protocol combined with the EC was assessed in vivo on mice. RESULTS The SNR measured close to the coil is significantly higher (10 times and up to 3 mm of the EC center) than the SNR measured with the QVBC. The gain in SNR can be used to reduce the in-plane pixel size up to 39 × 39 µm(2) (234 µm slice thickness) without time penalty. The different colon wall layers can only be distinguished on images acquired with the EC. CONCLUSION Dedicated EC provides suitable images for the assessment of mice colon wall layers. This proof of concept provides gains in spatial resolution and leads to adequate protocols for the assessment of human colorectal cancer, and can now be used as a new imaging tool for a better understanding of the pathology.
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Affiliation(s)
- Hugo Dorez
- Université de Lyon, CREATIS, CNRS UMR 5220, INSERM U1044, INSA-Lyon, Université Lyon 1, Villeurbanne, France.
| | - Raphaël Sablong
- Université de Lyon, CREATIS, CNRS UMR 5220, INSERM U1044, INSA-Lyon, Université Lyon 1, Villeurbanne, France
| | - Laurence Canaple
- Institut de Génomique Fonctionnelle de Lyon, Université de Lyon 1, UMR 5242 CNRS, Ecole Normale Supérieure de Lyon, Lyon, France
| | - Hervé Saint-Jalmes
- LTSI, INSERM U642, Université Rennes 1, Rennes, France.,CRLCC, Centre Eugène Marquis, Rennes, France
| | - Sophie Gaillard
- Université de Lyon, CREATIS, CNRS UMR 5220, INSERM U1044, INSA-Lyon, Université Lyon 1, Villeurbanne, France
| | - Driffa Moussata
- Université de Lyon, CREATIS, CNRS UMR 5220, INSERM U1044, INSA-Lyon, Université Lyon 1, Villeurbanne, France.,Hôpital Régional Universitaire de Tours-Service Hépato-Gastroentérologie, Tours, France
| | - Olivier Beuf
- Université de Lyon, CREATIS, CNRS UMR 5220, INSERM U1044, INSA-Lyon, Université Lyon 1, Villeurbanne, France
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10
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Russo S, Steele S, Fredman E, Biswas T. Current topics in the multimodality treatment of locally advanced rectal cancer. Future Oncol 2016; 12:963-79. [PMID: 26880222 DOI: 10.2217/fon.16.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The multimodality approach to the treatment of locally advanced rectal cancer has evolved to include neoadjuvant radiotherapy with or without concurrent chemotherapy, total mesorectal excision and adjuvant fluoropyrimidine-based chemotherapy. Though this broad strategy has yielded improvements in local control compared with historical data, overall survival remains largely unchanged. Current investigations focus on improving patient selection through new imaging modalities, improving surgical techniques, incorporating more aggressive systemic treatment regimens and the selective use of radiation. Here, we review emerging data regarding newer staging techniques, neoadjuvant chemotherapy, optimal timing of surgery, selective use of radiation and nonoperative approaches to the management of locally advanced rectal cancers.
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Affiliation(s)
- Suzanne Russo
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Scott Steele
- Department of Surgery, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Elisha Fredman
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Tithi Biswas
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA
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11
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Murad FM, Komanduri S, Abu Dayyeh BK, Chauhan SS, Enestvedt BK, Fujii-Lau LL, Konda V, Maple JT, Pannala R, Thosani NC, Banerjee S. Echoendoscopes. Gastrointest Endosc 2015; 82:189-202. [PMID: 26077457 DOI: 10.1016/j.gie.2015.02.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 02/10/2015] [Indexed: 02/08/2023]
Abstract
Advances in echoendoscopes and their processors have significantly expanded the role of EUS and its clinical applications.The diagnostic and therapeutic capabilities of EUS continue to evolve and improve. EUS has made a large impact on patient care but comes with significant startup and maintenance costs. As improved technology continues to enhance image resolution while decreasing the size of EUS processors, use of endosonography will become more widespread. EUS will continue to be a vital part of patient care and complement currently available cross-sectional imaging.
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12
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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: 24] [Impact Index Per Article: 2.7] [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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13
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Whiting P, Savović J, Higgins JPT, Caldwell DM, Reeves BC, Shea B, Davies P, Kleijnen J, Churchill R. ROBIS: A new tool to assess risk of bias in systematic reviews was developed. J Clin Epidemiol 2015; 69:225-34. [PMID: 26092286 PMCID: PMC4687950 DOI: 10.1016/j.jclinepi.2015.06.005] [Citation(s) in RCA: 1086] [Impact Index Per Article: 120.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 05/25/2015] [Accepted: 06/05/2015] [Indexed: 12/13/2022]
Abstract
Objective To develop ROBIS, a new tool for assessing the risk of bias in systematic reviews (rather than in primary studies). Study Design and Setting We used four-stage approach to develop ROBIS: define the scope, review the evidence base, hold a face-to-face meeting, and refine the tool through piloting. Results ROBIS is currently aimed at four broad categories of reviews mainly within health care settings: interventions, diagnosis, prognosis, and etiology. The target audience of ROBIS is primarily guideline developers, authors of overviews of systematic reviews (“reviews of reviews”), and review authors who might want to assess or avoid risk of bias in their reviews. The tool is completed in three phases: (1) assess relevance (optional), (2) identify concerns with the review process, and (3) judge risk of bias. Phase 2 covers four domains through which bias may be introduced into a systematic review: study eligibility criteria; identification and selection of studies; data collection and study appraisal; and synthesis and findings. Phase 3 assesses the overall risk of bias in the interpretation of review findings and whether this considered limitations identified in any of the phase 2 domains. Signaling questions are included to help judge concerns with the review process (phase 2) and the overall risk of bias in the review (phase 3); these questions flag aspects of review design related to the potential for bias and aim to help assessors judge risk of bias in the review process, results, and conclusions. Conclusions ROBIS is the first rigorously developed tool designed specifically to assess the risk of bias in systematic reviews.
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Affiliation(s)
- Penny Whiting
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK; The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West at University Hospitals Bristol NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol BS1 2NT; Kleijnen Systematic Reviews Ltd, Unit 6, Escrick Business Park, Riccall Road, Escrick, York YO19 6FD, UK.
| | - Jelena Savović
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK; The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West at University Hospitals Bristol NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol BS1 2NT
| | - Julian P T Higgins
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK; Centre for Reviews and Dissemination, University of York, York YO10 5DD, UK
| | - Deborah M Caldwell
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Barnaby C Reeves
- School of Clinical Sciences, University of Bristol, Bristol Royal Infirmary, Level Queen's Building, 69 St Michael's Hill, Bristol BS2 8DZ, UK
| | - Beverley Shea
- Community Information and Epidemiological Technologies Institute of Population Health, 1 Stewart Street, Room 319, Ottawa, Ontario, K1N 6N5, Canada
| | - Philippa Davies
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK; The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West at University Hospitals Bristol NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol BS1 2NT
| | - Jos Kleijnen
- Kleijnen Systematic Reviews Ltd, Unit 6, Escrick Business Park, Riccall Road, Escrick, York YO19 6FD, UK; School for Public Health and Primary Care (CAPHRI), Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - Rachel Churchill
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
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Arya S, Das D, Engineer R, Saklani A. Imaging in rectal cancer with emphasis on local staging with MRI. Indian J Radiol Imaging 2015; 25:148-61. [PMID: 25969638 PMCID: PMC4419424 DOI: 10.4103/0971-3026.155865] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Imaging in rectal cancer has a vital role in staging disease, and in selecting and optimizing treatment planning. High-resolution MRI (HR-MRI) is the recommended method of first choice for local staging of rectal cancer for both primary staging and for restaging after preoperative chemoradiation (CT-RT). HR-MRI helps decide between upfront surgery and preoperative CT-RT. It provides high accuracy for prediction of circumferential resection margin at surgery, T category, and nodal status in that order. MRI also helps assess resectability after preoperative CT-RT and decide between sphincter saving or more radical surgery. Accurate technique is crucial for obtaining high-resolution images in the appropriate planes for correct staging. The phased array external coil has replaced the endorectal coil that is no longer recommended. Non-fat suppressed 2D T2-weighted (T2W) sequences in orthogonal planes to the tumor are sufficient for primary staging. Contrast-enhanced MRI is considered inappropriate for both primary staging and restaging. Diffusion-weighted sequence may be of value in restaging. Multidetector CT cannot replace MRI in local staging, but has an important role for evaluating distant metastases. Positron emission tomography-computed tomography (PET/CT) has a limited role in the initial staging of rectal cancer and is reserved for cases with resectable metastatic disease before contemplating surgery. This article briefly reviews the comprehensive role of imaging in rectal cancer, describes the role of MRI in local staging in detail, discusses the optimal MRI technique, and provides a synoptic report for both primary staging and restaging after CT-RT in routine practice.
