Diagnosis Of Rectal Carcinoma Research Articles

Significance of apparent diffusion coefficient in diagnosis of rectal carcinoma.

The apparent diffusion coefficient (ADC) is a quantitative parameter that facilitates the detection and reliable differentiation of rectal cancer. MR differentiation between rectal carcinoma, post-radiation proctitis, and normal rectal wall with the ADC values and their comparison depending onthe level of tumor markers and pathohistological characteristics of rectal carcinoma. The retrospective study performed at the Oncology Institute of Vojvodina included 300 patients, 100 each with rectal cancer, post-radiation proctitis, and normal rectum. Mean ADC values were obtained by measuring the region of interest (ROI) of the rectal wall. Rectal cancer showed lower ADC values (0.665 ± 0.086 x 10-3mm2/s) compared to both post-radiation proctitis (1.648 ± 0.268 x 10-3mm2/s) and normal rectum (1.180 ± 0.110 x 10-3mm2/s) (p<0.001). No significant differences in ADC values were observed between different grades of rectal cancer (p=0.874; p>0.05), depending on the presence of metastases in the lymph nodes (p=0.357; p>0.05), different TN stage (p=0.196; p>0.05), local spread of the tumor (p=0.312; p>0.05), the presence of RAS mutation (p=0.829; p>0.05) and the value of tumor markers (p=0.923; p>0.05). ADC values below 1.013 x 10-3mm2/s with 100% sensitivity and 96% specificity indicate the presence of rectal cancer in relation to normal wall, with a positive predictive value of 96.1% and a negative of 100%. ADC values below 1.255 x 10-3mm2/s with 100% sensitivity and 95% specificity indicate rectal cancer in relation to post-radiation proctitis. ADC values above 1.339 x 10-3mm2/s with 87% sensitivity and 89% specificity indicate post-radiation proctitis in relation to normal wall. The ADC is a useful marker in differentiating between rectal cancer, post-radiation proctitis, and normal rectal wall with high sensitivity and specificity, but it cannot be used to distinguish the histological grades of rectal cancer, nor other pathohistological parameters.

Infratemporal fossa metastasis of colorectal carcinoma

Metastatic disease of colorectal carcinoma can be present at the time of initial diagnosis or develop along the course of the disease. The liver is the most common site of distant metastasis of colorectal carcinoma. Other sites that are frequently involved include lung, peritoneum and bone. Head and neck involvement is extremely rare. We report a case of a middle-aged lady who was treated for colorectal carcinoma presented with infratemporal fossa metastasis 3years after the diagnosis of rectal carcinoma.

Anastomotic leakage after curative anterior resection for rectal cancer: short and long‐term outcome

The influence of symptomatic anastomotic leakage (AL) after anterior resection (AR) for rectal cancer on short and long-term mortality and local and distant recurrence was analysed. All patients with a first diagnosis of rectal carcinoma were prospectively registered in a national database. This comprised 1494 Danish citizens who had had a curative AR between May 2001 and December 2004. Data on survival and recurrence were obtained from the National Patient Register. Multivariate analyses were performed. Anastomotic leakage increased the 30-day mortality [odds ratio (OR) 4.01 (95% CI 2.24-7.17)]. Of other possible risk factors, only age had a significant interaction with leakage, as the risk of death within 30 days of AR decreased with increasing age. Long-term survival decreased significantly after AL [hazard ratio (HR) of 1.63, CI 1.21-2.19]. A total of 97 (6.7%) and 258 (18.0%) patients had local and distant recurrence respectively in the follow-up period. The risk of local and distant recurrence after AL was not different with HR of 1.50 (CI 0.84-2.69) and 1.13 (CI 0.76-1.69) respectively. No other factors influenced the risk of recurrence due to AL. Anastomotic leakage after AR for rectal cancer increases the 30-day and long-term mortality, but AL did not increase the risk of local and distant recurrence.

