title: A comparison of endoanal ultrasound and computed tomography in staging rectal cancer and in clinical decision making - a preliminary study.
abstract: BACKGROUND
  The treatment options and the prognosis of rectal cancer (RC) depend mainly on the stage. Computed tomography (CT) has been the main staging tool in RC but endoanal ultrasound (EAUS) is thought to be more accurate.
  
  
  METHODS
  Patients with histologically proven rectal cancer presenting for the first time were staged using CT and EAUS. TNM staging was used to stage the rectal cancer.
  
  
  RESULTS
  24 patients (M:F 1:1) with a mean age of 57.3 (range = 23-80, SD = 15.3) years were included. The majority had a tumour of stage IIA/T3N0M0 (CT = 10, EAUS = 12). The staging of the tumour was the same in both investigations in 11 patients, while in 8 patients, EAUS staging was higher. The agreement for the T and N stages were kappa 0.24 and 0.5 respectively. There was a moderate and fair agreement between the overall TNM staging (weighted kappa 0.435) and the treatment strategies (weighted kappa 0.226) respectively, based on each imaging method. Of the 13 patients whose staging was different, the management changed in 6 (25%) patients (p = 0.016). CT identified distal metastases in 2 patients.
  
  
  CONCLUSIONS
  EAUS and CT have only a fair to moderate agreement for staging and deciding treatment. However,EAUS has a significant influence when deciding treatment protocols.
authors.affiliation: University Surgical Unit, The National Hospital of Sri Lanka, Colombo.
authors.forename: D P
authors.initials: DP
authors.lastname: Wickramasinghe
authors.forename: D N
authors.initials: DN
authors.lastname: Samarasekera
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D012004:Rectal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D014057:Tomography, X-Ray Computed; D055815:Young Adult