ENDOSCOPIC RECTAL ULTRASOUND IN RECTAL ADENOCARCINOMA STAGING: CAN A SURGEON RELY ON ENDOSCOPIC FINDINGS BEFORE THE SURGERY? - COMPARISON WITH POSTOPERATIVE PATHOLOGICAL DIAGNOSIS.

Abstract

Our aim in this study was to demonstrate the usefulness of endoscopic rectal ultra- sound scan (ERUS) in providing information that can help surgeons decide on therapeutic approach and type of surgical procedure in patients with rectal cancer. We compared ERUS findings with postoperative pathological data in 41 patients with endoscopic and pathological (PH) diagnosis of rectal cancer. These patients underwent ERUS examination to determine the extent of the disease and the findings were subsequently compared with postoperative pathological diagnosis. After ERUS examination, there were three patients in group T0, five in group T1, 12 in group T2, 17 in group T3, two in group T4, and two patients had a mucinous metastatic type of cancer. After excluding 15 patients who met the exclusion criteria, we compared ERUS findings of 26 patients with their pathological diagnosis to determine the sensitivity and accuracy of ERUS. The total sensitivity of the ERUS in preoperative staging of the tumor stage T0-T4 was 96%. Accuracy was 89%. This study showed that a surgeon can rely on the findings of ERUS performed by an experienced endoscopist before deciding of type of surgical procedure for T0-T2, and even T3 degree of rectal cancer. T3 rectal cancers are in the "gray zone", so both procedures, ERUS and nuclear magnetic resonance imaging (NMR), are needed to decide on the final therapeutic approach. NMR remains the gold standard for staging T4 rectal cancer.