Endoscopic ultrasound and magnetic resonance imaging for re-staging rectal cancer after radiotherapy.
OBJECTIVE
To compare the sensitivity and specificity of two imaging techniques, endoscopic ultrasound (EUS) and magnetic resonance imaging (MRI), in patients with rectal cancer after neoadjuvant chemoradiation therapy. And we compared EUS and MRI data with histological findings from surgical specimens.


METHODS
Thirty-nine consecutive patients (51.3% Male; mean age: 68.2 +/- 8.9 years) with histologically confirmed distal rectal cancer were examined for staging. All patients underwent EUS and MRI imaging before and after neoadjuvant chemoradiation therapy.


RESULTS
After neoadjuvant chemoradiation, EUS and MRI correctly classified 46% (18/39) and 44% (17/39) of patients, respectively, in line with their histological T stage (P > 0.05). These proportions were higher for both techniques when nodal involvement was considered: 69% (27/39) and 62% (24/39). When patients were sorted into T and N subgroups, the diagnostic accuracy of EUS was better than MRI for patients with T0-T2 (44% vs 33%, P > 0.05) and N0 disease (87% vs 52%, P = 0.013). However, MRI was more accurate than EUS in T and N staging for patients with more advanced disease after radiotherapy, though these differences did not reach statistical significance.


CONCLUSIONS
EUS and MRI are accurate imaging techniques for staging rectal cancer. However, after neoadjuvant RT-CT, the role of both methods in the assessment of residual rectal tumors remains uncertain.
Mezzi
Gianni
G
Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy. mezzi.gianni@hsr.it
Arcidiacono
Paolo Giorgio
PG
Carrara
Silvia
S
Perri
Francesco
F
Petrone
Maria Chiara
MC
De Cobelli
Francesco
F
Gusmini
Simone
S
Staudacher
Carlo
C
Del Maschio
Alessandro
A
Testoni
Pier Alberto
PA
D000368:Aged; D003131:Combined Modality Therapy / Q000379:methods; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging / Q000379:methods*; D011379:Prognosis; D012004:Rectal Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000532:radiotherapy; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed / Q000379:methods