title: Modified Wong's classification improves the accuracy of rectal cancer staging by endorectal ultrasound and MRI.
abstract: BACKGROUND
  Douglas Wong proposed a new classification of tumor penetration in the rectal wall (T stage) in an attempt to incorporate the prognostic heterogeneity of T3 rectal cancers into the preoperative staging.
  
  
  OBJECTIVE
  This study aimed to evaluate if the accuracy of endorectal ultrasound and MRI in predicting rectal cancer T staging improves when using a modified Wong's classification.
  
  
  METHODS
  This prospective series compares local standard TN staging and a modified Wong's classification.
  
  
  METHODS
  This study was conducted by a specialized Colorectal Multidisciplinary Team at a tertiary teaching hospital.
  
  
  METHODS
  Seventy patients underwent surgery for middle or low rectal cancer between 2002 and 2008 without neoadjuvant radiochemotherapy. We compared the preoperative staging with the pathological staging to determine the preoperative accuracy of endorectal ultrasound and MRI when using a modified Wong's classification vs the standard TN classification.
  
  
  METHODS
  A modified version of Wong's classification was used for preoperative and pathological staging.
  
  
  METHODS
  The primary outcome measured was the accuracy in the preoperative T staging.
  
  
  RESULTS
  The overall accuracy of endorectal ultrasound and MRI in assessing T staging was 68.6% and 72.9% (uT1/2, 90%; uT3, 58.3%; and uT4, 100% and rT1/2, 88%; rT3, 63.4%; and rT4, 75%). By using the proposed modified Wong's classification, the overall accuracy of endorectal ultrasound and MRI improved to 82.9% and 90%.
  
  
  CONCLUSIONS
  The interobserver variability in radiological assessment was not evaluated.
  
  
  CONCLUSIONS
  With use of the modified Wong's classification proposed in this study, the overall accuracy of preoperative imaging in assessing T staging of rectal cancer is substantially improved, especially when endorectal ultrasound and MRI stage match, enhancing the selection of patients for neoadjuvant radiochemotherapy.
authors.affiliation: 1Colorectal Multidisciplinary Team, Hospital Clinico Universitario, University of Valencia, Valencia, Spain 2Department of General Surgery, Colorectal Unit, Hospital La Fe, University of Valencia, Valencia, Spain 3Imaging Department, ERESA, Valencia, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Muñoz
authors.forename: Pablo
authors.initials: P
authors.lastname: Granero-Castro
authors.forename: Matteo
authors.initials: M
authors.lastname: Frasson
authors.forename: Jorge
authors.initials: J
authors.lastname: Escartin
authors.forename: Pedro
authors.initials: P
authors.lastname: Esclapez
authors.forename: Salvador
authors.initials: S
authors.lastname: Campos
authors.forename: Blas
authors.initials: B
authors.lastname: Flor-Lorente
authors.forename: Eduardo
authors.initials: E
authors.lastname: Garcia-Granero
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000628:therapy; D019160:Endosonography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000628:therapy