Role of endoscopy in staging colorectal cancer

The treatment of colorectal cancer depends in large measure on the depth of tumor invasion and the extent of lymph node involvement. Endoscopic ultrasonography (EUS) has added a new dimension to the evaluation of tumor invasion and lymph node involvement in gastrointestinal cancer. The overall EUS accuracy for colorectal cancer T-staging is 78%, specificity is 73%, and sensitivity is 94%. In determining the nodal involvement by tumor, EUS has an accuracy of 75%, specificity of 73%, and sensitivity of 74%. Comparison with computerized tomography (CT), magnetic resonance imaging (MRI), and MRI with endorectal coil (MRIEC) shows that EUS is an effective single modality for assessing tumor penetration of the rectal wall. It does not, however, allow the assessment of distant metastatic disease. For assessing lymph node involvement, MRIEC offers the most comprehensive information.