Abstract
Endorectal ultrasonography is valuable method for accurate local staging of rectal cancer. Precise evaluation of tumor stage is essential for optimal therapy planning in patients with rectal cancer. Furthermore, it has great influence on the resectability and the risk of recurrence following resection. Endorectal ultrasonography has become the most common diagnostic tool for locally staging rectal cancer due to its advantages over magnetic resonance imaging (MRI) and computer tomography (CT). Among these diagnostic modalities ERUS has been known to be most accurate. Moreover, endorectal ultrasonography is inexpensive and quick diagnostic procedure associated with minimal discomfort to the patient. However, the use of CT, MRI, and more recently magnetic resonance imaging with endorectal coil often remains necessary. These modalities may be useful supplements in patients with suspected T4 lesion, when endorectal ultrasonography is technically unsuccessful and in cases of diagnostic dilemma. Major improvements in diagnostic and staging of rectal cancer have led to stage-oriented surgery, planning of therapy individually for each patient, reduce of local recurrences, and better overall survival. This article reviews the current use of endorectal ultrasonography in preoperative staging of rectal cancer as the most practical and accurate diagnostic modality for preoperative locoregional staging of rectal cancer at this time.
Highlights
The first step in the management of patients with newly diagnosed rectal cancer is to evaluate whether the disease is localized or whether there are any signs of distant spread
Depending on the tumor stage different treatment concepts, including local excision, radical resection and multimodality therapy are available for patients with rectal cancer
Several studies have shown that Endorectal ultrasonography (ERUS) is practical, reliable and accurate diagnostic tool in rectal cancer staging and during the last decade it has become the most common diagnostic modality for locally staging rectal cancer
Summary
The first step in the management of patients with newly diagnosed rectal cancer is to evaluate whether the disease is localized or whether there are any signs of distant spread. Endorectal ultrasonography (ERUS) has added a new dimension to the evaluation of tumor invasion and lymph node involvement in rectal cancer. The value of CT in rectal cancer staging is limited mainly due to inability of CT to determine the depth of tumor invasion and its low sensitivity for malignant lymph nodes. The former is caused by the limited intrinsic soft-tissue contrast of CT that prohibits the visualization of the various layers of the bowel wall, and the latter because the detection of malignant lymph nodes is based on size [5]. ERUS provides better accuracy rates for T and N stage but MRI shows clear images between rectal cancer and adjacent organs, lateral pelvic lymph node status, and possible levator ani invasion and is irreplaceable in diagnostic evaluation of some cases. The fifth line, is the hyperechoic line and represents the interface between muscularis propria and the perirectal fat [12]
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