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Affiliation(s)
- Supreeta Arya
- Department of Radio-Diagnosis, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Deepak Das
- Department of Radio-Diagnosis, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Reena Engineer
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Avanish Saklani
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
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15
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Onyeuku NE, Ayala-Peacock DN, Russo SM, Blackstock AW. The multidisciplinary approach to the treatment of rectal cancer: 2015 update. Expert Rev Gastroenterol Hepatol 2015; 9:507-17. [PMID: 25431898 DOI: 10.1586/17474124.2015.987753] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The multidisciplinary approach to the management of rectal cancer continues to evolve with developments in surgery, radiation therapy as well as systemic chemotherapy. Refinement of surgical techniques to improve organ preservation, selective use of neoadjuvant (or adjuvant) therapies, improvements in staging modalities and emerging criteria for the selection of tailored therapies are some of the advancements made over the last three decades. In addition, neoadjuvant treatment alternatives, multimodality sequencing and adaptive therapies based on treatment response continue to be a subject of clinical investigation. The current article reviews the salient topics related to the multidisciplinary treatment of resectable rectal cancer.
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Affiliation(s)
- Nasarachi E Onyeuku
- Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC, USA
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16
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Waage JER, Leh S, Røsler C, Pfeffer F, Bach SP, Havre RF, Haldorsen IS, Ødegaard S, Baatrup G. Endorectal ultrasonography, strain elastography and MRI differentiation of rectal adenomas and adenocarcinomas. Colorectal Dis 2015; 17:124-31. [PMID: 25407010 PMCID: PMC4312907 DOI: 10.1111/codi.12845] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 04/17/2014] [Indexed: 12/17/2022]
Abstract
AIM Strain elastography is a method for recording tissue hardness. Strain in different areas may be compared using strain ratio (SR). The aims of this study were to validate a previously proposed SR cut-off value of 1.25 for differentiating adenocarcinomas from adenomas and to compare the performance of endorectal ultrasonography (ERUS), strain elastography and MRI in the same patients. METHOD A prospective evaluation of 120 consecutive patients with rectal neoplasia, using a predetermined elastography strain ratio cut-off value, was performed to differentiate adenomas from adenocarcinomas. ERUS and MRI were performed according to standard routine at Haukeland University Hospital, defining T0 as adenomas and T1-T4 as adenocarcinomas. Subsequent histopathology was used as the reference standard. RESULTS Histopathological evaluation revealed 21 adenomas and 99 adenocarcinomas. Sensitivity, specificity and accuracy (with 95% CI) were as follows: ERUS: 0.96 (0.90-0.99), 0.62 (0.40-0.80) and 0.90 (0.83-0.94); elastography SR: 0.96 (0.90-0.99), 0.86 (0.66-0.96) and 0.94 (0.88-0.97); and MRI: 0.99 (0.94-1.00), 0.07 (0.00-0.31) and 0.87 (0.80-0.93). CONCLUSION This study confirms that the elastography SR assessment accurately differentiates sessile adenomas from adenocarcinomas. SR assessment has a superior ability to differentiate adenomas and adenocarcinomas when compared with ERUS and MRI. MRI examination seems unable to recognize adenomas and should be interpreted with care when early-stage rectal neoplasia is suspected.
