title: Staging of rectal cancer by EUS: depth of infiltration in T3 cancers is important.
abstract: BACKGROUND
  EUS is an established method for staging of rectal cancer. Nevertheless, there are few data about the significance of infiltration depth measured by EUS.
  
  
  OBJECTIVE
  Assessment of accuracy of T and N staging by EUS with attention to infiltration depth as provided by EUS.
  
  
  METHODS
  Part retrospective, part prospective study.
  
  
  METHODS
  Community and tertiary referral hospital, covering the period before neoadjuvant therapy for advanced rectal cancer was established.
  
  
  METHODS
  Eighty-three patients (60% men) with untreated rectal cancer.
  
  
  METHODS
  EUS examination.
  
  
  METHODS
  We examined the correlation between EUS findings and postoperative histology. T3 cancers as diagnosed by EUS were classified into minimally invasive (1-2 mm) or advanced (>2 mm) tumors depending on the depth of infiltration beyond the muscularis propria.
  
  
  RESULTS
  Accuracy of T staging and N status was 76% and 63%, respectively. Overstaging by EUS was more common in minimally invasive T3 by EUS (uT3) (8 of 16 [50%]) compared with advanced uT3 tumors (1 of 24 [4%]) (P=.01). Accuracy of EUS discrimination between T1/2 and T3/4 in rectal cancer for all but minimally invasive uT3 rectal tumors was 88%.
  
  
  CONCLUSIONS
  Partly retrospective analysis.
  
  
  CONCLUSIONS
  EUS examination of rectal carcinoma determines T stage with high accuracy. Additionally, it provides information beyond T and N staging. The 50% probability of overstaging patients with minimally invasive uT3N0 by EUS may argue for managing these cancers as stage I disease, ie, to refer the patient for surgery without neoadjuvant therapy.
authors.affiliation: Department of Pathology, Klinikum Chemnitz gGmbH, Chemnitz, Germany. Christian_Juergensen@charite.de
authors.forename: Christian
authors.initials: C
authors.lastname: Jürgensen
authors.forename: Andreas
authors.initials: A
authors.lastname: Teubner
authors.forename: Jörg-Olaf
authors.initials: JO
authors.lastname: Habeck
authors.forename: Friederike
authors.initials: F
authors.lastname: Diener
authors.forename: Hans
authors.initials: H
authors.lastname: Scherübl
authors.forename: Ulrich
authors.initials: U
authors.lastname: Stölzel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011379:Prognosis; D012004:Rectal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D012189:Retrospective Studies; D012720:Severity of Illness Index