Abstract
In rectal cancer, depth of infiltration and metastatic involvement of lymph nodes are important prognostic factors. The correct choice of operative treatment depends on the extent of the disease. In a prospective study, the value of endorectal ultrasound in staging rectal cancer was evaluated, and factors affecting the method's accuracy are discussed. The overall accuracy in staging depth of infiltration was 89 percent. Overstaging occurred in 10.2 percent, understaging in 0.8 percent. Tumors of the lower rectum are incorrectly staged in 16.7 percent, whereas tumors of the middle and upper rectum had an incorrect staging in 6.3 percent (P <0.001). Compared with computed tomography, endorectal sonography is the more accurate staging method (74.7 vs.90.8 percent). In staging lymph nodes, the overall accuracy was 80.2 percent, sensitivity was 89.4 percent, specificity was 73.4 percent, positive predictive value (PPV) was 71.2 percent, and negative predictive value (NPV) was 90.4 percent. The staging accuracy depends on the size of the node. Endorectal ultrasound is a safe, inexpensive, and accurate staging method, in the assessment of both depth of infiltration and nodal status. The results are strongly related to the experience of the investigator.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Mason AY. Rectal cancer: the spectrum of selective surgery. J R Soc Med 1976;69:237–44.
Williams NS, Durdey P, Quirke P,et al. Pre-operative staging of rectal neoplasm and its impact on clinical management. Br J Surg 1985;72:868–74.
Nicholls RJ, Maxon AY, Morson BC, Dixon AK, Fry IK. The clinical staging of rectal cancer. Br J Surg 1982;69:404–9.
Waizer A, Zitron S, Ben-Baruch D, Baniel J, Wolloch Y, Dintsman M. Comparative study for preoperative staging of rectal cancer. Dis Colon Rectum 1989;32:53–6.
Feifel G, Hildebrandt U, Dhom G. Die endorectale Sonographie beim Rectumcarcinom. Chirurg 1985;56:398–402.
Beynon J, Mortensen NJ, Rigby HS. Rectal endosonography, a new technique for the preoperative staging of rectal carcinoma. Eur J Surg Oncol 1988;14:297–309.
Herzog U, Gemsenjäger E, Tondelli P, Schuppisser JP, Gallacchi P. Präoperatives “clinical staging” beim Rektumtumor. Helv Chir Acta 1986;M53:659–61.
Hauenstein KH, Ruf G, Rudolf M, Wimmer B, Dinkel E. Präoperatives tumorstaging beim rektumkarzinom-eine prospektive studie. Radiologe 1986;26:364–8.
Angelelli G, Macarini L, Lupo L, Caputi-Jambrenghi O, Pannarale O. Memeo V. Rectal carcinoma: CT staging with water as contrast medium. Radiology 1990;177:511–4.
Dixon AK, Fry IK, Morson BC, Nicholls RJ, Mason AY. Pre-operative computed tomography of carcinoma of the rectum. Br J Radiol 1981;54:655–9.
Kramann B, Hildebrandt U. Computed tomography versus endosonography in the staging of rectal carcinoma: a comparative study. Int J Colorectal Dis 1986;1:216–8.
Holdsworth PJ, Johnston D, Chalmers AG,et al. Endoluminal ultrasound and computed tomography in the staging of rectal cancer. Br J Surg 1988;75:1019–22.
UICC. TNM-klassifikation maligner tumoren. 4th ed. Berlin: Springer, 1987.
Hildebrandt U, Feifel G. Preoperative staging of rectal cancer by intrarectal ultrasound. Dis Colon Rectum 1985;28:42–6.
Beynon J, Mortensen NJ, Foy DM, Channer JL, Rigby HS, Virjee J. Preoperative assessment of mesorectal lymph node involvement in rectal cancer. Br J Surg 1989;76:276–9.
Glaser F, Layer G, Zuna I, Van Kaick G, Schlag P, Herfarth Ch. Präoperative beurteilung pararectaler lymphknoten durch ultraschall. Chirurg 1990;61:587–91.
Hildebrandt U, Feifel G, Schwarz HP, Scherr O. Endorectal ultrasound: instrumentation and clinical aspects. Int J Colorectal Dis 1986;1:203–7.
Boscaini M, Masoni L, Montori A. Transrectal ultrasonography: three years' experience. Int J Colorectal Dis 1986;1:208–11.
Beynon J, Mortensen NJ, Foy DM, Channer JL, Virjee J, Goddard P. Endorectal sonography: laboratory and clinical experience in Bristol. Int J Colorectal Dis 1986;1:212–5.
Mason AY. The place of local resection in the treatment of rectal carcinoma. J R Soc Med 1970;63:1259–62.
Thoeni RF, Moss AA, Schnyder P, Margulis AR. Detection and staging of primary rectal and rectosigmoid cancer by computed tomography. Radiology 1981;141:135–8.
Moss AA, Thoeni RF, Schnyder P, Margulis AR. Value of computed tomography in the detection and staging of rectal carcinomas. J Comput Assist Tomogr 1981;5;870–4.
Beynon J, Mortensen NJ, Foy DM, Channer JL, Virjee J, Goddard P. Pre-operative assessment of local invasion in rectal cancer: digital examination, endoluminal sonography or computed tomography? Br J Surg 1986;73:1015–7.
Zaunbauer W, Haertel M, Fuchs WA. Computed tomography in carcinoma of the rectum. Gastrointest Radiol 1981;6:79–84.
Romano G, de Rosa P, Vallone G, Rotondo A, Grassi R, Santangelo ML. Intrarectal ultrasound and computed tomography in the pre- and postoperative assessment of patients with rectal cancer. Br J Surg 1985;72:S117–9.
Chapuis PH, Newland RC, Dent OF, Bokey EL, Hinder JM. Current perspectives in staging large bowel cancer. Aust N Z J Surg 1990;60:261–5.
Rifkin MD, Wechsler RJ. A comparison of computed tomography and endorectal ultrasound in staging rectal cancer. Int J Colorectal Dis 1986;1:219–23.
Ruf G, Hauenstein KH, Rudolf M, Schöffel U, Lausen M, Wimmer B. Präoperatives staging des rectumcarcinoms mit der Computertomographie. Langenbecks Arch Chir 1986;368:3–11.
Saitoh N, Okui K, Sarashina H, Suzuki M, Arai T, Nunomura M. Evaluation of echographic diagnosis of rectal cancer using intrarectal ultrasonic examination. Dis Colon Rectum 1986;29:234–42.
Glaser F, Schlag P, Herfarth Ch. Endorectal ultrasonography for the assessment of invasion of rectal tumors and lymph node involvement. Br J Surg 1990;77:883–7.
Orrom WJ, Wong WD, Rothenberger DA, Jensen LL, Goldberg SM. Endorectal ultrasound in the peroperative staging of rectal tumors: a learning experience. Dis Colon Rectum 1990;33:654–9.
Accarpio G, Scopinaro G, Claudiani F, Davini D, Mallarini G, Saitta S. Experience with local rectal cancer excision in light of two recent preoperative diagnostic methods. Dis Colon Rectum 1987;30:296–8.
Hildebrandt U, Feifel G, Dhom. The evaluation of the rectum by transrectal ultrasonography. Ultrasound Q 1988;6:167–79.
Jochem RJ, Reading CC, Dozois RR, Carpenter HA, Charboneau W. Endorectal ultrasonographic staging of rectal carcinoma. Mayo Clin Proc 1990;65:1571–7.
Rifkin MD, Ehrlich SM, Marks G. Staging of rectal carcinoma: prospective comparison of endorectal US and CT. Radiology 1989;170:319–22.
Dershaw DD, Enker WE, Cohen AM, Sigurdson ER. Transrectal ultrasonography of rectal carcinoma. Cancer 1990;66:2336–40.
Napoleon B, Pujol B, Berger F, Valette PJ, Gerard JP, Souget JC. Accuracy of endosonography in the staging of rectal cancer treated by radiotherapy. Br J Surg 1991;78:785–8.
Mascagni D, Corbellini L, Urciuoli P, Di Matteo G. Endoluminal ultrasound for early detection of local recurrence of rectal cancer. Br J Surg 1989;76:1176–80.
Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg 1982;69:613–6.
Heald RJ. The “holy plane” of rectal surgery. J R Soc Med 1988;81:503–8.
Tio TL, Tytgat GN. Endoscopic ultrasonography in the assessment of intra and transmural infiltration of tumours in the esophagus, stomach and papilla of Vater and in the detection of extraesophageal lesions. Endoscopy 1984;16:203–10.
Hildebrandt U, Klein T, Feifel G, Schwarz HP, Koch B, Schmitt RM. Endosonography of pararectal lymph nodes:in vitro andin vivo evaluation. Dis Colon Rectum 1990;33:863–8.
Hinder JM, Chu J, Bokey EL, Chapuis PH, Newland RC. Use of transrectal ultrasound to evaluate direct tumour spread and lymph node status in patients with rectal cancer. Aust N Z J Surg 1990;60:19–23.
Bucci L, Salfi R, Meraviglia F, Mazzeo F. Rectal lymphoscintigraphy. Dis Colon Rectum 1984;27:370–5.
Montori A, Miscusi G, Saracca L, Dell'Anna A, Ciofetta G, Risa L, Barbarossa C. Transrectal sonography and endoscopic lymphoscintigraphy in the preoperative staging of rectal cancer. Dig Surg 1984;1:200–4.
Reasbeck PG, Manktelow A, McArthur AM, Packer SG, Berkeley BB. An evaluation of pelvic lymphoscintigraphy in the staging of colorectal carcinoma. Br J Surg 1984;71:936–40.
Encke A, Baum RP, Hottenrott Ch, Lorenz M, Hör G. Die bedeutung der immundiagnostik für metastasen- und rezidivchirurgie. Chirurg 1988;559:309–16.
Doerr RJ, Abdel-Nabi H, Krag D, Mitchell E. Radio-labeled antibody imaging in the management of colorectal cancer. Results of a multicenter clinical study. Ann Surg 1991;214:118–24.
Thoeni RF. CT evaluation of carcinomas of the colon and rectum. Radiol Clin North Am 1989;27:731–41.
Butch RJ, Stark DD, Wittenberg J,et al. Staging rectal cancer by MR and CT. AJR 1986;146:1155–60.
Guinet C, Buy JN, Ghossain MA,et al. Comparison of magnetic resonance imaging and computed tomography in the preoperative staging of rectal cancer. Arch Surg 1990;125:385–8.
Herrera-Ornelas L, Justiniano J, Castillo N, Peterelli NJ, Stulc JP, Mittelman A. Metastases in small lymph nodes from colon cancer. Arch Surg 1987;122:1253–6.
Author information
Authors and Affiliations
About this article
Cite this article
Herzog, U., von Flüe, M., Tondelli, P. et al. How accurate is endorectal ultrasound in the preoperative staging of rectal cancer?. Dis Colon Rectum 36, 127–134 (1993). https://doi.org/10.1007/BF02051167
Issue Date:
DOI: https://doi.org/10.1007/BF02051167