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Affiliation(s)
- J E R Waage
- Department of Surgery, Haukeland University HospitalBergen, Norway,Department of Clinical Medicine, University of BergenBergen, Norway
| | - S Leh
- Department of Clinical Medicine, University of BergenBergen, Norway,Department of Pathology, Haukeland University HospitalBergen, Norway
| | - C Røsler
- Department of Radiology, Haukeland University HospitalBergen, Norway
| | - F Pfeffer
- Department of Surgery, Haukeland University HospitalBergen, Norway,Department of Clinical Medicine, University of BergenBergen, Norway
| | - S P Bach
- Academic Department of Surgery, Queen Elizabeth HospitalEdgbaston, Birmingham, UK
| | - R F Havre
- Department of Clinical Medicine, University of BergenBergen, Norway,Department of Medicine, National Centre for Ultrasound in Gastroenterology, Haukeland University HospitalBergen, Norway
| | - I S Haldorsen
- Department of Clinical Medicine, University of BergenBergen, Norway,Department of Radiology, Haukeland University HospitalBergen, Norway
| | - S Ødegaard
- Department of Clinical Medicine, University of BergenBergen, Norway,Department of Medicine, National Centre for Ultrasound in Gastroenterology, Haukeland University HospitalBergen, Norway
| | - G Baatrup
- Department of Clinical Medicine, University of BergenBergen, Norway,Department of Surgery A, Odense University HospitalSvendborg, Denmark,Institute for Regional Health Science, University of Southern DenmarkOdense, Denmark
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17
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Waage JER, Bach SP, Pfeffer F, Leh S, Havre RF, Ødegaard S, Baatrup G. Combined endorectal ultrasonography and strain elastography for the staging of early rectal cancer. Colorectal Dis 2015; 17:50-6. [PMID: 25176033 DOI: 10.1111/codi.12764] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 06/27/2014] [Indexed: 12/22/2022]
Abstract
AIM Strain elastography is a novel approach to rectal tumour evaluation. The primary aim of this study was to correlate elastography to pT stages of rectal tumours and to assess the ability of the method to differentiate rectal adenomas (pT0) from early rectal cancer (pT1-2). Secondary aims were to compare elastography with endorectal ultrasonography (ERUS) and to propose a combined strain elastography and ERUS staging algorithm. METHOD In all, 120 consecutive patients with a suspected rectal tumour were examined in this staging study. Patients receiving surgery without neoadjuvant radiotherapy were included (n = 59). All patients were examined with ERUS and elastography. Treatment decisions were made by multidisciplinary team (MDT) assessment, without considering the strain elastography examination. RESULTS Histopathology identified 21 adenomas, 13 pT1, 9 pT2, 15 pT3 and one pT4. Mean elastography strain ratios were predictive of T stage (P = 0.01). Differentiation of adenomas from early rectal cancer (pT1-2) had sensitivity, specificity and accuracy of 0.82, 0.86 and 0.84 for elastography and 0.82, 0.62 and 0.72 for ERUS. A combined staging algorithm was developed to identify tumours eligible for local resection. Based on MDT evaluation 32% of tumours later identified as pT0 or pT1 were treated with total mesorectal excision, even though a local excision might have sufficed. Combined ERUS and elastography evaluation would have significantly reduced this number to 9% (P = 0.008). CONCLUSION Elastography may improve the staging of adenomas and early rectal cancer compared with ERUS alone. Combined ERUS and elastography assessment is likely to further improve the selection of patients for local resection.
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Affiliation(s)
- J E R Waage
- Department of Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
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18
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Liu ZL, Zhou T, Liang XB, Ma JJ, Zhang GJ. Learning curve of endorectal ultrasonography in preoperative staging of rectal carcinoma. Mol Clin Oncol 2014; 2:1085-1090. [PMID: 25279202 DOI: 10.3892/mco.2014.352] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 06/17/2014] [Indexed: 12/25/2022] Open
Abstract
Accurate preoperative staging of rectal carcinoma is essential for optimal treatment. This study was designed to evaluate the accuracy and learning curve of endorectal ultrasonography (ERUS) in the preoperative staging of rectal carcinoma. We retrospectively analyzed the records of patients with rectal carcinoma who underwent preoperative ERUS followed by curative surgery at the Shanxi Province Tumor Hospital between January, 2007 and March, 2010. The patients were divided into three groups, namely A, B and C, depending on whether the examination was performed between January and December, 2007, between January and December, 2008 or between January, 2009 and March, 2010, respectively. Five physicians with no prior experience in ERUS performed the examinations. We compared the ERUS staging with the pathological findings using the tumor-node-metastasis (TNM) classification. The accuracy of ERUS in T and N staging after each additional consecutive 20 patients was calculated for physicians D, E and F. A total of 319 patients underwent ERUS prior to surgery. There were 38 patients in group A, 135 in group B and 146 in group C. Two of the five physicians performed only 47 of the 319 examinations, whereas the remaining 272 patients were examined by physicians D (n=162), E (n=64) and F (n=46). The overall accuracy in assessing the extent of rectal wall invasion (T) was 67%, with 16% of the cases overstaged and 17% understaged and the accuracy in assessing nodal involvement (N) was 66%, with 11% of the cases overstaged and 23% understaged. The total T and N staging accuracy of physicians D, E and F was 75 and 72%; 59 and 59%; and 50 and 52%, respectively. For physicians D, E and F, the accuracy of T and N staging after each additional 20 patients was calculated and the curve of the accuracy reached a plateau after physician D completed 80 cases. Therefore, ERUS is a valuable tool for assessing the depth of tumor invasion and it appears that after ~80 cases a physician may be considered able to apply it efficiently.
