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Colorectal adenomas: inflammatory changes that simulate malignancy after laser coagulation--evaluation with
F J Hulsmans1, L M Mathus-Vliegen, S Bosman
1Department of Radiology, Academic Medical Centre, Amsterdam, The Netherlands.
Radiology
|May 1, 1993
Summary
Transrectal ultrasound (TRUS) after colorectal adenoma treatment can mimic malignancy due to inflammation. Avoid TRUS for 6 weeks post-treatment to prevent overstaging and ensure accurate cancer screening.
Area of Science:
- Gastroenterology
- Diagnostic Imaging
- Surgical Pathology
Background:
- Colorectal adenoma treatment, particularly photocoagulation, can induce inflammatory changes in the rectal wall.
- These post-treatment changes may present a diagnostic challenge, potentially simulating malignant infiltration on imaging.
Purpose of the Study:
- To evaluate if inflammatory changes following colorectal adenoma photocoagulation can be misinterpreted as malignant infiltration using transrectal ultrasound (TRUS).
- To correlate TRUS findings with histological evidence in an experimental setting.
Main Methods:
- Retrospective review of 23 transrectal ultrasound (TRUS) examinations in 17 patients treated for colorectal adenoma.
- Experimental study involving ultrasound (US) and microscopy of porcine colorectal specimens to assess inflammatory changes.
Main Results:
- Early TRUS follow-up (within 6 weeks) after photocoagulation showed wall changes, including thickened muscle layers with irregular outer margins, in some patients.
- In 3 of 13 early examinations, these lesions mimicked malignancy.
- Histological correlation in pigs confirmed that inflammation and serositis caused the abnormal US appearance and malignancy-mimicking features.
Conclusions:
- Transrectal ultrasound (TRUS) findings after colorectal adenoma photocoagulation can mimic malignancy due to post-treatment inflammation.
- TRUS should be avoided for screening colorectal adenoma malignancy within the first 6 weeks after polypectomy or laser treatment to prevent overstaging.
