| A New Rectal Ultrasonographic Method for the Staging of Rectal Cancer |
 |
 |
 |
| Written by Javier Fabra |
| Friday, 02 October 2009 00:00 |
A New Rectal Ultrasonographic Method for the Staging of Rectal CancerMarc Beer-Gabel, Yehudith Assouline, Oded Zmora, Maurice Venturero, Simon Bar-Meir, Binjamin Avidan. Dis Colon Rectum 2009; 52: 1475–1480 Comments: José-M Ramírez I have read with great interest de paper from Beer-Gabel et al. As they point out, the worldwide accepted best technique of rectal ultrasound employs a balloon at the tip of the probe for rectal distension. The idea of scanning the rectal wall by just water filling the rectum is not new (see A. Heinz et al at Surg Endosc 1989; 3:92-95), and most studies in this subject agree about the advantages and better results. However, the great problem of this method is to properly fill the entire rectum and to keep the water inside it, difficult when the tumour is close to anal verge. In any case, this is an important paper that remember us that even stenosant rectal tumours can be well staged by means of ultrasound. PURPOSE: Radial transrectal ultrasound is the most frequently used method for preoperative staging of rectal cancer. Accuracy rates of transrectal ultrasound have fallen significantly to 64% and 70% for tumor and node staging, respectively. The use of a frontal probe may overcome the drawbacks of radial transrectal ultrasound. This study was designed to compare the accuracy of frontal transrectal ultrasound performed with a frontal probe with the classic procedure, which uses a radial probe, in the preoperative T and N staging of rectal cancer. METHODS: Seventy-four patients with rectal adenocarcinoma underwent both techniques. Thirty patients had a neoadjuvant treatment. The staging accuracy of both methods was determined by comparing the results of each with the findings of surgical histopathologic evaluation. RESULTS: Forty-six men and 28 women were recruited. Frontal transrectal ultrasound was performed in all patients. Staging was amenable in only 58 patients with the radial transrectal ultrasound because the tumors were either stenotic or too proximal. Frontal transrectal ultrasound was accurate in the T staging of 89% of the tumors, whereas radial transrectal ultrasound was accurate in only 69% (P 0.004). The difference was even more significant when we compared accuracy among the 58 patients in whom both examinations were completed (P 0.002). Both methods had similar accuracy for lymph node staging. Neoadjuvant treatment had no influence on accuracy. No overstaging of the tumor occurred with the frontal transrectal ultrasound. Understaging was more frequently encountered with radial transrectal ultrasound than with frontal transrectal ultrasound (26% vs. 11%, respectively; P 0.036). CONCLUSION: Compared with radial transrectal ultrasound, frontal transrectal ultrasound has a better accuracy for T staging of rectal cancer. Its advantage in overcoming the drawbacks of radial transrectal ultrasound may make this procedure the method of choice for rectal cancer staging. |
| Last Updated ( Monday, 07 September 2009 18:21 ) |