Background: EUS has a high diagnostic accuracy for rectal cancer nodal staging. In our experience linear echoendoscopes can detect malignant LNs not identified with radial imaging, however a comparison of these two modalities has not been reported. Aims: Perform a prospective pilot study to assess: 1.) if linear EUS can improve sensitivity for N staging when added to radial EUS, and 2.) if the change in N stage impacts patient management. Hypothesis: Linear EUS can detect malignant LNs not identified with radial EUS. Methods: 28 consecutive patients referred for staging of rectal cancer underwent a radial EUS exam. After completing the radial exam and recording the T stage and location of visualized LNs, a linear EUS exam was then performed. The endoscopist again noted the location of visualized LNs followed by FNA. LNs were not sampled when the aspiration needle would have traversed the primary tumor. Gold standard for LN stage was surgical pathology for all patients staged N0 and surgical pathology and/ or FNA results for patients with N1 stage. Results: 28 patients underwent radial and linear EUS. In 6/28 patients perirectal LNs were detected only with linear EUS, and in a 7th patient iliac vessel LNs were detected only with linear EUS. ) and in the remaining patients the combined linear/radial exam did not result in a change in N stage. In 3/7 patients the additional LNs identified were classified benign and therefore did not change the TNM stage or patient management. In 4/7 patients the addition of linear EUS identified malignant lymph nodes that were missed by radial imaging alone and subsequently confirmed by EUS FNA. In these 4 patients management was altered based on the linear EUS findings (administration of preoperative chemoradiation in 3 patients, identification of distant nodal metastases in 1 patient thereby enlarging the radiation treatment field). Overall N stage accuracy for radial EUS vs combined radial/ linear EUS 79% vs 93%. Conclusions: The results of this pilot study demonstrate enhanced detection of malignant lymphadenopathy in rectal cancer when linear EUS is added to a radial EUS exam with a subsequent change in patient management. Linear EUS exam should be considered in patients without an indication for FNA based on radial EUS imaging alone.
Fabbri, C., De Luca, L., Macchia, S., Salvi, F., Cennamo, V., Piemontese, A., et al. (2004). Misinterpretation of endoscopic ultrasonography re-staging after preoperative radiochemotherapy in rectal cancer: Preliminary results. GASTROINTESTINAL ENDOSCOPY, 59(5), AB219-AB219.
Misinterpretation of endoscopic ultrasonography re-staging after preoperative radiochemotherapy in rectal cancer: Preliminary results
Fabbri, C;Macchia, S;Billi, P;Foschini, MP;Frezza, G;
2004
Abstract
Background: EUS has a high diagnostic accuracy for rectal cancer nodal staging. In our experience linear echoendoscopes can detect malignant LNs not identified with radial imaging, however a comparison of these two modalities has not been reported. Aims: Perform a prospective pilot study to assess: 1.) if linear EUS can improve sensitivity for N staging when added to radial EUS, and 2.) if the change in N stage impacts patient management. Hypothesis: Linear EUS can detect malignant LNs not identified with radial EUS. Methods: 28 consecutive patients referred for staging of rectal cancer underwent a radial EUS exam. After completing the radial exam and recording the T stage and location of visualized LNs, a linear EUS exam was then performed. The endoscopist again noted the location of visualized LNs followed by FNA. LNs were not sampled when the aspiration needle would have traversed the primary tumor. Gold standard for LN stage was surgical pathology for all patients staged N0 and surgical pathology and/ or FNA results for patients with N1 stage. Results: 28 patients underwent radial and linear EUS. In 6/28 patients perirectal LNs were detected only with linear EUS, and in a 7th patient iliac vessel LNs were detected only with linear EUS. ) and in the remaining patients the combined linear/radial exam did not result in a change in N stage. In 3/7 patients the additional LNs identified were classified benign and therefore did not change the TNM stage or patient management. In 4/7 patients the addition of linear EUS identified malignant lymph nodes that were missed by radial imaging alone and subsequently confirmed by EUS FNA. In these 4 patients management was altered based on the linear EUS findings (administration of preoperative chemoradiation in 3 patients, identification of distant nodal metastases in 1 patient thereby enlarging the radiation treatment field). Overall N stage accuracy for radial EUS vs combined radial/ linear EUS 79% vs 93%. Conclusions: The results of this pilot study demonstrate enhanced detection of malignant lymphadenopathy in rectal cancer when linear EUS is added to a radial EUS exam with a subsequent change in patient management. Linear EUS exam should be considered in patients without an indication for FNA based on radial EUS imaging alone.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
