Staging of rectosigmoid neoplasia with colonoscopic endoluminal ultrasonography.
BACKGROUND
The accurate staging of colorectal neoplasia may aid the stratification of patients for adjuvant treatment. At present the mural extent of neoplasia proximal to the mid rectum is difficult to determine. Prediction of mural invasion could help identify patients suitable for radical resection, minimal access surgery or endoscopic treatment. Colonoscopic endoluminal ultrasonography (EUS) was used in a prospective study to determine the stage of rectosigmoid neoplasia in 121 patients.


METHODS
Mural tumour (T) stage was designated by EUS as uT0/1-uT4 in 121 patients. Nodal (N) staging was performed in 39 cases. EUS staging was compared with histological stage (pT and pN) in 93 patients who underwent resection.


RESULTS
Mural staging of disease using colonoscopic EUS showed good correlation with histo-pathological stage (kappa = 0.85 (95 per cent confidence interval 0.76-0.95)). Overall pT and pN stage accuracy of EUS was 92 and 65 per cent respectively.


CONCLUSIONS
EUS accurately assessed tumour stage although node staging remained suboptimal. Colonoscopic EUS may aid the selection of treatment in patients with rectosigmoid neoplasia.
University Department of Surgery, Bristol Royal Infirmary, UK.
S A
SA
Norton
M G
MG
Thomas
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000379:methods; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D012680:Sensitivity and Specificity; D012811:Sigmoid Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*