title: Restaging locally advanced rectal cancer by different imaging modalities after preoperative chemoradiation: a comparative study.
abstract: BACKGROUND
  To compare the accuracy of different imaging modalities, alone and in combination in predicting findings at surgery after preoperative chemoradiation for locally advanced rectal cancer.
  
  
  METHODS
  Following chemoradiation, tumors were reclassified on the basis of findings on pelvic computed tomography (CT) (94 patients), endorectal ultrasonography (EUS) (138 patients) alone or by both CT and EUS (80 patients). The ability of the imaging modalities, to predict the pathologic T status, N status, and TNM stage at surgery was evaluated and compared.
  
  
  RESULTS
  Mean age of the patients was 64.5 years (range 28-88 years); 55% were male. CT and EUS combined had a positive predictive value of 20% for pathologic pT1 stage, 29% for pT1, 29% for pT2, and 58% for pT3. Predictive values for the operative TNM stage were 50% for stage I, 45% for stage II, and 31% for stage III. These values did not exceed those for each modality alone.
  
  
  CONCLUSIONS
  The performance of preoperative CT and EUS in predicting the T and TNM stage of rectal cancer at surgery is poor. Neither modality alone nor the two combined is sufficiently accurate to serve as the basis for decisions regarding treatment modification.
authors.affiliation: Department of Gastroenterology, Rabin Medical Center, Beilinson Hospital, Petach Tikva 49100, Israel. dickmanr1@gmail.com.
authors.forename: Ram
authors.initials: R
authors.lastname: Dickman
authors.forename: Yulia
authors.initials: Y
authors.lastname: Kundel
authors.forename: Rachel
authors.initials: R
authors.lastname: Levy-Drummer
authors.forename: Ofer
authors.initials: O
authors.lastname: Purim
authors.forename: Nir
authors.initials: N
authors.lastname: Wasserberg
authors.forename: Eyal
authors.initials: E
authors.lastname: Fenig
authors.forename: Aaron
authors.initials: A
authors.lastname: Sulkes
authors.forename: Baruch
authors.initials: B
authors.lastname: Brenner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging / Q000379:methods*; D011237:Predictive Value of Tests; D012004:Rectal Neoplasms / Q000175:diagnosis* / Q000601:surgery* / Q000628:therapy*; D012007:Rectum / Q000000981:diagnostic imaging; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography