In the last twenty years, endorectal ultrasound (ERUS) has become the primary method for locoregional staging of rectal cancer. ERUS is the most accurate modality for assessing local depth of invasion of rectal carcinoma into the rectal wall layers (T stage). Lower accuracy for T2 tumors is commonly reported, which could lead to sonographic overstaging of T3 tumors following preoperative therapy. Unfortunately, ERUS is not as good for predicting nodal metastases as it is for tumor depth, which could be related to the unclear definition of nodal metastases. The use of multiple criteria might improve accuracy. Failure to evaluate nodal status
could lead to inadequate surgical resection. ERUS can accurately distinguish early cancers from advanced ones, with a high detection rate of residual carcinoma in the rectal wall. ERUS is also useful for detection of local recurrence at the anastomosis site, which might require fine-needle aspiration of the tissue. Overstaging is more frequent than understaging, mostly due to inflammatory changes. Limitations of ERUS are operator and experience dependency, limited tolerance of patients, and limited range of depth of the transducer. The ERUS technique requires a learning curve for orientation and identification of images and planes. With sufficient time and effort, quality and accuracy of the ERUS procedure could be improved.
Tha ler W, Watzka S, Mar tin F, et al. Pre op er a tive stag - ing of rec tal can cer by endoluminal ul tra sound vs. mag - netic res o nance im ag ing. Pre lim i nary re sults of a pro spec tive, com par a tive study. Dis Co lon Rec tum 1994;37:1189 ^ 93.
Skandarajah AR, Tjandra JJ. Pre op er a tive locoregional im ag ing in rec tal can cer. ANZ J Surg 2006; 76:497^ 504.
Gar cia-Aguilar J, Pol lack J, Lee SH, et al. Ac cu racy of endorectal ultrasonography in pre op er a tive stag ing of rec tal tu mors. Dis Co lon Rec tum 2002;45:10 ^ 5.
Marusch F, Koch A, Schmidt U, et al. Rou tine use of transrectal ul tra sound in rec tal car ci noma: re sults of a pro spec tive multicenter study. En dos copy 2002;34: 385^ 90.
Hildebrandt U, Klein T, Feifel G, Schwarz HP, Koch B, Schmitt RM. Endosonography of pararectal lymph nodes. In vi tro and in vivo eval u a tion. Dis ColonRectum1990;33:863^ 8.
TioTL, Coene PP, van Delden OM,Tytgat GN. Colorectal carcinoma: preoperative TNM classifica - tion with endosonography. Ra di ol ogy 1991;179:165 ^ 70.
Moriya Y, Sugihara K, AkasuT, Fujita S. Im por tance of ex tended lymphadenectomy with lat eral node dis - sec tion for ad vanced lower rec tal can cer.World J Surg 1997;21:728 ^ 32.
Bhutani MS. Re cent de vel op ments in the role of en - do scopic ultrasonography in dis eases of the co lon and rec tum. Curr Opin Gastroenterol 2007;23:67 ^ 73.
Beynon J, Mortensen NJ, Foy DM, Channer JL, Virjee J, Goddard P. Pre-op er a tive as sess ment of lo - cal invasion in rectal cancer : digital examination, endoluminal sonography or com puted to mog ra phy? Br J Sur g 19 8 6;73 :1015 ^ 7.
Levy M, Alberts SR, Clain JE, et al. En do scopic ul - tra sound guided fine nee dle as pi ra tion (EUS-FNA) de tec tion of ma lig nant iliac nodes in rec tal can cer. Gastrointest Endosc 2006;63:AB97.
Kim JC, Kim HC,Yu CS, et al. Ef fi cacy of 3-di men - sional endorectal ultrasonography com pared with con - ven tional ultrasonography and com puted to mog ra phy in pre op er a tive rec tal can cer stag ing. AmJ Surg 2006;192:89 ^ 97.
Hunerbein M, Pegios W, Rau B, Vogl TJ, Fe lix R, Schlag PM. Pro spec tive com par i son of endorectal ul - tra sound, three-di men sional endorectal ul tra sound, and endorectal MRI in the pre op er a tive eval u a tion of rec tal tu mors. Pre lim i nary re sults. Surg Endosc 2000; 14 :10 0 5 ^ 9.
