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[Preoperative diagnostic procedures in locally advanced rectal carcinoma (> or =T3 or N+). What does endoluminal ultrasound achieve at staging and restaging (after neoadjuvant radiochemotherapy) in contrast to computed tomography?].
- Source :
-
Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen [Chirurg] 2003 Mar; Vol. 74 (3), pp. 224-34. - Publication Year :
- 2003
-
Abstract
- Introduction: Neoadjuvant radiochemotherapy (neoRT/CT) in locally advanced rectal cancer requires an exact initial determination of the depth of the cancerous infiltration (T-status) and of locoregional lymph node metastasis (N-status). For staging and restaging, contrast-enhanced computed tomography (CT) is usually used. In specialised centers, the endorectal ultrasound (rES) may be preferred.<br />Methods: Between January 1998 and May 2001, the T- and N-status of 102 patients with adenocarcinoma of the rectum (> or =T3 or N+) was determined prospectively by rES and CT (group I: n=61 without neo-RT/CT, examined once; group II: n=41 examined before and after neoRT/CT). All diagnostic findings were compared using the (y)pTNM-classification.<br />Results: In the patients from group I, the depth of infiltration (uT) was predicted correctly by rES in 75% and by CT in 48% of cases; the carcinomas were understaged in 10% and 41% of cases and overstaged in 15% and 11%, respectively. According to the histopathological findings, the N-status was determined correctly by rES and CT in 75% and 57% of cases, understaging occurred in 8% and 30% and overstaging in 17% and 13%, respectively. In cases in which both methods resulted in identical T- (uT+ctT) or N-staging (uN+ctN), the accuracy increased to 82% and 80%, respectively. In patients from group II, after neoRT/CT rES and CT allowed the exact prediction of the yuT-stage in 66% and 51%, respectively. Only 2% were understaged by rES (understaging by CT: 22%). Overstaging occurred in 32% and 27% by rES and CT, respectively. The N-status determined by rES and CT was in accordance with the histopathological findings in 68% and 76%of cases, respectively. Understaging occurred in 20% and 17%,overstaging in 12% and 7%, respectively. Again identical staging results in both rES and CT increased the accuracy of the T- (yuT+yctT) or N- (yuN+yctN) classification to 90% and 83%, respectively. In group II, downsizing of the tumor by more than one T-stage was correctly assessed by rES results in 15/20 cases (75%). A complete remission of initial uT3-carcinoma was diagnosed correctly in only two of eight ypT0-cases. In contrast, CT demonstrated a remission of disease in all cases but was unable to predict the extent of tumour reduction. A remission of lymph node metastasis was accurately shown by rES in 17/19 cases (90%) and by CT in 10/12 cases (83%).<br />Conclusion: The staging of pretherapeutic, locoregional T- and N-status by rES is superior to that by CT (T-status: P=0.0164, N-status: P=0.0035). At restaging, rES offers higher accuracy in the detection of residual tumour infiltration (but not significantly to CT, yT-status: P=0.0833, yN-status: P=0.7962) and assessment of local remission. Therefore rES should be the method of choice in staging to avoid overtreatment in neoadjuvant settings.After neoRT/CT, the predictive efficacy of the rES for the downsizing/-staging of rectal cancer must be evaluated on greater numbers of patients receiving standardised diagnostic procedures and therapy.
- Subjects :
- Adenocarcinoma diagnostic imaging
Adenocarcinoma drug therapy
Adenocarcinoma radiotherapy
Adult
Aged
Aged, 80 and over
Antimetabolites, Antineoplastic administration & dosage
Antimetabolites, Antineoplastic therapeutic use
Combined Modality Therapy
Female
Fluorouracil administration & dosage
Fluorouracil therapeutic use
Humans
Logistic Models
Lymphatic Metastasis
Male
Middle Aged
Neoadjuvant Therapy
Neoplasm Metastasis
Neoplasm Staging
Postoperative Care
Preoperative Care
Prospective Studies
Radiotherapy Dosage
Rectal Neoplasms diagnostic imaging
Rectal Neoplasms drug therapy
Rectal Neoplasms radiotherapy
Adenocarcinoma diagnosis
Adenocarcinoma pathology
Adenocarcinoma surgery
Endosonography
Rectal Neoplasms diagnosis
Rectal Neoplasms pathology
Rectal Neoplasms surgery
Rectum pathology
Tomography, X-Ray Computed
Subjects
Details
- Language :
- German
- ISSN :
- 0009-4722
- Volume :
- 74
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen
- Publication Type :
- Academic Journal
- Accession number :
- 12647079
- Full Text :
- https://doi.org/10.1007/s00104-002-0609-z