title: Endorectal ultrasound in the management of patients with malignant rectal polyps.
abstract: OBJECTIVE
  This study was designed to determine the efficacy of endorectal ultrasound in the management of patients with malignant rectal polyps removed by snare excision during colonoscopy.
  
  
  METHODS
  A retrospective review of the medical records and endorectal ultrasound images of 63 patients with endoscopically removed rectal polyps containing invasive adenocarcinoma subsequently staged by endorectal ultrasound. Patients underwent surgery or were followed at a single institution. The polyp characteristics and ultrasound images were compared with the presence of residual tumor in the surgical specimen in patients who underwent further surgery or with recurrence in patients who did not.
  
  
  RESULTS
  The morphology of the polyps was described in 31 patients (49 percent); they were sessile in 26 (41 percent) and pedunculated in 6 (9 percent). The margins were positive in 22 patients (35 percent), negative in 19 (30 percent), and not specified in 22 (35 percent). Most tumors were well or moderately differentiated; only 3 (5 percent) were poorly differentiated. Thirty-three patients underwent further surgery (3 low anterior resection, and 30 transanal excision); 30 had no further surgery. The accuracy of endorectal ultrasound in assessing the presence of residual cancer in the rectal wall in patients who had surgery was 54 percent, with a 39 percent positive predictive value and 65 percent negative predictive value. Endorectal ultrasound accurately identified metastatic lymph nodes in two of three patients who had radical surgery. Endorectal ultrasound was more useful than polyp morphologic or histologic criteria to determine the presence of residual cancer in the rectal wall.
  
  
  CONCLUSIONS
  Endorectal ultrasound does not definitely exclude the possibility of residual tumor in the rectal wall or mesenteric nodes of patients who had a malignant polyp snared endoscopically. Consequently, decisions regarding the definitive management of these patients cannot be based exclusively on the endorectal ultrasound images of the polypectomy site.
authors.affiliation: Department of Surgery, University of California, San Francisco, California, USA.
authors.forename: Julio
authors.initials: J
authors.lastname: García-Aguilar
authors.forename: Enrique
authors.initials: E
authors.lastname: Hernández de Anda
authors.forename: David A
authors.initials: DA
authors.lastname: Rothenberger
authors.forename: Charles O
authors.initials: CO
authors.lastname: Finne
authors.forename: Robert D
authors.initials: RD
authors.lastname: Madoff
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003113:Colonoscopy; D016099:Endoscopy, Gastrointestinal; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011127:Polyps / Q000000981:diagnostic imaging* / Q000601:surgery*; D012004:Rectal Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D012189:Retrospective Studies