Worrell S, Horvath K, Blakemore T, Flum D. Endorectal ul tra sound de tec tion of fo cal car ci noma within rec tal adenomas. Am J Surg 2004;187:625-629
Starck M, Bohe M, Simanaitis M, Valentin L. Rec tal endosonography can dis tin guish be nign rec tal le sions from in va sive early rec tal can cers. Colorectal Dis 2003;5:246-250
Steele SR, Mar tin MJ, Place RJ. Flex i ble endorectal ul tra sound for pre dict ing patho logic stage of rec tal can cers. Am J Surg 2002;184:126-130
Schaffzin DM, Wong WD. Endorectal ul tra sound in the preoperative evaluation of rectal cancer. Clin Colorectal Can cer 2004;4:124-132
Rau B, Hu¨nerbein M, Barth C, et al. Ac cu racy of endorectal ul tra sound af ter pre op er a tive radiochemotherapy in lo cally ad vanced rec tal can cer. Surg Endosc 1999;13:980-984
Bhutani MS. Re cent de vel op ments in the role of en - do scopic ultrasonography in dis eases of the co lon and rec tum. Curr Opin Gastroenterol 2007;23:67-73
Gavioli M, Bagni A, Piccagli I, Fundaro S, Natalini G. Use ful ness of endorectal ul tra sound af ter pre op er a - tive radiother apy in rectal cancer; comparison be - tween sonographic and histopathologic changes. Dis Co lon Rec tum 2000;43: 1075-1083
Assenat E, The´zenas S, Samalin E, et al. The value of en do scopic rec tal ul tra sound in pre dict ing the lat eral clear ance and out come in pa tients with lower-third rec tal adenocarcinoma. Endoscopy 2007;39:309-313
Hhnerbein M, Totkas S, Moesta KT, Ulmer C, Handke T, Schlag PM. The role of transrectal ul tra sound-guided bi opsy in the post op er a tive fol low-up of pa tients with rec tal can cer. Sur gery 2001;129:164-169
Christensen AF, Niel sen MB, Svendsen LB, Engelholm SA. Three-di men sional anal endosonography may im prove de tec tion of re cur rent anal can cer. Dis Co lon Rec tum 2006; 49:1527-1532
Kim JC, Kim HC, Yu SC, et al. Ef fi cacy of 3-di men - sional endorectal ultrasonography com pared with con ven tional ultrasonography and com puted to mog ra - phy in preoperative rectal cancer staging. Am J Surg 2006;192:89-97
Giovannini M, Bories E, Pesenti C, Moutardier V, Lelong B, Delpe´ro JR. Three-di men sional endorectal ul tra sound us ing a new free hand soft ware pro gram: re - sults in 35 pa tients with rec tal can cer. En dos copy 2006;38:339-343
Man ger T, Stroh C. Ac cu racy of endorectal ultrasonography in the pre op er a tive stag ing of rec tal can cer. Tech Coloproctol 2004;8:S14-S15
Hhnerbein M, Pegios W, Rau B, Vogl TJ, Fe lix R, Schlag PM. Pro spec tive com par i son of endorectal ul tra - sound, threedimensional endorectal ul tra sound, and endorectal MRI in the pre op er a tive eval u a tion of rec tal tu mors. Surg Endosc 2000;14:1005-1009
Kim JC, Cho YK, Kim SY, Park SK, Lee MG. Com - par a tive study of three-di men sional and con ven tional endorectal ultrasonography used in rec tal can cer stag - ing. Surg Endosc 2002;16:1280-1285
NIH Con sen sus Con fer ence. Adjuvant ther apy for pa - tients with co lon and rec tal can cer. JAMA 1990;264:1444-1450
Dhamanaskar KP, Thurston W, Wil son SR. Transvaginal sonography as an ad junct to endorectal sonography in the stag ing of rec tal can cer in women. AJR Am J Roentgenol 2006;187:90-98
Zammit M, Jenkins T, Urie A, O`Dwyer PJ, Mol loy RG. A tech ni cally dif fi cult endorectal ul tra sound is more likely to be in ac cu rate. Colorectal Dis 2005;7:486-491
Hhnerbein M. Endorectal ul tra sound in rec tal can cer. Colorectal Dis 2003;5:402-405
K, Sakaguchi M, Higuchi Y, Namiki K, Muto T. Small spot sign of rec tal car ci noma by endorectal ultrasonography: histologic re la tion and clin i cal im - pact on post op er a tive re cur rence. Dis Co lon Rec tum 1998;41:649-653
Barbaro B, Valentini V, Coco C, et al. Tu mor vascularity eval u ated by transrectal color dopp ler US in pre dict ing ther apy out come for low-ly ing rec tal can cer. Int J Radiat Oncol Biol Phys 2005;63:1304-1308
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