title: Preoperative biopsy of pararectal lymph nodes in rectal cancer using endoluminal ultrasonography.
abstract: OBJECTIVE
  Because definitive information regarding lymph node status in rectal cancer would be valuable preoperatively, we evaluated the safety, feasibility, and accuracy of performing endoluminal ultrasound-guided biopsies of pararectal lymph nodes in 26 rectal cancer patients. Biopsies were compared with the pararectal tissues removed at surgery.
  
  
  METHODS
  Using a longitudinally oriented 7.0-MHz ultrasound probe and an 18-gauge spring-loaded core biopsy needle, patients underwent biopsies of lymph nodes detected ultrasonographically without complications.
  
  
  RESULTS
  A biopsy of adenocarcinoma was obtained in 13 patients, lymphoid material in 5 patients, and irrelevant material in 8 patients. Accuracy rate (true positives divided by number of procedures) was 77 percent, with a sensitivity of 71 percent, a specificity of 89 percent, a positive predictive value of 92 percent, and a negative predictive value of 62 percent. When adenocarcinoma or lymphoid material was obtained, there was only one false positive and one false negative.
  
  
  CONCLUSIONS
  Endoluminal ultrasonography-guided lymph node biopsy is simple and safe, and when adenocarcinoma or lymphoid material is obtained on biopsy, clinical decision making can be based on this information.
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Foundation, Ohio 44195-5044.
authors.forename: J W
authors.initials: JW
authors.lastname: Milsom
authors.forename: C
authors.initials: C
authors.lastname: Czyrko
authors.forename: T L
authors.initials: TL
authors.lastname: Hull
authors.forename: S A
authors.initials: SA
authors.lastname: Strong
authors.forename: V W
authors.initials: VW
authors.lastname: Fazio
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000379:methods*; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012004:Rectal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D012007:Rectum; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014463:Ultrasonography