title: Diagnostic accuracy of endoscopic ultrasonography for rectal neuroendocrine neoplasms.
abstract: OBJECTIVE
  To investigate the diagnostic accuracy of endoscopic ultrasonography (EUS) for rectal neuroendocrine neoplasms (NENs) and the differential diagnosis of rectal NENs from other subepithelial lesions (SELs).
  
  
  METHODS
  The study group consisted of 36 consecutive patients with rectal NENs histopathologically diagnosed using biopsy and/or resected specimens. The control group consisted of 31 patients with homochronous rectal non-NEN SELs confirmed by pathology. Epithelial lesions such as cancer and adenoma were excluded from this study. One EUS expert blinded to the histological results reviewed the ultrasonic images. The size, original layer, echoic intensity and homogeneity of the lesions and the perifocal structures were investigated. The single EUS diagnosis recorded by the EUS expert was compared with the histological results.
  
  
  RESULTS
  All NENs were located at the rectum 2-10 cm from the anus and appeared as nodular (n = 12), round (n = 19) or egg-shaped (n = 5) lesions with a hypoechoic (n = 7) or intermediate (n = 29) echo pattern and a distinct border. Tumors ranged in size from 2.3 to 13.7 mm, with an average size of 6.8 mm. Homogeneous echogenicity was seen in all tumors except three. Apart from three patients (stage T2 in two and stage T3 in one), the tumors were located in the second and/or third wall layer without involvement of the fourth and fifth layers. In the patients with stage T1 disease, the tumors were located in the second wall layer only in seven cases, the third wall layer only in two cases, and both the second and third wall layers in 27 cases. Approximately 94.4% (34/36) of rectal NENs were diagnosed correctly by EUS, and 74.2% (23/31) of other rectal SELs were classified correctly as non-NENs. Eight cases of other SELs were misdiagnosed as NENs, including two cases of inflammatory lesions and one case each of gastrointestinal tumor, endometriosis, metastatic tumor, lymphoma, neurilemmoma, and hemangioma. The positive predictive value of EUS for rectal NENs was 80.9% (34/42), the negative predictive value was 92.0% (23/25), and the diagnostic accuracy was 85.1%.
  
  
  CONCLUSIONS
  EUS has satisfactory diagnostic accuracy for rectal NENs with good sensitivity, but unfavorable specificity, making the differential diagnosis of NENs from other SELs challenging.
authors.affiliation: Hong-Tan Chen, Guo-Qiang Xu, Yi-Peng Chen, Li-Hua Chen, You-Ming Li, Department of Gastroenterology, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China.
authors.forename: Hong-Tan
authors.initials: HT
authors.lastname: Chen
authors.affiliation: Hong-Tan Chen, Guo-Qiang Xu, Yi-Peng Chen, Li-Hua Chen, You-Ming Li, Department of Gastroenterology, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China.
authors.forename: Guo-Qiang
authors.initials: GQ
authors.lastname: Xu
authors.affiliation: Hong-Tan Chen, Guo-Qiang Xu, Yi-Peng Chen, Li-Hua Chen, You-Ming Li, Department of Gastroenterology, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China.
authors.forename: Xiao-Dong
authors.initials: XD
authors.lastname: Teng
authors.affiliation: Hong-Tan Chen, Guo-Qiang Xu, Yi-Peng Chen, Li-Hua Chen, You-Ming Li, Department of Gastroenterology, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China.
authors.forename: Yi-Peng
authors.initials: YP
authors.lastname: Chen
authors.affiliation: Hong-Tan Chen, Guo-Qiang Xu, Yi-Peng Chen, Li-Hua Chen, You-Ming Li, Department of Gastroenterology, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China.
authors.forename: Li-Hua
authors.initials: LH
authors.lastname: Chen
authors.affiliation: Hong-Tan Chen, Guo-Qiang Xu, Yi-Peng Chen, Li-Hua Chen, You-Ming Li, Department of Gastroenterology, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China.
authors.forename: You-Ming
authors.initials: YM
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D018278:Carcinoma, Neuroendocrine / Q000000981:diagnostic imaging* / Q000473:pathology; D016022:Case-Control Studies; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D016099:Endoscopy, Gastrointestinal; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012004:Rectal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D047368:Tumor Burden
keywords: Diagnosis; Endoscopic ultrasonography; Neuroendocrine neoplasms; Rectum