The value of endosonographic rectal carcinoma staging in routine diagnostics: a 10-year analysis.
BACKGROUND
Endosonography is currently the gold standard for the local staging of rectal carcinoma, but its accuracy varies from 62% to 91%. This study aimed to determine the accuracy of endosonography, to evaluate the interobserver variability, and to compare the performance of the 7.5-MHz and the 10-MHz ultrasound scanners.


METHODS
Between 1990 and 2000, 458 patients with rectal cancer were included in the study. All the patients had undergone rectal endosonography with a 7.5-MHz scan (period 1: 1990-1996) or a 10-MHz scan (period 2: 1997-2000). Endosonographic staging was compared with pathologic staging.


RESULTS
The overall rate for correctly classified patients was 69% with respect to the T category and 68% with respect to the N category. There was no difference between the two scanners. In terms of accuracy, the T3 category tumors were the most (86%) and the T4 tumors the least (36%) accurately classified. Overstaging of tumors (19%) was much more frequent than understaging (12%). A high interobserver variability of 61% to 77% was noted. For pT1 tumors, the 10-MHz scan was almost two times more accurate than the 7.5-MHz scan (71% vs 36%).


CONCLUSIONS
The accuracy of endosonographic staging of rectal carcinoma very much depends on the T category. A high-resolution scanner and an experienced examiner can help to ensure that endosonography remains an important tool in the staging process of patients with rectal carcinoma, especially early carcinoma.
Kauer
W K H
WK
Department Surgery, Chirurgische Klinik und Poliklinik, Klinikum rechts der lsar, Technische Universität München, Ismaningerstrasse 22, 81675, München, Germany. werner_kauer@yahoo.de
Prantl
L
L
Dittler
H J
HJ
Siewert
J R
JR
D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000473:pathology; D003955:Diagnostic Tests, Routine; D004724:Endoscopy; D019160:Endosonography / Q000295:instrumentation; D006801:Humans; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging; D009361:Neoplasm Invasiveness / Q000000981:diagnostic imaging; D009367:Neoplasm Staging / Q000295:instrumentation / Q000379:methods*; D015588:Observer Variation; D011300:Preoperative Care; D012004:Rectal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity