Assessment of the accuracy of transrectal ultrasonography in anorectal neoplasia

Author:

Mackay S G1,Pager C K2,Joseph D1,Stewart P J3,Solomon M J12

Affiliation:

1. Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia

2. Surgical Outcomes and Research Centre, Sydney, Australia

3. Concord Hospital, University of Sydney, Sydney, Australia

Abstract

Abstract Background Accurate preoperative staging of anorectal neoplasia is required to identify patients for whom local excision or adjuvant therapy may be appropriate. The objectives of this study were to review the accuracy of endoluminal transrectal ultrasonography (TRUS) in the staging of rectal cancers and to determine the learning curve before optimal staging accuracy can be achieved. Methods The results of all TRUS examinations for the assessment of anorectal neoplasia performed by two colorectal surgeons at two teaching hospitals of the University of Sydney from 1991 to 2001 were collected prospectively. Results Of the 433 patients examined by TRUS, 356 were included, of whom 263 (73·9 per cent) had nodal status assessed histologically. Of the 77 patients excluded, 50 had undergone radiotherapy before operation. TRUS achieved excellent accuracy when compared with histopathology reports using κ statistics for standard Union Internacional Contra la Cancrum (UICC) staging (κ = 0·89), tumour wall penetration (κ = 0·70), lymph node detection (κ = 0·66) and a proposed new staging system (κ = 0·94). In addition, the increase in TRUS accuracy with operator experience demonstrates the need to perform 50 or more procedures before optimal accuracy is achieved. Conclusion TRUS provides an appropriate investigation with which to select patients with T1 tumours for local excision, and patients with T3 or T4 tumours for preoperative radiotherapy. The relative inaccuracy of staging T2 tumours by TRUS has led to a proposed alternative ultrasonographic staging system.

Publisher

Oxford University Press (OUP)

Subject

Surgery

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1. Transanal approaches to rectal neoplasia;Seminars in Colon and Rectal Surgery;2022-09

2. Rectal Carcinoma: Imaging for Staging;Fundamentals of Anorectal Surgery;2018-12-25

3. Colorectal Cancer in Pregnancy;Non-Obstetric Surgery During Pregnancy;2018-10-30

4. Overstaging: A Challenge in Rectal Cancer Treatment;Visceral Medicine;2018

5. Learning curve for endorectal ultrasound in young and elderly: lights and shades;Open Medicine;2016-01-01

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