Preoperative Staging Of Rectal Cancer Research Articles

Improving the Quality of MRI Reports of Preoperative Patients With Rectal Cancer: Effect of National Guidelines and Structured Reporting.

Since the implementation of new guidelines for rectal cancer in The Netherlands in April 2014, clinical stage as seen at preoperative MRI indicates whether neoadjuvant therapy is necessary before rectal cancer surgery. Therefore, the importance of correct MRI interpretation has increased. The aim of this study was to evaluate the completeness of MRI reports of rectal cancer and the effect of implementation of the new guidelines and standardized reporting on the completeness of these reports. Data were collected from all patients who consecutively underwent rectal cancer surgery at one hospital between January 2011 and July 2017. Data were extracted from electronic patient records. The study included 492 MRI examinations. Before implementation of the new guidelines, a median of 4 of 10 items (interquartile range [IQR], 3-6 items) were described in each MRI report. After implementation of the new guidelines, the number of items described improved significantly (median, 7 items; IQR, 6-8 items; p < 0.001). Implementation of a standardized report led to further significant improvement (median, 9 items; IQR, 9-10 items; p < 0.001). The items scored most frequently were distance between the tumor and the anal verge (85.6%) and length of the tumor (87.6%). The items scored least were presence or absence of extramural venous invasion (21.1%) and morphologic features of the tumor (24.6%). Implementation of a standardized protocol and a standardized reporting system for MRI in preoperative staging of rectal cancer results in a more complete MRI report.

Diagnostic value of endoscopic ultrasonography in staging of rectal cancer

Objective To evaluate the diagnostic value of endoscopic ultrasonography (EUS) in staging of rectal cancer (RC). Methods From January 2015 to January 2017, the clinical data of 204 patients with RC and received EUS and surgery were retrospectively analyzed. Patients were divided into surgery alone group (155 cases) and preoperative neoadjuvant chemoradiation therapy (CRT) plus surgery group (49 cases). The preoperative staging by EUS and postoperative pathological staging of two groups were compared. Kappa test was performed for statistical analysis. Results Compared with postoperative pathologic diagnosis, the accuracy rate of EUS in the evaluation of invasion depth of RC in surgery alone group was 81.9% (127/155), and the accuracy rates in the diagnosis of Tis, T1, T2, T3 and T4 were 3/4, 11/13, 82.1%(32/39), 91.1%(41/45) and 74.1%(40/54), respectively, with a good consistency (kappa=0.751, P<0.01). However, the accuracy rate of EUS in the invasion depth of RC in CRT plus surgery group was 34.7% (17/49), and the accuracy rates in the diagnosis of T2, T3 and T4 were 1/13, 2/7 and 14/16, respectively, with a poor consistency (kappa=0.107, P=0.850). Compared with postoperative pathologic diagnosis, the diagnostic accuracy rate of EUS in evaluating regional lymph node metastasis in surgery alone group was 70.3% (109/155), and the accuracies in the diagnosis of cases with or without regional lymph node metastasis were 40.7% (24/59) and 88.5% (85/96), respectively, with a poor consistency (kappa=0.317, P<0.01). The diagnostic accuracy rate of EUS in evaluating regional lymph node metastasis of preoperative CRT plus surgery group was 51.0% (25/49), and the accuracies in the diagnosis of cases with or without regional lymph node metastasis were 5/11 and 52.6% (20/38), respectively, with a poor consistency (kappa=0.014, P=0.911). Conclusions EUS can accurately evaluate the depth of tumor invasion and lymph node metastasis in preoperative staging of RC, which may be helpful for determining clinical treatment strategy. However, for patients received CRT treatment, EUS has a limited value in diagnosing and staging the tumor. Key words: Rectal neoplasms; Endosonography; Neoplasm staging; Diagnosis

Value of high resolution magnetic resonance imaging in preoperative staging of rectal cancer

Value of high resolution magnetic resonance imaging in preoperative staging of rectal cancer

Rectal Carcinoma, Recent Staging Strategy by MRI Using Diffusion Weighted Sequence

Objective: MRI is currently the imaging modality of choice for the detection, characterization, and staging of rectal cancer. A variety of examinations have been used for preoperative staging of rectal cancer, including digital rectal examination, endorectal (endoscopic) ultrasound, CT, and MRI. Endoscopic ultrasound is the imaging modality of choice for small and small superficial tumors. MRI is superior to CT for assessing invasion to adjacent organs and structures, especially low tumors that carry a high risk of recurrence. Background: Colorectal cancer (CRC) is the third most common cancer in both sexes combined worldwide, after prostate and breast cancer with an incidence of 40 in 100,000. Rectal carcinoma accounts for more than one-third of colorectal tumors and is associated with significant morbidity and mortality. Currently, MRI using diffusion weighted sequence is the most sensitive and specific modality in staging rectal cancer as it is able to depict the mesorectal fascia and its relation to the tumor margins precisely. Methods: This study included 50 patients, (32 male and 18 female) previously diagnosed as cancer rectum based on proctoscope and histopathological biopsy. The age range of the patients was from 18 years to 78 years. All patients will be subjected to the following: detailed history, clinical examination, proctoscopic assessment and histopathological data. All patients underwent MRI of the pelvis specifically cancer rectum protocol. Results: The most frequently encountered clinical presentation among cancer rectum patients was bleeding per rectum (14), constipation (26), incidentally discovered liver metastasis (6) and intestinal obstruction (4). MRI evaluation of T staging in correlation to the histopathological examination showed sensitivity (80%), specificity (93%), accuracy (94%). Lymph node (LN) metastatic spread was evaluated by MRI and showed sensitivity (87%), specificity (92%), accuracy (92.6%), PPV (84.8%) and NPV (96.7%). Regarding circumferential resection margin (CRM) MRI assessment revealed; sensitivity (96%), specificity (94%), accuracy (96%), PPV (95%) and NPV (94.3%). Conclusions: MRI is an accurate and sensitive imaging method delineating tumoral margins, mesorectal fascia involvement, lymph nodes, and distant metastasis. MRI can accurately delineate the mesorectal fascia involvement, which is one of the main decision points in planning treatment.

CT or MRI Which is better for Rectal Cancer Imaging?

Colorectal cancer is one of the common causes of cancer-related mortality with rectal cancer representing a significant proportion. Cross-sectional imaging techniques especially computed tomography (CT) and magnetic resonance imaging (MRI) play an important role in preoperative staging of rectal cancer. There has always been a debate about the single best imaging modality for staging of rectal cancer in order to achieve the best surgical outcome. Hence, this article focuses on the comparative role of CT & MRI in staging of rectal cancers.

Accuracy of MR imaging in preoperative staging of rectal cancer

Accuracy of MR imaging in preoperative staging of rectal cancer

The Importance of Preoperative Staging of Rectal Cancer Using Multiparametric MRI. A Systematic Review

A correct preoperative stadialization of rectal carcinoma has a direct influence upon its therapeutic strategy, resulting in a significant improvement of the survival rate and life quality after the treatment. The therapeutic strategy refers to the option of undergoing or not preoperative radiochemotherapy before the total mesorectal excision (TME). The technical advances in the magnetic resonance domain makes possible the multiparametric examinations (mp MRI) with medical equipments (3T models are common) good enough to obtain images having an excellent quality, which allow a correct diagnosis of the local tumour spread. These multiparametric examinations include T2 multiplan sequences and T1 sequences, which offer valuable morphological information due to the high resolution of anatomic structures and DWI functional sequences, with a decisive role in tracing residual tumours after post-surgery radiochemotherapy. The functional examination using DWI is the only highly accurate non-invasive diagnostic method which can differentiate the fibrosis from vital tumoral remnants. The dynamic contrast-enhanced examination (DCE) combined with DWI and volumetry can give supplementary information as to the complete and incomplete response to RCT, and is efficient in detecting a local recurrence after TME. Also, MRI is the only diagnostic method which has the necessary accuracy to assess the meso-rectal fascia, which represents the circumferential resection margin (CRM) in the case of TME. With the help of MRI we can measure with a precision similar to histology the minimal distance to the mesorectal fascia, essential in planning the surgical treatment, and more important than the T stadialization. This allows the selection of patients with an unfavourable prognosis factor who would benefit from radiotherapy or from RCT. The evaluation of other prognostic factors as the condition of nodes, their number and primary site, and the extramural venous invasion (EMVI) have an important role in the individualized therapy.

The Importance of Preoperative Staging of Rectal Cancer Using ultiparametric MRI Part II: TNM Cancer Staging.

The Importance of Preoperative Staging of Rectal Cancer Using ultiparametric MRI Part II: TNM Cancer Staging.

Three-dimensional ultrasound in the preoperative staging of rectal cancer: State of the art

Imaging modalities such as endorectal ultrasonography (ERUS), pelvic magnetic resonance (MRI) and computed tomography play a fundamental role in evaluating recatl cancer preoperatively, planning surgical procedures, and selecting patients for neoadjuvant therapy. Based on the best available evidence, ERUS is recommended to accurately discriminate between T1 and T2 lesions, for low rectal cancer, defined as 0-5cm from the anal verge, if local excision (with transanal excision of transanal endoscopic microsurgery) is being considered. MRI is the best modality to detect mesorectal fascia invasion and to predict circumferential resection margin involvement. Both modalities have similar limitations in distinguishing metastatic from bening lumph node in the mesorectum. Due to higher panoramicity and multiplanar reconstruction, three-dimensional ERUS allows to visualize the spatial relationship of the rectal tumour in the context of the surrounding structures, improving the accuracy of ultra-sonographic staging. Technological advances and perspectives of ERUS under investigations are represented by real-time colour elastography, Doppler US and contrast-enhanced US.

PWE-328 Accuracy of pre-operative mri assessment of tumour staging in rectal cancer

<h3>Introduction</h3> Magnetic resonance imaging (MRI) is routinely used for pre-operative rectal cancer (RC) staging. Several meta-analyses have demonstrated that MRI has good sensitivity and specificity when assessing the T stage and the circumferential resection margin (CRM), but was consistently poor for detection of lymph node metastases.^1,2The current study aims to compare the pre-operative staging on the MRI scan with the post-operative pathological stage in patients patients not undergoing neoadjuvant therapy in a single tertiary colorectal centre. <h3>Method</h3> 20 blinded MRI scans of the pelvis in patients with RC were given to two consultant gastrointestinal radiologists and their interpretation was compared to each other, the original MRI report, and to the final pathological report. These scans were reported by the use of a standardised proforma. A Cohen–s kappa coefficient analysis was performed on 145 historic RC cases to test the correlation between T and N stage on pre-operative MRI scans compared to the definitive histopathological result. <h3>Results</h3> There was inter-reporter agreement on T and N stage in 11/20 (55%) and 10/20 (50%) of scans respectively. Agreement on EMVI and CRM positivity was 60% and 75% respectively. When these results were compared to the pathology results, at least one radiologist had the correct T and N stage in 60% and 75% of cases using the proforma, compared to 35% for T and N stage on the original MRI report. When 145 MRI reports were retrospectively reviewed (all reported without a proforma), the kappa statistic (κ) of 0.131 indicated a poor strength of agreement between the MRI stage and the pathological stage. Similarly T stage was predicted correctly in only 42.4% (76/145) of cases, and a kappa statistic (κ) of 0.135. <h3>Conclusion</h3> There is a growing consensus is the medical literature that we should not be relying on MRI scans to accurately stage RC. The discrepancy between MRI staging and histology may be explained by variable quality of the scans between different machines and institutions, and standardising the scanning protocols may improve accuracy. The findings fit with the growing consensus in the medical literature that we should not be relying on MRI scans to accurately stage RC. Dual consultant reporting of pelvic MRI scans, as well as the utilisation of the reporting proforma is a potential way of increasing the accuracy of this staging tool. <h3>Disclosure of interest</h3> None Declared. <h3>References</h3> Kwok H, Bissett IP, Hill GL. Preoperative staging of rectal cancer. Int J Colorectal Dis. 2000;15 Shandra B, <i>et al</i>. Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging—a meta-analysis 1. Radiology 2004;232

PWE-304 How accurate is pre-operative staging of the pelvic lymph nodes by MRI and ct in rectal cancers requiring abdomino-perineal resection: Abstract PWE-304 Table 1

<h3>Introduction</h3> MRI has proven extremely useful in pre-operative staging of rectal cancer. It has replaced CT scanning in assessment of the pelvis to become the current basis for Multi-Disciplinary Team discussion and decision making in relation to neoadjuvant therapy. However, recent studies correlating MRI and histopathology results for all rectal cancers have found a poorer performance for MRI in low rectal cancers. This study aimed to assess and compare the performance of CT and MRI scanning in assessing lymph node positivity in rectal cancers requiring abdomino-perineal excision of rectum (APER). <h3>Method</h3> All patients who underwent APER operations for rectal cancer in one NHS trust between Jan 2004 and Nov 2014 were identified from a pathology database. This covered the period in which MRI gradually replaced CT scanning in staging the pelvis. Exclusion criteria were benign disease, cancers other than adenocarcinoma and absence of CT or MRI scan preoperatively or where lymph node status was not reported. Pathological TNM staging was used to assess regional lymph node (LN) involvement. These findings were compared with those reported on CT and/or MRI scan. <h3>Results</h3> 150 patients fulfilled the criteria. 132 patients had pre-operative CT scan assessment of lymph node status. 58 patients had pre-operative MRI scan assessment. 48 patients had both a CT and an MRI scan pre-operatively. Table 1shows the comparison of reported lymph node stage by histopathological assessment of the specimen and CT/MRI. In terms of identifying LN positivity, CT achieved a sensitivity of 39% with a specificity of 78% while MRI achieved a sensitivity of 71% with a specificity of 35%. <h3>Conclusion</h3> The specificity of MRI in this cohort of patients undergoing APER suggests that decisions based on LN positivity will risk significant overtreatment. Although CT was considerably less sensitive it was more specific. As MRI was gradually replacing CT, data were available for comparison but not from identical time periods. There were also a number of radiologists involved in reporting both the CT and MRI scans. However, these data do suggest that in routine practice, pre-operative imaging of low rectal cancer by CT will under-estimate LN involvement while reliance on MRI will over-estimate LN involvement. <h3>Disclosure of interest</h3> None Declared.

Accuracy of endoscopic ultrasound in the preoperative staging and the guidance of transanal endoscopic microsurgery for rectal cancer

To explore the accuracy of endoscopic ultrasound (EUS) in preoperative staging of rectal cancer and to guide the treatment of transanal endoscopic microsurgery (TEM) in early rectal cancer. Clinical data of 80 patients with rectal cancer receiving EUS examination for preoperative staging in our department between June and December 2012 were retrospectively analyzed. Consistence comparison of EUS preoperative staging and pathological staging was performed to identify the accuracy of EUS preoperative staging. All the patients underwent operation within 1 week after EUS examination. According to preoperative staging, early rectal cancer(Tis or T1N0M0) patients with lesions less 20 cm to anus underwent TEM. The overall accuracy of EUS for preoperative T stage was 68.8%(55/80), and for T1, T2, T3, T4 was 91.3%(73/80), 83.8%(68/80), 77.5%(62/80), 85.0%(67/80), which had a good consistence with postoperative pathological T staging(Kappa=0.562). The overall accuracy of EUS for preoperative N stage was 52.7%(39/74), and for N0, N1, N2 stage was 64.9%(48/74), 55.4%(41/74), 85.1%(63/74), which had a poor consistence with postoperative pathological N staging(Kappa=0.235). Six patients underwent TEM successfully, with mean operation time 99(65 to 123) min, without intraoperative and postoperative complication, and were discharged 2-3 days after operation. Enteroscope showed good recovery 1 month later. Pathology confirmed that all the lesions were early rectal cancer. During postoperative follow-up of 14.8 (11 to 19) months, there was no local recurrence and distant metastasis. Preoperative EUS has a good accuracy with pathologic T stage, and can guide TEM in early rectal cancer.

Preoperative staging of rectal cancer with MRI: correlation with pathologic staging

IntroductionAn accurate preoperative rectal cancer staging is crucial to the correct management of the disease. Despite great controversy around this issue, pelvic magnetic resonance (RM) is said to be the imagiologic standard modality. This work aimed to evaluate magnetic resonance accuracy in preoperative rectal cancer staging comparing with the anatomopathological results. MethodsWe calculated sensibility, specificity, positive (VP positive) and negative (VP negative) predictive values for each T and N. We evaluated the concordance between both methods of staging using the Cohen weighted K (Kw), and through ROC curves, we evaluated magnetic resonance accuracy in rectal cancer staging. Results41 patients met the inclusion criteria. We achieved an efficacy of 43.9% for T and 61% for N staging. The respective sensibility, specificity, positive and negative predictive values are 33.3%, 94.7%, 33.3% and 94.7% for T1; 62.5%, 32%, 37.0% and 57.1% for T2; 31.8%, 79%, 63.6% and 50% for T3 and 27.8%, 87%, 62.5% and 60.6% for N. We obtained a poor concordance for T and N staging and the anatomopathological results. The ROC curves indicated that magnetic resonance is ineffective in rectal cancer staging. ConclusionMagnetic resonance has a moderate efficacy in rectal cancer staging and the major difficulty is in differentiating T2 and T3.

