A prospective, blinded assessment of the impact of preoperative staging on the management of rectal cancer

Gavin C Harewood ¹, Maurits J Wiersema , Heidi Nelson

⁰Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA.

Gastroenterology +

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July 10, 2002

View abstract on PubMed

Summary

Endoscopic ultrasonography (EUS) significantly impacts rectal cancer treatment decisions, improving tumor staging accuracy compared to CT scans. Fine-needle aspiration (FNA) offers limited additional benefit for nodal staging.

Area Of Science

Gastroenterology
Surgical Oncology
Diagnostic Imaging

Background

Preoperative staging of rectal carcinoma influences therapeutic decisions, but the role of fine-needle aspiration (FNA) remains unclear.
The diagnostic performance of pelvic computed tomography (CT), rectal endoscopic ultrasonography (EUS), and EUS-guided FNA for staging rectal cancer requires further evaluation.

Purpose Of The Study

To assess the impact of preoperative staging on treatment decisions for rectal cancer.
To compare the tumor (T) and nodal (N) staging accuracy of pelvic CT, EUS, and EUS-FNA.

Main Methods

A prospective, blinded study involving 80 consecutive patients with newly diagnosed rectal cancer.
Therapy decisions were recorded after sequential disclosure of staging information (CT, then EUS, then EUS-FNA) to the surgeon.

Main Results

EUS staging changed the treatment plan in 31% of patients compared to CT alone (P=0.02).
EUS demonstrated higher T staging accuracy (91%) than CT (71%).
N staging accuracy was comparable between CT (76%), EUS (82%), and EUS-FNA (76%).

Conclusions

Preoperative EUS staging leads to increased use of neoadjuvant therapy compared to CT alone.
EUS-FNA provided minimal additional benefit for N staging and changed management in only one patient.
EUS is superior to CT for T staging in rectal carcinoma; FNA may benefit select early T-stage cases.

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