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Sixty-three patients with primary rectal adenocarcinomas have been examined prior to surgery with rectal endosonography (ES). Maximum depths of tumour penetration measured endosonographically have been compared with subsequent maximum depths measured on the fixed resected specimen (n = 30) and the histological slide (n = 61). In both cases there was a good degree of correlation between the ultrasonic estimations of depth and the histological ones (r = 0.36, p = 0.05, CI = 95% and r = 0.46, p less than 0.001, CI = 99% respectively). In 12 cases ultrasonic depths of tumour were also measured in the laboratory and then compared with depths from fixed (n = 12) and fresh specimens (n = 5) with a good correlation (r = 0.75, p = 0.005, CI = 99% and r = 0.79, p = 0.036, CI = 95% respectively). Rectal endosonographic estimation of rectal cancer depth of invasion is an accurate measure of tumour penetration and may help distinguish between fixation due to inflammatory tissue and tumour fixity.

A retrospective survey to study hilar smooth muscle proliferation was performed on 410 superficial lymph nodes from 130 patients. Smooth muscle proliferation of variable degree was found in a total of 32 patients, affecting both inguinal and axillary nodes. A slight predominance of inguinal lesions was noted, and a higher proportion of nodes from male patients was affected. The smooth muscle proliferation was not age related nor was it associated with metastatic carcinoma. An association between smooth muscle proliferation and prominent hilar vascularity was found. In individual cases where several nodes had been removed, there was a tendency for more than one node to show smooth muscle proliferation, suggesting that there is a locally acting diffusible aetiological agent. We think the smooth muscle proliferation we have described is of vascular origin, and that it may reflect a previous inflammatory reaction.

The normal echographic pattern produced by the colon and rectum has been investigated in vitro. Five basic ultrasonic layers or interfaces have clearly been identified; a first echogenic layer produced by the mucosa, then an echopoor layer representing the mucosa and muscularis mucosae, an echogenic layer which was submucosa, echopoor layer which was muscularis propria and an echogenic layer which was either pararectal fat or serosa. The effectiveness of endoluminal ultrasound (ELU) in the pre-operative staging of rectal cancer has been assessed in a group of 67 patients who were also, where possible, graded by digital examination and in some cases computer aided tomography (CT) (33 patients). Digital examination had an overall accuracy of 50% and could predict invasion beyond or confinement to the rectal with an accuracy of 64%. ELU is a highly accurate method for staging local invasion and when compared to post-operative histopathology had an overall correlation coefficient of 0.88 (p less than 0.001) (Rank Spearman). Our overall accuracy was 91% and it could predict invasion beyond the muscularis propria with a sensitivity of 96%, specificity of 94% and positive predictive value of 98%. In the cohort studied by both radiological techniques ELU was more accurate than CT where overall accuracy was 79%, sensitivity was 84%, specificity was 63% and the positive predictive value was 88%.