Value of endorectal ultasound in predicting the circumferential resection margin and maximum tumor thickness of T3 rectal cancer

To evaluate the accuracy of endorectal ultrasound (ERUS) in predicting the circumferential resection margin (CRM) and maximum tumor thickness (MTT) of in T3 rectal cancer. Clinicl data of 53 patients with pT3 rectal cancer admitted to the Department of General Surgery in the Peking Union Medical College Hospital from June 2011 to January 2014 were retrospectively analyzed. CRM and MTT measured by ERUS were compared with corresponding pathologic measurements to assess the accuracy of ERUS diagnosis. ERUS correctly predicted CRM status in 52 patients (98.1%, 52/53), whose sensitivity was 100%, specificity was 97.8%, positive predictive value was 85.7%, and negative predictive value was 100%. ERUS correctly predicted MTT status in 51 patients (96.2%, 51/53), whose sensitivity was 100%, specificity was 95.5%, positive predictive value was 66.6%, and negative predictive value was 100%. In the Bland and Altman plot, the agreement between ERUS and pathology was good. Endorectal ultrasonography can accurately diagnose CRM and MTT, which can satisfy the clinical need for preoperative staging of rectal cancer.

Synchronous rectal and prostate cancer – The impact of MRI on incidence and imaging findings

ObjectiveTo evaluate the incidence of synchronous diagnosis of rectal and prostate cancer and to identify how the role of magnetic resonance imaging (MRI) for preoperative staging of rectal cancer has affected the incidence. MethodsRegional data from the Swedish Colorectal Cancer Registry and the Regional Cancer Registry in Stockholm-Gotland area (two million inhabitants) between the years 1995–2011 were used. Patients were included when the rectal cancer was diagnosed prior to the prostate cancer. Medical records and pre-treatment MRI were retrospectively reviewed. ResultsOf 29,849 patients diagnosed with either disease, synchronous diagnosis was made in 29 patients (0.1%). Two patients were diagnosed in the years 1995–1999, seven patients between the years 2000–2005 and 20 patients between the years 2006–2011. The most common presentation, for the prostate cancer was incidental finding during staging for rectal cancer, n=20, and of those led MRI to the diagnosis in 14 cases.At retrospective review, all patients had focal lesions in the prostate on MRI and patients with higher suspicion of malignancy on MRI had more locally advanced disease. ConclusionSynchronous rectal and prostate cancer are a rare entity, but a strong increase in synchronous diagnosis is seen which may be attributed to improved diagnostic methods, including the use of pre-treatment MRI in routine work-up for rectal cancer.

Comparison Between Endoscopic Ultrasound and Magnetic Resonance Imaging for the Staging of Rectal Cancer

Introduction: Preoperative staging of rectal cancer is paramount in guiding therapeutic management. With improvements in pelvic MRI, the optimal modality to stage rectal cancer is less clear. The purpose of this study is to compare the concordance of endoscopic ultrasound (EUS) and magnetic resonance imaging (MRI) in staging rectal cancer. Methods: Sixty-one patients with histologically proven rectal cancer who underwent both EUS and MRI for staging purposes were compared in this retrospective study. Gold standard surgical pathology is unavailable in this cohort as the majority received preoperative therapy. Patients who had neo-adjuvant chemotherapy and/or radiation prior to these studies were excluded. The data was obtained from an IRB approved database. Results: Sixty-one patients (45 men [74%], mean age 56±10 years) were included. Agreement in the patients’ tumor (T) staging between EUS and MRI was 39/61 (63.9%). The overall correlation of T staging between EUS and MRI showed fair agreement (κ=.30; 95% CI 0.11, 0.49). Agreement in patients’ nodal (N) staging between EUS and MRI was 21/33 (63.6%). The overall correlation in N staging showed moderate agreement (κ=.43; 95% CI 0.21, 0.65). Agreement in patients’ T staging between EUS and MRI in determining T1/T2 versus T3/T4 was 54/61 (89%). The overall correlation of T1/T2 versus T3/T4 showed moderate agreement (κ=0.56; 95% CI 0.28, 0.85). Conclusion: Overall, EUS and MRI had fair to moderate agreement in T and N staging of rectal cancer. Importantly, agreement was strongest in the ability to determine between T1 and T2 vs T3 and T4 lesions, as this determination is necessary in guiding primary therapeutic decision making. While EUS has the added benefit of tissue acquisition, given the fair to moderate agreement in staging, these modalities appear complementary for the staging of rectal cancer.

