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. 1997 Apr;225(4):432–438. doi: 10.1097/00000658-199704000-00013

Three-dimensional endosonography for staging of rectal cancer.

M Hünerbein 1, P M Schlag 1
PMCID: PMC1190752  PMID: 9114803

Abstract

OBJECTIVE: This prospective study was conducted to investigate the value of three-dimensional (3D) endosonography for staging of rectal cancer. SUMMARY BACKGROUND DATA: Transrectal ultrasound is the most sensitive technique for peroperative staging and follow-up of rectal cancer. Major limitations of this technique include the complexity of image interpretation and the inability to examine stenotic tumors or to identify recurrent rectal cancer. METHODS: Three-dimensional endosonography was performed in 100 patients with rectal tumors. Transrectal volume scans were obtained using a 3D multiplane transducer (7.5/10.0 MHz). Stenotic tumors were examined with a 3D frontfire transducer (5.0/7.5 MHz). The volume scans were processed and analyzed on a Combison 530 workstation (Kretztechnik, Zipf, Austria). RESULTS: The 3D endosonography and conventional endosonography were performed in 49 patients with nonstenotic rectal cancer. Display of volume data in three perpendicular planes or as 3D view facilitated the interpretation of ultrasound images and enhanced the diagnostic information of the data. The accuracy of 3D endosonography in the assessment of infiltration depth was 88% compared to 82% with the conventional technique. In the determination of lymph node involvement, 3D and two-dimensional endosonography provided accuracy rates of 79% and 74%, respectively. The 3D scanning allowed the visualization of obstructing tumors using reconstructed planes in front of the transducer. Correct assessment of the infiltration depth was possible in 15 of 21 patients with obstructing tumors (accuracy, 76%). Three-dimensional endosonography displayed suspicious pararectal lesions in 30 patients. Transrectal ultrasound-guided biopsy was extremely precise (accuracy, 98%) and showed malignancy in 10 of 30 patients. Histologic analysis changed the endosonographic diagnosis in 8 (27%) of the patients. CONCLUSIONS: The 3D endosonography permits examination of rectal cancer using previously unattainable planes and 3D views. The 3D imaging and ultrasound-guided biopsy seem capable to improve staging of rectal cancer and should be evaluated in further studies.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ackroyd J. S., Pattison M., Browse N. L. A study of the mechanical properties of fresh and preserved human femoral vein wall and valve cusps. Br J Surg. 1985 Feb;72(2):117–119. doi: 10.1002/bjs.1800720216. [DOI] [PubMed] [Google Scholar]
  2. Balthazar E. J., Megibow A. J., Hulnick D., Naidich D. P. Carcinoma of the colon: detection and preoperative staging by CT. AJR Am J Roentgenol. 1988 Feb;150(2):301–306. doi: 10.2214/ajr.150.2.301. [DOI] [PubMed] [Google Scholar]
  3. Bannon J. P., Marks G. J., Mohiuddin M., Rakinic J., Jian N. Z., Nagle D. Radical and local excisional methods of sphincter-sparing surgery after high-dose radiation for cancer of the distal 3 cm of the rectum. Ann Surg Oncol. 1995 May;2(3):221–227. doi: 10.1007/BF02307027. [DOI] [PubMed] [Google Scholar]
  4. Beynon J., Mortensen N. J., Foy D. M., Channer J. L., Rigby H., Virjee J. Preoperative assessment of mesorectal lymph node involvement in rectal cancer. Br J Surg. 1989 Mar;76(3):276–279. doi: 10.1002/bjs.1800760320. [DOI] [PubMed] [Google Scholar]
  5. Dahl O., Horn A., Morild I., Halvorsen J. F., Odland G., Reinertsen S., Reisaeter A., Kavli H., Thunold J. Low-dose preoperative radiation postpones recurrences in operable rectal cancer. Results of a randomized multicenter trial in western Norway. Cancer. 1990 Dec 1;66(11):2286–2294. doi: 10.1002/1097-0142(19901201)66:11<2286::aid-cncr2820661106>3.0.co;2-t. [DOI] [PubMed] [Google Scholar]
  6. Dresing K., Stock W. Ultrasonic endoluminal examination in the follow-up of colorectal cancer. Initial experience and results. Int J Colorectal Dis. 1990 Dec;5(4):188–194. doi: 10.1007/BF00303273. [DOI] [PubMed] [Google Scholar]
  7. Freeny P. C., Marks W. M., Ryan J. A., Bolen J. W. Colorectal carcinoma evaluation with CT: preoperative staging and detection of postoperative recurrence. Radiology. 1986 Feb;158(2):347–353. doi: 10.1148/radiology.158.2.3941861. [DOI] [PubMed] [Google Scholar]
  8. Glaser F., Friedl P., von Ditfurth B., Schlag P., Herfarth C. Influence of endorectal ultrasound on surgical treatment of rectal cancer. Eur J Surg Oncol. 1990 Aug;16(4):304–311. [PubMed] [Google Scholar]
  9. Glaser F., Layer G., Zuna I., van Kaick G., Schlag P., Herfarth C. Präoperative Beurteilung pararectaler Lymphknoten durch Ultraschall. Chirurg. 1990 Aug;61(8):587–591. [PubMed] [Google Scholar]
  10. Gérard A., Buyse M., Nordlinger B., Loygue J., Pène F., Kempf P., Bosset J. F., Gignoux M., Arnaud J. P., Desaive C. Preoperative radiotherapy as adjuvant treatment in rectal cancer. Final results of a randomized study of the European Organization for Research and Treatment of Cancer (EORTC). Ann Surg. 1988 Nov;208(5):606–614. doi: 10.1097/00000658-198811000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Heberer G., Denecke H., Demmel N., Wirsching R. Local procedures in the management of rectal cancer. World J Surg. 1987 Aug;11(4):499–503. doi: 10.1007/BF01655815. [DOI] [PubMed] [Google Scholar]
  12. Heimann T. M., Oh C., Steinhagen R. M., Greenstein A. J., Perez C., Aufses A. H., Jr Surgical treatment of tumors of the distal rectum with sphincter preservation. Ann Surg. 1992 Oct;216(4):432–437. doi: 10.1097/00000658-199210000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Herzog U., von Flüe M., Tondelli P., Schuppisser J. P. How accurate is endorectal ultrasound in the preoperative staging of rectal cancer? Dis Colon Rectum. 1993 Feb;36(2):127–134. doi: 10.1007/BF02051167. [DOI] [PubMed] [Google Scholar]
  14. Hildebrandt U., Feifel G. Preoperative staging of rectal cancer by intrarectal ultrasound. Dis Colon Rectum. 1985 Jan;28(1):42–46. doi: 10.1007/BF02553906. [DOI] [PubMed] [Google Scholar]
  15. Hildebrandt U., Feifel G., Schwarz H. P., Scherr O. Endorectal ultrasound: instrumentation and clinical aspects. Int J Colorectal Dis. 1986 Oct;1(4):203–207. doi: 10.1007/BF01648337. [DOI] [PubMed] [Google Scholar]
  16. Hildebrandt U., Klein T., Feifel G., Schwarz H. P., Koch B., Schmitt R. M. Endosonography of pararectal lymph nodes. In vitro and in vivo evaluation. Dis Colon Rectum. 1990 Oct;33(10):863–868. doi: 10.1007/BF02051923. [DOI] [PubMed] [Google Scholar]
  17. Hinder J. M., Chu J., Bokey E. L., Chapuis P. H., Newland R. C. Use of transrectal ultrasound to evaluate direct tumour spread and lymph node status in patients with rectal cancer. Aust N Z J Surg. 1990 Jan;60(1):19–23. doi: 10.1111/j.1445-2197.1990.tb07347.x. [DOI] [PubMed] [Google Scholar]
  18. Jones D. J., Zaloudik J., James R. D., Haboubi N., Moore M., Schofield P. F. Predicting local recurrence of carcinoma of the rectum after preoperative radiotherapy and surgery. Br J Surg. 1989 Nov;76(11):1172–1175. doi: 10.1002/bjs.1800761120. [DOI] [PubMed] [Google Scholar]
  19. Kusunoki M., Yanagi H., Kamikonya N., Hishikawa Y., Shoji Y., Yamamura T., Utsunomiya J. Preoperative detection of local extension of carcinoma of the rectum using magnetic resonance imaging. J Am Coll Surg. 1994 Dec;179(6):653–656. [PubMed] [Google Scholar]
  20. Müller-Schimpfle M., Brix G., Layer G., Schlag P., Engenhart R., Frohmuller S., Hess T., Zuna I., Semmler W., van Kaick G. Recurrent rectal cancer: diagnosis with dynamic MR imaging. Radiology. 1993 Dec;189(3):881–889. doi: 10.1148/radiology.189.3.8234720. [DOI] [PubMed] [Google Scholar]
  21. Orrom W. J., Wong W. D., Rothenberger D. A., Jensen L. L., Goldberg S. M. Endorectal ultrasound in the preoperative staging of rectal tumors. A learning experience. Dis Colon Rectum. 1990 Aug;33(8):654–659. doi: 10.1007/BF02150740. [DOI] [PubMed] [Google Scholar]
  22. 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 Apr;29(4):234–242. doi: 10.1007/BF02553025. [DOI] [PubMed] [Google Scholar]
  23. Schlag P., Lehner B., Strauss L. G., Georgi P., Herfarth C. Scar or recurrent rectal cancer. Positron emission tomography is more helpful for diagnosis than immunoscintigraphy. Arch Surg. 1989 Feb;124(2):197–200. doi: 10.1001/archsurg.1989.01410020067011. [DOI] [PubMed] [Google Scholar]
  24. Solomon M. J., McLeod R. S., Cohen E. K., Simons M. E., Wilson S. Reliability and validity studies of endoluminal ultrasonography for anorectal disorders. Dis Colon Rectum. 1994 Jun;37(6):546–551. doi: 10.1007/BF02050988. [DOI] [PubMed] [Google Scholar]
  25. Sugarbaker P. H., Gianola F. J., Dwyer A., Neuman N. R. A simplified plan for follow-up of patients with colon and rectal cancer supported by prospective studies of laboratory and radiologic test results. Surgery. 1987 Jul;102(1):79–87. [PubMed] [Google Scholar]
  26. Thompson W. M., Halvorsen R. A., Foster W. L., Jr, Roberts L., Gibbons R. Preoperative and postoperative CT staging of rectosigmoid carcinoma. AJR Am J Roentgenol. 1986 Apr;146(4):703–710. doi: 10.2214/ajr.146.4.703. [DOI] [PubMed] [Google Scholar]
  27. Waizer A., Powsner E., Russo I., Hadar S., Cytron S., Lombrozo R., Wolloch Y., Antebi E. Prospective comparative study of magnetic resonance imaging versus transrectal ultrasound for preoperative staging and follow-up of rectal cancer. Preliminary report. Dis Colon Rectum. 1991 Dec;34(12):1068–1072. doi: 10.1007/BF02050063. [DOI] [PubMed] [Google Scholar]
  28. de Lange E. E. Staging rectal carcinoma with endorectal imaging: how much detail do we really need? Radiology. 1994 Mar;190(3):633–635. doi: 10.1148/radiology.190.3.8115601. [DOI] [PubMed] [Google Scholar]

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