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. 2009 Nov 28;15(44):5563-7.
doi: 10.3748/wjg.15.5563.

Endoscopic ultrasound and magnetic resonance imaging for re-staging rectal cancer after radiotherapy

Gianni Mezzi  1 , Paolo Giorgio Arcidiacono, Silvia Carrara, Francesco Perri, Maria Chiara Petrone, Francesco De Cobelli, Simone Gusmini, Carlo Staudacher, Alessandro Del Maschio, Pier Alberto Testoni
Affiliations

Endoscopic ultrasound and magnetic resonance imaging for re-staging rectal cancer after radiotherapy

Gianni Mezzi et al. World J Gastroenterol. .

Abstract

Aim: To compare the sensitivity and specificity of two imaging techniques, endoscopic ultrasound (EUS) and magnetic resonance imaging (MRI), in patients with rectal cancer after neoadjuvant chemoradiation therapy. And we compared EUS and MRI data with histological findings from surgical specimens.

Methods: Thirty-nine consecutive patients (51.3% Male; mean age: 68.2 +/- 8.9 years) with histologically confirmed distal rectal cancer were examined for staging. All patients underwent EUS and MRI imaging before and after neoadjuvant chemoradiation therapy.

Results: After neoadjuvant chemoradiation, EUS and MRI correctly classified 46% (18/39) and 44% (17/39) of patients, respectively, in line with their histological T stage (P > 0.05). These proportions were higher for both techniques when nodal involvement was considered: 69% (27/39) and 62% (24/39). When patients were sorted into T and N subgroups, the diagnostic accuracy of EUS was better than MRI for patients with T0-T2 (44% vs 33%, P > 0.05) and N0 disease (87% vs 52%, P = 0.013). However, MRI was more accurate than EUS in T and N staging for patients with more advanced disease after radiotherapy, though these differences did not reach statistical significance.

Conclusion: EUS and MRI are accurate imaging techniques for staging rectal cancer. However, after neoadjuvant RT-CT, the role of both methods in the assessment of residual rectal tumors remains uncertain.

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Figures

Figure 1
Figure 1
Rectal EUS. A: Before neoadjuvant chemoradiation treatment: evidence of perirectal fat tissue invasion, with fat speculation; B: After neoadjuvant chemoradiation treatment: reduction of tumor size and perirectal fat invasion.
Figure 2
Figure 2
Rectal RMI. A: Before neoadjuvant chemoradiation treatment: evidence of perirectal fat tissue invasion, with fat spiculation, and enlarged mesorectal lymph nodes; B: After neoadjuvant chemoradiation treatment: reduction of tumor size, perirectal fat invasion, enlarged lymph nodes; non-homogeneous mesorectal fat tissue.
Figure 3
Figure 3
Rectal EUS and elastosonography before neoadjuvant chemoradiation treatment. Elastography showing hard tissue inside the lesion.
See this image and copyright information in PMC

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