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Affiliation(s)
- Zuo-Liang Liu
- Department of Gastrointestinal Surgery, Institute of Hepatobiliary, Pancreas and Intestinal Disease, The Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Tong Zhou
- Department of Gastrointestinal Surgery, Institute of Hepatobiliary, Pancreas and Intestinal Disease, The Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Xiao-Bo Liang
- Department of Anorectal Surgery, Shanxi Province Tumor Hospital, Taiyuan, Shanxi 030001, P.R. China
| | - Jun-Jie Ma
- Department of Anorectal Surgery, Shanxi Province Tumor Hospital, Taiyuan, Shanxi 030001, P.R. China
| | - Guang-Jun Zhang
- Department of Gastrointestinal Surgery, Institute of Hepatobiliary, Pancreas and Intestinal Disease, The Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
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Fang JY, Zheng S, Jiang B, Lai MD, Fang DC, Han Y, Sheng QJ, Li JN, Chen YX, Gao QY. Consensus on the Prevention, Screening, Early Diagnosis and Treatment of Colorectal Tumors in China: Chinese Society of Gastroenterology, October 14-15, 2011, Shanghai, China. Gastrointest Tumors 2014; 1:53-75. [PMID: 26672726 DOI: 10.1159/000362585] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is steadily increasing in China. Colorectal adenoma (CRA) is the most important precancerous disease of CRC. Screening for colorectal tumors can aid early diagnosis. Advances in endoscopic mucosal resection and endoscopic submucosal dissection can aid the early treatment of colorectal tumors. Furthermore, because of high risk of recurrence after removal of adenomas under endoscopy, factors contributing to recurrence, the follow-up mode and the interval established, and the feasibility of application and the time of various chemical preventions should be concerned. However, a relevant consensus on the screening, early diagnosis and treatment, and prevention of colorectal tumors in China is lacking. SUMMARY The consensus recommendations include epidemiology, pathology, screening, early diagnosis, endoscopic treatment, monitoring and follow-up, and chemoprevention of colorectal tumors in China. KEY MESSAGE This is the first consensus on the prevention, screening, early diagnosis and treatment of CRA and CRC in China based on evidence in the literature and on local data. PRACTICAL IMPLICATIONS Through reviewing the literature, regional data and passing the consensus by an anonymous vote, gastroenterology experts from all over China launch the consensus recommendations in Shanghai. The incidence and mortality of CRC in China has increased, and the incidence or detection rate of CRA has increased rapidly. Screening for colorectal tumors should be performed at age 50-74 years. Preliminary screening should be undertaken to find persons at high risk, followed by colonoscopy. A screening cycle of 3 years is recommended for persistent interventions. Opportunistic screening is a mode suitable for the current healthcare system and national situation. Colonoscopy combined with pathological examination is the standard method for the diagnosis of colorectal tumors. CRA removal under endoscopy can prevent CRC to some extent, but CRA has an obvious recurrence trend. The follow-up interval after the removal or surgery of colorectal tumors should be different with lesions. Primary prevention of CRA includes improved diet with more fiber, supplements containing calcium and vitamin D, supplements containing folic acid for those with low hemoglobin levels, and cessation of tobacco smoking. Non-steroidal anti-inflammatory drugs and selective cyclooxygenase-2 inhibitors have been recognized to prevent recurrence after adenoma removal.