Application of magnetic resonance hydrography in diagnosis of rectal carcinoma

目的 探讨综合应用磁共振水成像技术对直肠癌术前诊断和分期的价值.方法 对本院34例临床确诊为直肠癌的患者应用磁共振水成像技术检查,并与术后病理诊断结果进行对比分析.结果 34例直肠癌患者均能显示原发病灶.手术病理诊断T1、T2、T3、T4期肿瘤中,磁共振水成像检查的准确率分别为67%,77%,87%,100%,总准确率为82%.判断淋巴结转移的敏感性、特异性和准确率分别为69%、63%、68%.对邻近组织脏器浸润、远处转移判断的准确率分别为94%、97%.结论 磁共振水成像对直肠癌的诊断和分期有较大价值,可以较准确地判断肿瘤在肠壁的浸润深度及盆腔内淋巴结的转移。

Brush cytology for the diagnosis of rectal carcinoma.

The use of brush cytology as an aid in the preoperative diagnosis of rectal cancer was prospectively assessed at 328 examinations in 289 consecutive patients with rectal lesions suspicious of carcinoma. Forty-five patients were reported as having benign polyps. There was 97 per cent agreement between conventional biopsy and cytology brushings for this group. Some 249 patients underwent a subsequent resection allowing comparison with formal histology. Forceps biopsy produced a true-positive diagnosis of cancer in 218 patients (89.7 per cent) and cytology in 222 (91 per cent). The sensitivity for forceps biopsy and cytology was 81 and 83 per cent respectively, with a combined sensitivity of 98 per cent. It is concluded that the addition of cytology to forceps biopsy increases the diagnostic yield in a single examination, and may be a complementary method of establishing the diagnosis of rectal lesions.

The value of CT with implanting water-cap in diagnosis of rectal carcinoma

目的 探讨直肠内植入水囊CT扫描对直肠癌的诊断价值.方法40例直肠癌患者直肠内注入水囊后行CT扫描,将CT表现与手术病理结果相对照,重点分析直肠癌浸润深度及范围并进行术前T分期.结果直肠水囊法CT扫描可显示直肠癌肿所致肠壁增厚,术前原发病灶显示率为95%,T分期准确率为82.5%.结论直肠水囊法CT扫描技术操作简单且方便安全,可明确显示直肠癌的浸润范围,为临床诊断提供更多信息。

Adenocarcinoma of the Rectum in Childhood Following Chemotherapy and Radiotherapy for a Rhabdomyosarcoma - A Case Report

We report a case of rectal adenocarcinoma in a 9-year-old boy, which took the form of a second malignant neoplasm following treatment for an early childhood malignancy. The abdominal complaints were for a long time interpreted as an infectious disease. At the time of diagnosis of the rectal carcinoma, the tumor had already progressed to the stage of metastatic disease. Therapy consisted of deep anterior rectal resection and regional arterial chemotherapy for liver metastases. The child died 18 months after the diagnosis of rectal carcinoma. As survival for childhood tumors improves, rare second malignant neoplasms will become increasingly common in children and adolescents. This phenomenon emphasizes the need for continued clinical surveillance of patients who have been treated with chemotherapy or irradiation for childhood tumors. The increased risk of second malignant neoplasms and an early onset of adult-type tumors has to be considered.

Prospective Evaluation of Preoperative 3 Tesla MRI in the Diagnosis of Rectal Carcinoma

Purpose: The purpose of this study was to prospectively investigate the ability of Magnetic Resonance Imaging at 3 Tesla to depict the topographical anatomical relations and tumor stage of rectal carcinoma compared to histology.

Rectal carcinoma: double-contrast MR imaging for preoperative staging.

To evaluate and compare the imaging findings and staging of rectal carcinoma by using conventional magnetic resonance (MR) imaging, MR imaging with an enema of superparamagnetic ferristene-based contrast material, and MR imaging with an enema of ferristene solution plus intravenous injection of gadodiamide. Twenty-nine patients (17 women, 12 men; age range, 39-91 years) referred with a diagnosis of rectal carcinoma were examined. Analysis of the rectal wall and staging of the tumor were performed. In all patients, the MR imaging findings were correlated with the histopathologic findings. The contrast material enema caused distention of the rectum and an intraluminal signal void, whereas the gadodiamide injection caused enhancement of the mucosa on T1-weighted images. This enhancement enabled evaluation of the normal rectal wall and differentiation of the mucosa, tunica muscularis, and perirectal space, which was not possible on the nonenhanced images. Double-contrast (ferristene solution plus gadodiamide) MR imaging was superior to imaging with only ferristene-based contrast material and had a sensitivity of 100%, specificity of 70%, and accuracy of 90% in distinguishing tumor stages worse than Dukes A. Double contrast material-enhanced MR imaging enables accurate rectal carcinoma staging, which is not possible at nonenhanced imaging.

