Endoscopy 2011; 43(5): 425-431
DOI: 10.1055/s-0030-1256111
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Endorectal ultrasound in rectal carcinoma – do the literature results really correspond to the realities of routine clinical care?

F.  Marusch[*] 1 ,  2 , H.  Ptok[*] 1 ,  3 , M.  Sahm4 , U.  Schmidt5 , K.  Ridwelski1 , I.  Gastinger1 , H.  Lippert1,6
  • 1An-Institut für Qualitätssicherung, Otto-v.-Guericke-Universität Magdeburg, Magdeburg, Germany
  • 2Klinik für Chirurgie, Klinikum Ernst von Bergmann, Potsdam, Germany
  • 3Klinik für Chirurgie, Carl-Thiem-Klinikum Cottbus, Cottbus, Germany
  • 4Klinik für Chirurgie, DRK Kliniken Berlin Köpenick, Berlin, Germany
  • 5StatConsult, Magdeburg, Germany
  • 6Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Germany
Further Information

Publication History

submitted 21 August 2010

accepted after revision 16 November 2010

Publication Date:
13 January 2011 (online)

Background and study aims: This multicenter, prospective, country-wide quality-assurance study at more than 300 hospitals in Germany was designed to characterize and analyze the diagnostic accuracy of rectal endoscopic ultrasound (EUS) in the routine clinical staging of rectal carcinoma (depth of tumor infiltration).

Patients and methods: Patients were surveyed between 1 January 2000 and 31 December 2008. Those who received neoadjuvant therapy after EUS were excluded. The correspondence between the EUS assessment of tumor depth (uT) and that determined by histology (pT) was calculated, and the influence of hospital volume upon the sensitivity, specificity, and positive and negative predictive values was investigated.

Results: At 384 hospitals providing care at all levels, 29 206 patients were included; of the 27 458 treated by surgical resection, EUS was performed for 12 235 (44.6 %). Of these, 7096 did not receive neoadjuvant radiochemotherapy, allowing a uT–pT comparison. The uT–pT correspondence was 64.7 % (95 % confidence interval [CI] 63.6 % – 65.8 %); the frequency of understaging was 18 % (95 %CI 17.1 % – 18.9 %) and that of overstaging was 17.3 % (95 %CI 16.4 % – 18.2 %). The kappa coefficient was greatest in the category T1 (κ = 0.591). For T3 tumors κ was 0.468. The poorest correspondence was found for T2 and T4 tumors (κ = 0.367 and 0.321, respectively). A breakdown by hospital volume showed that the uT–pT correspondence was 63.2 % (95 %CI 61.5 % – 64.9 %) for hospitals undertaking ≤ 10 EUS/year, 64.6 % (95 %CI 62.9 % – 66.2 %) for doing 11 – 30 EUS/year, and 73.1 % (95 %CI 69.4 % – 76.5 %) for those hospitals performing > 30 EUS/year.

Conclusions: In clinical routine, the diagnostic accuracy of transrectal ultrasound in staging rectal carcinoma does not attain the very good results reported in the literature. Only in the hands of diagnosticians with a large case volume of rectal carcinoma patients can EUS lead to therapy-relevant decisions.

References

1 F. Marusch and H. Ptok were equally involved in this work and should be regarded as joint first authors of this paper.

F. MaruschMD 

Department of Surgery
Ernst von Bergmann Hospital

Charlottenstr. 72
14467 Potsdam
Germany

Fax: +49-331-2415200

Email: fmarusch@klinikumevb.de

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