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Affiliation(s)
- Jing-Yuan Fang
- Division of Gastroenterology and Hepatology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China ; Shanghai Institute of Digestive Disease, Shanghai, China ; Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai, China ; State Key Laboratory of Oncogene and Related Genes, Shanghai Jiaotong University, Shanghai, China
| | - Shu Zheng
- Key Laboratory of Cancer Prevention and Intervention of China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences of Zhejiang Province, Cancer Institute, Hangzhou, China ; Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Bo Jiang
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Mao-De Lai
- Department of Pathology and Pathophysiology, Zhejiang University School of Medicine, Hangzhou, China
| | - Dian-Chun Fang
- Department of Gastroenterology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Ying Han
- Department of Gastroenterology, General Hospital of Beijing Military Area, Beijing, China
| | - Qian-Jiu Sheng
- Department of Gastroenterology, General Hospital of Beijing Military Area, Beijing, China
| | - Jing-Nan Li
- Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Ying-Xuan Chen
- Division of Gastroenterology and Hepatology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China ; Shanghai Institute of Digestive Disease, Shanghai, China ; Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai, China ; State Key Laboratory of Oncogene and Related Genes, Shanghai Jiaotong University, Shanghai, China
| | - Qin-Yan Gao
- Division of Gastroenterology and Hepatology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China ; Shanghai Institute of Digestive Disease, Shanghai, China ; Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai, China ; State Key Laboratory of Oncogene and Related Genes, Shanghai Jiaotong University, Shanghai, China
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Abstract
More than 1·2 million patients are diagnosed with colorectal cancer every year, and more than 600,000 die from the disease. Incidence strongly varies globally and is closely linked to elements of a so-called western lifestyle. Incidence is higher in men than women and strongly increases with age; median age at diagnosis is about 70 years in developed countries. Despite strong hereditary components, most cases of colorectal cancer are sporadic and develop slowly over several years through the adenoma-carcinoma sequence. The cornerstones of therapy are surgery, neoadjuvant radiotherapy (for patients with rectal cancer), and adjuvant chemotherapy (for patients with stage III/IV and high-risk stage II colon cancer). 5-year relative survival ranges from greater than 90% in patients with stage I disease to slightly greater than 10% in patients with stage IV disease. Screening has been shown to reduce colorectal cancer incidence and mortality, but organised screening programmes are still to be implemented in most countries.
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Affiliation(s)
- Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany.
| | - Matthias Kloor
- Department of Applied Tumor Biology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
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Lu M, Yan B, Song J, Ping W, Yue LX, Song B. Double-contrast-enhanced sonography for diagnosis of rectal lesions with pathologic correlation. JOURNAL OF ULTRASOUND IN MEDICINE 2014; 33:575-83. [PMID: 24658937 DOI: 10.7863/ultra.33.4.575] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Transabdominal sonography with a gastrointestinal contrast agent has been widely used in China for investigation of digestive disorders. Double-contrast-enhanced sonography combines a gastrointestinal luminal contrast agent with an intravenous contrast agent for imaging of lesions. The purpose of this pilot study was to assess the value of double-contrast-enhanced sonography for preoperative diagnosis of rectal lesions. METHODS We conducted a prospective single-center study using double-contrast-enhanced sonography of rectal lesions. Patients were administered both rectal and intravenous contrast agents, and imaging was performed transabdominally, transanally, and transrectally. Morphologic characteristics and perfusion parameters were compared between histologically proven adenocarcinomas, adenomas, and inflammatory masses. Perfusion parameters were analyzed with time-intensity curves, measuring the contrast arrival time, time to peak, peak intensity, and area under the curve of the lesions and normal rectal tissue. RESULTS From January 2009 to September 2012, 420 patients were recruited, with 227 patients meeting inclusion/exclusion criteria and having 232 rectal lesions analyzed (172 rectal adenocarcinomas, 45 adenomas, and 15 inflammatory masses). Adenocarcinomas had variable enhancement patterns. Adenomas were all hypoenhanced in a homogeneous pattern. Inflammatory masses had a hyperenhanced rim with no central enhancement. Time-intensity curve perfusion parameters (arrival time, time to peak, peak intensity, and area under the curve) of rectal adenocarcinomas, adenomas, and inflammatory masses were significantly different compared to normal rectal tissue (P < .05). The differences in the arrival time, peak intensity, and time to peak among the different lesions were also significant (P < .05). CONCLUSIONS Double-contrast-enhanced sonographic assessment of morphologic enhancement patterns combined with vascularity parameters may help differentiate benign and malignant rectal lesions.
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Affiliation(s)
- Man Lu
- Department of Radiology, West China Hospital of Sichuan University, 37 Guo Xue Xiang 610041 Chengdu, Sichuan, China.
