title: Does endoscopic ultrasound improve detection of locally recurrent anal squamous-cell cancer?
abstract: BACKGROUND
  Evaluating patients for recurrent anal cancer after primary treatment can be difficult owing to distorted anatomy and scarring. Many institutions incorporate endoscopic ultrasound to improve detection, but the effectiveness is unknown.
  
  
  OBJECTIVE
  The aim of this study is to compare the effectiveness of digital rectal examination and endoscopic ultrasound in detecting locally recurrent disease during routine follow-up of patients with anal cancer.
  
  
  METHODS
  This study is a retrospective, single-institution review.
  
  
  METHODS
  This study was conducted at an oncologic tertiary referral center.
  
  
  METHODS
  Included were 175 patients with nonmetastatic anal squamous-cell cancer, without persistent disease after primary chemoradiotherapy, who had at least 1 posttreatment ultrasound and examination by a colorectal surgeon.
  
  
  METHODS
  The primary outcomes measured were the first modality to detect local recurrence, concordance, crude cancer detection rate, sensitivity, specificity, and predictive value.
  
  
  RESULTS
  Eight hundred fifty-five endoscopic ultrasounds and 873 digital rectal examinations were performed during 35 months median follow-up. Overall, ultrasound detected 7 (0.8%) mesorectal and 32 (3.7%) anal canal abnormalities; digital examination detected 69 (7.9%) anal canal abnormalities. Locally recurrent disease was found on biopsy in 8 patients, all detected first or only with digital examination. Four patients did not have an ultrasound at the time of diagnosis of recurrence. The concordance of ultrasound and digital examination in detecting recurrent disease was fair at 0.37 (SE, 0.08; 95% CI, 0.21-0.54), and there was no difference in crude cancer detection rate, sensitivity, specificity, and negative or positive predictive values.
  
  
  CONCLUSIONS
  The heterogeneity of follow-up timing and examinations is not standardized in this study but is reflective of general practice.
  
  
  CONCLUSIONS
  Endoscopic ultrasound did not provide any advantage over digital rectal examination in identifying locally recurrent anal cancer, and should not be recommended for routine surveillance.
authors.affiliation: 1Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center, New York, New York 2Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Carrie Y
authors.initials: CY
authors.lastname: Peterson
authors.forename: Martin R
authors.initials: MR
authors.lastname: Weiser
authors.forename: Philip B
authors.initials: PB
authors.lastname: Paty
authors.forename: Jose G
authors.initials: JG
authors.lastname: Guillem
authors.forename: Garrett M
authors.initials: GM
authors.lastname: Nash
authors.forename: Julio
authors.initials: J
authors.lastname: Garcia-Aguilar
authors.forename: Sujata
authors.initials: S
authors.lastname: Patil
authors.forename: Larissa K
authors.initials: LK
authors.lastname: Temple
mesh_terms: D001005:Anus Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging*; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000000981:diagnostic imaging*; D015331:Cohort Studies; D051517:Digital Rectal Examination; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity