Abstract
The treatment options and the prognosis of rectal cancer (RC) depend mainly on the stage. Computed tomography (CT) has been the main staging tool in RC but endoanal ultrasound (EAUS) is thought to be more accurate. Patients with histologically proven rectal cancer presenting for the first time were staged using CT and EAUS. TNM staging was used to stage the rectal cancer. 24 patients (M:F 1:1) with a mean age of 57.3 (range = 23-80, SD = 15.3) years were included. The majority had a tumour of stage IIA/T3N0M0 (CT = 10, EAUS = 12). The staging of the tumour was the same in both investigations in 11 patients, while in 8 patients, EAUS staging was higher. The agreement for the T and N stages were kappa 0.24 and 0.5 respectively. There was a moderate and fair agreement between the overall TNM staging (weighted kappa 0.435) and the treatment strategies (weighted kappa 0.226) respectively, based on each imaging method. Of the 13 patients whose staging was different, the management changed in 6 (25%) patients (p = 0.016). CT identified distal metastases in 2 patients. EAUS and CT have only a fair to moderate agreement for staging and deciding treatment. However,EAUS has a significant influence when deciding treatment protocols.
Highlights
The treatment options and the prognosis of rectal cancer (RC) depend mainly on the stage
The majority had a tumour of stage IIA/T3N0M0 (CT = 10, endoanal ultrasound (EAUS) = 12)
The aims of our study were (i) to identify the correlation between stages and treatment strategy based on each imaging modality and (ii) to look at the impact of EAUS imaging on clinical decision making and patient management
Summary
The treatment options and the prognosis of rectal cancer (RC) depend mainly on the stage. Computed tomography (CT) has been the main staging tool in RC but endoanal ultrasound (EAUS) is thought to be more accurate. The incidence in Sri Lanka has risen from 0.7/100,000 in 1985 to 2.4/100,000 in 2005 [1]. Computed tomography (CT) has been the main modality of rectal cancer staging since 1981, recently, endoanal ultrasound (EAUS) and magnetic resonance imaging (MRI) have made their presence felt in a major way [2,3,4]. In Sri Lanka, there are only 8 CT scanners available in the public health sector and only 2 centres with EAUS facilities. CT remains the most available and widely used imaging modality in rectal cancer staging. Previous studies that compared CT imaging and EAUS in the staging of rectal cancer have failed to describe the impact of either imaging modality on patient management [5]
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