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22
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Abstract
BACKGROUND Endoscopic resection of benign colorectal polyps and early cancer is well established. Local staging is of paramount importance to ensure that local resection is feasible. Endoscopic ultrasound has been used to evaluate the depth of lesions in the rectum, but its use in the colon is limited. OBJECTIVE This prospective study aims to evaluate the accuracy of 20-MHz mini probe ultrasound before the endoscopic resection of colorectal tumors. DESIGN All patients underwent 20-MHz high-frequency mini probe ultrasound of the colorectal lesion during colonoscopic examination. The mini probes were inserted through the working channel of the colonoscope, and acoustic coupling was achieved by instilling water to completely submerge the lesion. The depth of infiltration of the colorectal tumor was identified before resection. The lesions were sent for histological examination, and the level of infiltration was compared with the preoperative ultrasound depth. SETTING This study was conducted at a tertiary referral university teaching hospital. PATIENTS Consecutive patients referred for consideration of endoscopic resection were included in the study. INTERVENTIONS All patients were subject to colonoscopic high-frequency mini probe ultrasound to evaluate the depth of lesion before local resection. MAIN OUTCOME MEASURES There were 2 outcome measures: the ultrasound depth of colorectal lesion and the histological depth. RESULTS One hundred four patients were included with a mean age of 70 years. The surgical procedures included 59 endoscopic mucosal resections, 36 transanal endoscopic microsurgeries, and 9 endoscopic submucosal dissections. The 20-MHz ultrasound correctly staged 100 of 104 lesions, an overall accuracy of 96.1%. Eighty-eight of 89 mucosal lesions and 11 of 12 submucosal lesions were correctly staged. LIMITATIONS The ultrasound examination was performed by the main author only and is therefore dependent on his experience alone. CONCLUSION Colonoscopic high-frequency mini probe ultrasound has high accuracy in determining the depth of colorectal lesion and is useful before endoscopic resection.
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Dewdney A, Cunningham D, Chau I. Selecting patients with locally advanced rectal cancer for neoadjuvant treatment strategies. Oncologist 2013; 18:833-42. [PMID: 23821325 DOI: 10.1634/theoncologist.2013-0022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Rectal cancer remains a significant problem worldwide. Outcomes vary significantly according to the stage of disease and prognostic factors, including the distance of the tumor from the circumferential resection margin. Accurate staging, including high-resolution magnetic resonance imaging, allows stratification of patients into low-, moderate-, and high-risk disease; this information can be used to inform multidisciplinary team decisions regarding the role of neoadjuvant therapy. Both neoadjuvant short-course radiotherapy and long-course chemoradiation reduce the risk of local recurrence compared with surgery alone, but they have little impact on survival. Although there remains a need to reduce overtreatment of those patients at moderate risk, evaluation of intensified regimens for those with high-risk disease is still required to reduce distant failure rates and improve survival in these patients with an otherwise poor prognosis.
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Affiliation(s)
- Alice Dewdney
- Department of Medicine, Royal Marsden Hospital, London and Surrey, UK
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Role of endoscopy in the staging and management of colorectal cancer. Gastrointest Endosc 2013; 78:8-12. [PMID: 23664162 DOI: 10.1016/j.gie.2013.04.163] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 04/03/2013] [Indexed: 12/23/2022]
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Kim EY. Endoscopic ultrasound, where are we now in 2012? Clin Endosc 2012; 45:321-3. [PMID: 22977827 PMCID: PMC3429761 DOI: 10.5946/ce.2012.45.3.321] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 07/23/2012] [Accepted: 07/23/2012] [Indexed: 02/06/2023] Open
Abstract
Topics related with endoscopic ultrasound (EUS) made up considerable portion among many invited lectures presented in International Digestive Endoscopy Network 2012 meeting. While the scientific programs were divided into the fields of upper gastrointestinal (UGI), lower gastrointestinal, and pancreato-biliary (PB) categories, UGI and PB parts mainly dealt with EUS related issues. EUS diagnosis in subepithelial lesions, estimation of the invasion depth of early gastrointestinal cancers with EUS, and usefulness of EUS in esophageal varices were discussed in UGI sessions. In the PB part, pancreatic cystic lesions, EUS-guided biliopancreatic drainage, EUS-guided tissue acquisition, and improvement of diagnostic yield in indeterminate biliary lesions by using intraductal ultrasound were discussed. Advanced techniques such as contrast-enhanced EUS, EUS elastography and forward-viewing echoendoscopy were also discussed. In this paper, I focused mainly on topics of UGI and briefly mentioned about advanced EUS techniques since more EUS related papers by other invited speakers were presented afterwards.
