title: A prospective, blinded assessment of the impact of preoperative staging on the management of rectal cancer.
abstract: OBJECTIVE
  The influence of preoperative staging of rectal carcinoma on therapeutic decisions is uncertain. The use of fine-needle aspiration (FNA) of perirectal nodes in this setting has not been evaluated. The aim of this prospective, blinded study of patients with rectal cancer was to assess the impact of preoperative staging on treatment decisions and compare the tumor (T), nodal (N) staging performance characteristics of pelvic computed tomography (CT), rectal endoscopic ultrasonography (EUS), and EUS FNA.
  
  
  METHODS
  Eighty consecutive patients with newly diagnosed rectal cancer were prospectively evaluated. Therapy decisions were recorded after sequential disclosure of staging information to the patient's surgeon.
  
  
  RESULTS
  In 31% of patients (95% confidence interval, 21%-42%), EUS staging information changed the surgeon's original treatment plan based on CT alone. The further addition of FNA changed therapy in one patient. T staging accuracy was 71% (CT) and 91% (EUS) (P = 0.02); N staging accuracy was 76% (CT), 82% (EUS), and 76% (EUS FNA) (P = NS).
  
  
  CONCLUSIONS
  Preoperative staging with EUS results in more frequent use of preoperative neoadjuvant therapy than if staging was performed with CT alone. The addition of FNA only changed the management of one patient, whereas FNA did not significantly improve N staging accuracy over EUS alone. FNA seems to offer the most potential for impacting management in those patients with early T stage disease, and its use should be confined to this subgroup of patients. EUS is more accurate than CT for determining T stage of rectal carcinoma.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Gavin C
authors.initials: GC
authors.lastname: Harewood
authors.forename: Maurits J
authors.initials: MJ
authors.lastname: Wiersema
authors.forename: Heidi
authors.initials: H
authors.lastname: Nelson
authors.forename: Robert L
authors.initials: RL
authors.lastname: Maccarty
authors.forename: Janet E
authors.initials: JE
authors.lastname: Olson
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Clain
authors.forename: David A
authors.initials: DA
authors.lastname: Ahlquist
authors.forename: Mary L
authors.initials: ML
authors.lastname: Jondal
mesh_terms: D000368:Aged; D001707:Biopsy, Needle; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D010347:Patient Care Planning; D011300:Preoperative Care; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D016037:Single-Blind Method; D014057:Tomography, X-Ray Computed