Abstract
BackgroundThe aim of this study is to assess biplane transrectal ultrasonography (TRUS) plus ultrasonic elastosonography (UE) and contrast-enhanced ultrasonography (CEUS) in T staging of rectal cancer.MethodsBetween March 2016 and January 2019, 66 rectal cancer patients who completed biplane TRUS plus UE and CEUS for preoperative workup and were treated by primary total mesorectal excision (TME) were retrospectively analyzed.ResultsThe accuracy of TRUS plus UE and CEUS in all T staging of rectal cancer was 69.7%. The highest accuracy was achieved in the T3 stage (87.5%), while it was 71.4 and 50.0% in the T1 and T2 stage, respectively. The mean sizes of uT1-T2 lesions and uT3-T4 lesions were 30.0 ± 10.6 mm (range, 10.0–55.0) and 40.2 ± 11.2 mm (range, 14.0–57.0), respectively (p < 0.001). According to the receiver operating characteristic (ROC) curve to predict pT stages (pT1,2 vs. pT3), the optimal cut-off value of lesions in greatest dimension was 28.5 mm by TRUS with areas under the curve (AUC) of 0.769, and the optimal cut-off values of peak systolic velocity (PSV) and resistive index (RI) were 18.8 cm/sec and 0.645, respectively. The AUCs of PSV and RI were 0.588 and 0.555, respectively.ConclusionsDiagnostic accuracy of TRUS plus UE and CEUS in T staging of rectal cancer does not reach the excellent published study results, especially for patients with early rectal cancer. Tumor sizes, PSV and RI are useful additions for TRUS in T staging of rectal cancer.
Highlights
The aim of this study is to assess biplane transrectal ultrasonography (TRUS) plus ultrasonic elastosonography (UE) and contrast-enhanced ultrasonography (CEUS) in T staging of rectal cancer
A metaanalysis of comparing the diagnostic accuracy of endorectal ultrasound (EUS) and magnetic resonance imaging (MRI) in the staging of rectal cancer indicated that EUS was superior to MRI in overall T staging [3]
Biplane TRUS plus UE and CEUS in pT stages of rectal cancer According to the 8th American Joint Committee on Cancer (AJCC) staging system, the pT stage distribution for all patients was 18.2% Stage pT1 (n = 12), 24.2% Stage pT2 (n = 16), and 57.6% Stage pT3 (n = 38)
Summary
The aim of this study is to assess biplane transrectal ultrasonography (TRUS) plus ultrasonic elastosonography (UE) and contrast-enhanced ultrasonography (CEUS) in T staging of rectal cancer. Accurate staging is critical for rectal cancer to select appropriate therapy. In the National Comprehensive Cancer Network (NCCN) guidelines for rectal cancer, endorectal ultrasound (EUS) was suggestted when magnetic resonance imaging (MRI) was contraindicated or considered for superficial lesions [2]. CEUS is complementary to ultrasonography-guided fine-needle aspiration for diagnosis, staging, and predicting treatment response [7]. The role of UE and CEUS for rectal cancer is limited [8–10]. The aim of this study is to assess biplane transrectal ultrasonography (TRUS) plus UE and CEUS in T staging of rectal cancer
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