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Affiliation(s)
- Eun Young Kim
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
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Ravizza D, Tamayo D, Fiori G, Trovato C, De Roberto G, de Leone A, Crosta C. Linear array ultrasonography to stage rectal neoplasias suitable for local treatment. Dig Liver Dis 2011; 43:636-41. [PMID: 21550864 DOI: 10.1016/j.dld.2011.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 02/08/2011] [Accepted: 03/27/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND Because of the many therapeutic options available, a reliable staging is crucial for rectal neoplasia management. Adenomas and cancers limited to the submucosa without lymph node involvement may be treated locally. AIMS The aim of this study is to evaluate the diagnostic accuracy of endorectal ultrasonography in the staging of neoplasias suitable for local treatment. METHODS We considered all patients who underwent endorectal ultrasonography between 2001 and 2010. The study population consisted of 92 patients with 92 neoplasias (68 adenocarcinomas and 24 adenomas). A 5 and 7.5MHz linear array echoendoscope was used. The postoperative histopathologic result was compared with the preoperative staging defined by endorectal ultrasonography. Adenomas and cancers limited to the submucosa were considered together (pT0-1). RESULTS The sensitivity, specificity, overall accuracy rate, positive predictive value, and negative predictive value of endorectal ultrasonography for pT0-1 were 86%, 95.6%, 91.3%, 94.9% and 88.7%. Those for nodal involvement were 45.4%, 95.5%, 83%, 76.9% and 84%, with 3 false positive results and 12 false negative. For combined pT0-1 and pN0, endorectal ultrasonography showed an 87.5% sensitivity, 95.9% specificity, 92% overall accuracy rate, 94.9% positive predictive value and 90.2% negative predictive value. CONCLUSION Endorectal linear array ultrasonography is a reliable tool to detect rectal neoplasias suitable for local treatment.
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Affiliation(s)
- Davide Ravizza
- European Institute of Oncology, Division of Endoscopy, Milan, Italy.
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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: 79] [Impact Index Per Article: 6.1] [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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Does a learning curve exist in endorectal two-dimensional ultrasound accuracy? Tech Coloproctol 2011; 15:301-11. [PMID: 21744098 DOI: 10.1007/s10151-011-0711-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2010] [Accepted: 06/24/2011] [Indexed: 01/26/2023]
Abstract
BACKGROUND Aim of the study was to assess adequacy of Colorectal Surgical Society of Australia and New Zealand (CSSANZ) endorectal ultrasound (ERUS) training and whether a subsequent learning curve exists. METHODS A prospective audit of ERUS for staging rectal cancer by a single surgeon from commencement of consultant practice was performed. Data were recorded in a prospectively maintained database. The audit commenced on completion of CSSANZ training. T- and N-stage were assessed clinically, then by ERUS prior to treatment and finally by histology over 8 years. RESULTS The results were compared over three time periods: the first a single year, then two three-year periods. Two hundred and seventy-two patients were examined. Two hundred and thirty-three were assessable for T-stage (13 no tumour excision, 26 long course pre-operative radiotherapy) and 142 for N-stage (74 endoanal excision, 17 proximal mesorectum un-assessable). Overall accuracy was 82% for T-stage and 73% for N-stage. Accuracy for T- and N-staging did not change significantly over the three time periods (T: 82.1, 82.3, 81.6%, P = 0.14; N: 83.3, 67.9, 74.2%, P = 0.31). The utility of ERUS was demonstrated by clinical assessment not being possible in 32% of cases and where the two modalities disagreed was correct 82% of the time. CONCLUSIONS Endorectal ultrasound rectal cancer staging is accurate for T-stage. Competency in ERUS can be achieved in the CSSANZ fellowship and accuracy does not improve with further experience. An ERUS accreditation scheme should be established for future trainees.
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Folkers ME, Adler DG. Endoscopic ultrasound for non-gastroenterologists: what you need to know. Hosp Pract (1995) 2011; 39:56-69. [PMID: 21576898 DOI: 10.3810/hp.2011.04.395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Endoscopic ultrasound (EUS) combines the use of flexible fiberoptic endoscopes with high-resolution ultrasound technology. It is increasingly used for the evaluation, staging, and diagnosis of many luminal and extraluminal gastrointestinal (GI) cancers, as well as non-GI tract ailments, including the staging of lung cancer. In the past decade, EUS has become available on a wide scale, with an increasing number of indications. The technology has been shown to be comparable with and often more sensitive than computed tomography scan and magnetic resonance imaging in staging many malignancies. The use of fine-needle aspiration and ultrasound-guided injection also allows for accurate tissue diagnosis and therapy of GI ailments. Despite increasing availability and indications for EUS over the past decade, general internists may not be aware of EUS technology, when to order an EUS, and how to integrate the results of an EUS into their management decisions. This article will review the general indications for EUS referral, limitations, and role of EUS in the practice of general medicine.
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Affiliation(s)
- Milan E Folkers
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Huntsman Cancer Center, Salt Lake City, UT 84312, USA
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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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