Interobserver variability in endoscopic ultrasonography: a prospective evaluation

Background: Endoscopic ultrasonography (EUS) is an imaging modality that is now widely used to stage gastrointestinal malignancies. Few studies have addressed the issue of interobserver variability in the interpretation of EUS, particularly as it pertains to the staging of rectal carcinoma. Methods: Twenty-six patients with a diagnosis of rectal carcinoma were evaluated prospectively by three endoscopists. One performed sigmoidoscopy, the second (primary endosonographer) performed an EUS staging examination with full knowledge of the patient history and sigmoidoscopic appearance of the lesion, and the third endoscopist (secondary endosonographer) performed EUS blinded to this information. The results of the respective examinations were then compared. Results: When the EUS findings of the endosonographers were compared, T stage agreed in 88% of patients, with the following kappa coefficients: T1 (κ = 0.00); T2 (κ = -0.04); T3 (κ = -0.05); T4 (κ = 0.00). Interrator N stage agreed in 73% of patients (κ = 0.42). Conclusion: Our study prospectively evaluated interobserver variation in staging rectal carcinoma by EUS. The protocol that was followed provides a useful template that eliminated potential observer bias. Fair agreement was demonstrated regarding lymph node assessment. Although the raters agreed in 88% of the patients, kappa statistic analysis did not reach significant agreement, due to this institution's preponderence of UT3 lesions. Thus, validation of our findings in a setting where a broader spectrum of disease is encountered is required. (Gastrointest Endosc 1996;44:573-7.)

Lymph node dissection, stage migration and perioperative risk in rectal carcinoma

In 348 patients with an initial diagnosis of rectal carcinoma operated on between 1985 and 1994 we investigated the quality of lymph node dissection, its influence on the perioperative risk and tumor staging. The same histopathological work-up was carried out in all cases. Whether resections or extirpations were performed, the number of dissected lymph nodes increased from 5.3 and (1985/1986) to 16.7 and 17.3 (1991/1992) and to 15.8 and 17.3 (1993/1994) respectively. Neither the type of operation nor the surgeon's experience had a significant influence on the number of lymph nodes dissected. The increase in the number of lymph nodes dissected had no negative effect on the length of the operation, the amount of blood infused during the operation or the perioperative risk. We found a significant correlation between the number of lymph nodes dissected and the number of lymph node metastases (P = 0.02) and between an increase in UICC stage III (P = 0.005) and pN2 tumors (P = 0.000) and an increase in the number of lymph nodes dissected. Central lymph node dissection by high ligation of the inferior mesenteric artery did not increase the perioperative risk in spite of the fact that in recent years we have observed more patients with multiple diseases.

A prospective study of the accuracy of preoperative computed tomographic staging of patients with biopsy-proven rectal carcinoma

From June 1983 to January 1986, 91 patients with biopsy-proven adenocarcinoma of the rectum had computed tomographic scans of the pelvis performed before treatment as part of a "sandwich" radiotherapy-surgery regimen. Two experienced diagnostic radiologists performed locoregional staging of all scans according to the University of California at San Francisco criteria; one of these radiologists repeated this staging at a later time to test the reproducibility of a single observer. Staging was performed without the use of any other radiographic studies or of any clinical information except the patients' age, sex, and the diagnosis of rectal carcinoma, to test the value of computed tomographic scans alone for staging. Agreement between the two stagings performed by the first observer was 51 percent, and interobserver agreement was only 37 percent. Agreement with Dukes' staging was only 33 percent. Therefore, preoperative pelvic computed tomographic scanning of primary rectal adenocarcinoma should not be relied upon for staging or for the selection of patients for treatment options.