MRI in local staging of rectal cancer: an update

Preoperative imaging for staging of rectal cancer has become an important aspect of current approach to rectal cancer management, because it helps to select suitable patients for neoadjuvant chemoradiotherapy and determine the appropriate surgical technique. Imaging modalities such as endoscopic ultrasonography, computed tomography, and magnetic resonance imaging (MRI) play an important role in assessing the depth of tumor penetration, lymph node involvement, mesorectal fascia and anal sphincter invasion, and presence of distant metastatic diseases. Currently, there is no consensus on a preferred imaging technique for preoperative staging of rectal cancer. However, high-resolution phased-array MRI is recommended as a standard imaging modality for preoperative local staging of rectal cancer, with excellent soft tissue contrast, multiplanar capability, and absence of ionizing radiation. This review will mainly focus on the role of MRI in preoperative local staging of rectal cancer and discuss recent advancements in MRI technique such as diffusion-weighted imaging and dynamic contrast-enhanced MRI.

Development and implementation of a synoptic MRI report for preoperative staging of rectal cancer on a population-based level.

Colorectal cancer physician champions across the province of Ontario, Canada, reported significant concern about appropriate selection of patients for preoperative chemoradiotherapy because of perceived variation in the completeness and consistency of MRI reports. The purpose of this work was to develop, pilot test, and implement a synoptic MRI report for preoperative staging of rectal cancer. This was an integrated knowledge translation project. This study was conducted in Ontario, Canada. Surgeons, radiologists, radiation oncologists, medical oncologists, and pathologists treating patients with rectal cancer were included in this study. A multifaceted knowledge translation strategy was used to develop, pilot test, and implement a synoptic MRI report. This strategy included physician champions, audit and feedback, assessment of barriers, and tailoring to the local context. A radiology webinar was conducted to pilot test the synoptic MRI report. Seventy-three (66%) of 111 Ontario radiologists participated in the radiology webinar and evaluated the synoptic MRI report. A total of 78% and 90% radiologists expressed that the synoptic MRI report was easy to use and included all of the appropriate items; 82% noted that the synoptic MRI report improved the overall quality of their information, and 83% indicated they would consider using this report in their clinical practice. An MRI report audit after implementation of the synoptic MRI report showed a 39% improvement in the completeness of MRI reports and a 37% uptake of the synoptic MRI report format across the province. Radiologists evaluating the synoptic MRI report and participating in the radiology webinar may not be representative of gastroenterologic radiologists in other geographic jurisdictions. The evaluation of completeness and uptake of the synoptic MRI reports is limited because of unmeasured differences that may occur before and after the MRI. A synoptic MRI report for preoperative staging of rectal cancer was successfully developed and pilot tested in the province of Ontario, Canada.

The Role of 3-D Endorectal Ultrasound in Rectal Cancer: Our Experience

In the last 20 years, endorectal ultrasound (ERUS) has been one of the main diagnostic methods for locoregional staging of rectal cancer. ERUS is accurate modality for evaluating local invasion of rectal carcinoma into the rectal wall layers (T category). Adding the three-dimensional modality (3-D) increases the capabilities of this diagnostic tool in rectal cancer patients. We review the literature and report our experience in preoperative 3-D ERUS in rectal cancer staging. In the group of 71 patients, the staging of preoperative 3-D endorectal ultrasonography was compared with the postoperative morphologic examination. Three-dimensional ERUS preoperative staging was confirmed with morphologic evaluation in 66 out of 71 cases (92.9%). The detection sensitivities of rectal cancer with 3-D ERUS were as follows: T1, 92.8%; T2, 93.1%; T3, 91.6%; and T4, 100.0%; with specificity values of T1, 98.2%; T2, 95.4%; T3, 97.8%; and T4, 98.5%. Three-dimensional ERUS correctly categorized patients with T1, 97.1%; T2, 94.3%; T3, 95.7%; and T4, 98.5%. The percentage of total overstaged cases was 2.75% and that of understaged cases was 6.87%. The metastatic status of the lymph nodes was determined with a sensitivity of 79.1% (19 of 24), specificity of 91.4% (43 of 47), and diagnostic accuracy of 87.3% (62 of 71). In our experience, 3-D ERUS has the potential to become the diagnostic modality of choice for the preoperative staging of rectal cancer.

The first Phuket International Symposium on Colorectal Disease: postgraduate course of the Asia Pacific Federation Congress 2013 of the International College of Surgeons

The first Phuket International Symposium on Colorectal Disease: postgraduate course of the Asia Pacific Federation Congress 2013 of the International College of Surgeons