The role of endoscopic ultrasound in the evaluation of rectal cancer

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The role of endoscopic ultrasound in the evaluation of rectal cancer Ali A Siddiqui*1, Yomi Fayiga2 and Sergio Huerta2 Address: 1Division of Gastroenterology, VA North Texas Health Care System and University of Texas Southwestern Medical School, Dallas, TX75216, USA and 2Division of GI/Endocrine Surgery2, VA North Texas Health Care System and University of Texas Southwestern Medical School, Dallas, TX75216, USA Email: Ali A Siddiqui* - [email protected]; Yomi Fayiga - [email protected]; Sergio Huerta - [email protected] * Corresponding author

Published: 18 October 2006 International Seminars in Surgical Oncology 2006, 3:36

doi:10.1186/1477-7800-3-36

Received: 10 October 2006 Accepted: 18 October 2006

This article is available from: http://www.issoonline.com/content/3/1/36 © 2006 Siddiqui et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract Accurate staging of rectal cancer is essential for selecting patients who can undergo sphincterpreserving surgery. It may also identify patients who could benefit from neoadjuvant therapy. Clinical staging is usually accomplished using a combination of physical examination, CT scanning, MRI and endoscopic ultrasound (EUS). Transrectal EUS is increasingly being used for locoregional staging of rectal cancer. The accuracy of EUS for the T staging of rectal carcinoma ranges from 8095% compared with CT (65-75%) and MR imaging (75-85%). In comparison to CT, EUS can potentially upstage patients, making them eligible for neoadjuvant treatment. The accuracy to determine metastatic nodal involvement by EUS is approximately 70-75% compared with CT (5565%) and MR imaging (60-70%). EUS guided FNA may be beneficial in patients who appear to have early T stage disease and suspicious peri-iliac lymphadenopathy to exclude metastatic disease.

Background Approximately 41,000 new cases of rectal cancer will be diagnosed in the year 2006 with an estimated 8,500 deaths [1]. The prognosis and management of this malignancy is dependent upon its stage at the time of initial presentation. Previously unrecognized lymph node metastasis may present in up to 10% of T1 lesions and 17% of T2 lesions [2]. In contrast to colon cancer, clinical preoperative tumor staging is essential since it allows selection of patients in need of neoadjuvant chemoradiation and those who may benefit from tumor load reduction to facilitate resection and potentially result in sphincter-preserving resections. Neoadjuvant chemoradiation is currently recommended for patients with advanced locoregional rectal cancer, i.e. those with tumor extension into the perirectal fat and/or involvement of the mesorectal or pelvic lymph nodes (T3, T4 N0, or Tx N1, N2) [3]. In these patients, neoadjuvant