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Z Gastroenterol 2008; 46(6): 580-589
DOI: 10.1055/s-2008-1027405
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Die Bedeutung der Endosonografie im Staging des Rektumkarzinoms

Role of Endoscopic Ultrasound (EUS) in the Staging of Rectal CancerC. Jürgensen1 , C. F. Dietrich2
  • 1Klinik für Innere Medizin II, Klinikum Chemnitz
  • 2Innere Medizin II, Caritas-Krankenhaus Bad Mergentheim
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Publication History

Manuskript eingetroffen: 19.1.2008

Manuskript akzeptiert: 2.4.2008

Publication Date:
09 June 2008 (online)

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Zusammenfassung

Für eine zeitgemäße Therapie des Rektumkarzinoms ist eine differenzierte präinterventionelle Diagnostik unerlässlich. Sie entscheidet über die Indikation zur neoadjuvanten Therapie und beeinflusst die Wahl des Operationsverfahrens. Der endoskopische Ultraschall ist etablierter Bestandteil dieser Diagnostik. Er zeichnet sich durch eine hohe Genauigkeit in der Bestimmung des T- und N-Stadiums aus. Neue Behandlungskonzepte und die rasante Entwicklung konkurrierender Methoden erfordern eine neue Standortbestimmung.

Abstract

Modern therapy of the rectal carcinoma is dependent on sophisticated preinterventional diagnostics, which is decisive with regard to the indication for neoadjuvant therapy and influences the decision concerning the method of surgery. Endoscopic ultrasound is an established part of this diagnostic process. It is characterised by a high accuracy in T and N staging. New therapeutic concepts and the rapid development of competing methods make a new assessment of its value necessary.

Schlüsselwörter

Rektumkarzinom - kolorektales Karzinom - intraepitheliale Neoplasie - Endosonografie - Tumorstaging - neoadjuvante Therapie

Key words

rectal carcinoma - colorectal carcinoma - intraepithelial neoplasm - endoscopic ultrasound - tumour staging - neoadjuvant therapy

Literatur

  • 1 Robert Koch Institut .http://www.rki.de. 
  • 2 Wittekind C, Greene F L, Henson D E. UICC TNM Supplement. A commentary on uniform use. New York; John Wiley & Sons 2003 3 rd ed
    Search in Google Scholar
  • 3 Heald R J, Husband E M, Ryall R D. The mesorectum in rectal cancer surgery - the clue to pelvic recurrence?.  Br J Surg. 1982;  69 613-616
    Search in Google Scholar
  • 4 Stelzner F. Zur Anatomie des Mesenterium und des Mesorektums.  Viszeralchirurgie. 2003;  38 195-200
    Search in Google Scholar
  • 5 Hall N R, Finan P J, al JAberi T. et al . Circumferential margin involvement after mesorectal excision of rectal cancer with curative intent. Predictor of survival but not local recurrence?.  Dis Colon Rectum. 1998;  41 979-983
    Search in Google Scholar
  • 6 Lopez-Kostner F, Lavery I C, Hool G R. et al . Total mesorectal excision is not necessary for cancers of the upper rectum.  Surgery. 1998;  124 612-661
    Search in Google Scholar
  • 7 Heald R J, Ryall R D. Recurrence and survival after total mesorectal excision for rectal cancer.  Lancet. 1986;  1 (8496) 1479-1482
    Search in Google Scholar
  • 8 Kapiteijn E, Marijnen C A, Nagtegaal I D. et al . Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer.  N Engl J Med. 2001;  345 638-646
    Search in Google Scholar
  • 9 Schmiegel W, Pox C, Adler G. et al . S3-Leitlinienkonferenz „Kolorektales Karzinom”.  Z Gastroenterol. 2004;  42 129-177
    Search in Google Scholar
  • 10 Junginger T, Hermanek P, Oberholzer K. et al . Rektumkarzinom: Behandeln wir zu häufig neoadjuvant? Vorschläge zu einer selektiveren MRT-basierten Indikation.  Zentralbl Chir. 2006;  131 275-284
    Search in Google Scholar
  • 11 Habr-Gama A, Perez R O, Nadalin W. et al . Long-term results of preoperative chemoradiation for distal rectal cancer correlation between final stage and survival.  J Gastrointest Surg. 2005;  9 90-99
    Search in Google Scholar
  • 12 Wiersema M J, Harewood G C. Endoscopic ultrasound for rectal cancer.  Gastroenterol Clin North Am. 2002;  31 1093-1105
    Search in Google Scholar
  • 13 Harewood G C. Assessment of publication bias in the reporting of EUS performance in staging rectal cancer.  Am J Gastroenterol. 2005;  100 808-816
    Search in Google Scholar
  • 14 Bipat S, Glas A S, Slors F J. et al . Rectal Cancer: Local Staging and Assessment of Lymph node involvement with Endoluminal US, CT, and MR Imaging - A Meta-Analysis.  Radiology. 2004;  232 773-783
    Search in Google Scholar
  • 15 Marusch F, Koch A, Schmidt U. et al . Routine use of transrectal ultrasound in rectal carcinoma: results of a prospective multicenter study.  Endoscopy. 2002;  34 385-390
    Search in Google Scholar
  • 16 Garcia-Aguilar J, Pollack J, Lee S H. et al . Accuracy of endorectal ultrasonography in preoperative staging of rectal tumors.  Dis Colon Rectum. 2002;  45 10-15
    Search in Google Scholar
  • 17 Mackay S G, Pager C K, Joseph D. et al . Assessment of the accuracy of transrectal ultrasonography in anorectal neoplasia.  Br J Surg. 2003;  90 346-350
    Search in Google Scholar
  • 18 Orrom W J, Wong W D, Rothenberger D A. et al . Endorectal ultrasound in the preoperative staging of rectal tumors. A learning experience.  Dis Colon Rectum. 1990;  33 654-659
    Search in Google Scholar
  • 19 Carmody B J, Otchy D P. Learning curve of transrectal ultrasound.  Dis Colon Rectum. 2000;  43 193-197
    Search in Google Scholar
  • 20 Herzog U, Flue von M, Tondelli P. et al . How accurate is endorectal ultrasound in the preoperative staging of rectal cancer?.  Dis Colon Rectum. 1993;  36 127-134
    Search in Google Scholar
  • 21 Sailer M, Leppert R, Bussen D. et al . Influence of tumor position on accuracy of endorectal ultrasound staging.  Dis Colon Rectum. 1997;  40 1180-1186
    Search in Google Scholar
  • 22 Chapet O, Romestaing P, Mornex F. et al . Preoperative radiotherapy for rectal adenocarcinoma: Which are strong prognostic factors?.  Int J Radiat Oncol Biol Phys. 2005;  61 1371-1377
    Search in Google Scholar
  • 23 Starck M, Bohe M, Simanaitis M. et al . Rectal endosonography can distinguish benign rectal lesions from invasive early rectal cancers.  Colorectal Dis. 2003;  5 246-250
    Search in Google Scholar
  • 24 Borschitz T, Junginger T. Stellenwert der lokalen Exzision bei Rektumkarzinomen.  Viszeralchirurgie. 2006;  41 306-312
    Search in Google Scholar
  • 25 Kikuchi R, Takano M, Takagi K. et al . Management of early invasive colorectal cancer. Risk of recurrence and clinical guidelines.  Dis Colon Rectum. 1995;  38 1286-1295
    Search in Google Scholar
  • 26 Glancy D G, Pullyblank A M, Thomas M G. The role of colonoscopic endoanal ultrasound scanning (EUS) in selecting patients suitable for resection by transanal endoscopic microsurgery (TEM).  Colorectal Dis. 2005;  7 148-150
    Search in Google Scholar
  • 27 Hizawa K, Suekane H, Aoyagi K. et al . Use of endosonographic evaluation of colorectal tumor depth in determining the appropriateness of endoscopic mucosal resection.  Am J Gastroenterol. 1996;  91 768-771
    Search in Google Scholar
  • 28 Watanabe H, Miwa H, Terai T. et al . Endoscopic ultrasonography for colorectal cancer using submucosal saline solution injection.  Gastrointest Endosc. 1997;  45 508-511
    Search in Google Scholar
  • 29 McClave S A, Jones W F, Woolfolk G M. et al . Mistakes on EUS staging of colorectal carcinoma: error in interpretation or deception from innate pathologic features?.  Gastrointest Endosc. 2000;  51 682-689
    Search in Google Scholar
  • 30 Harewood G C, Kumar K S, Clain J E. et al . Clinical implications of quantification of mesorectal tumor invasion by endoscopic ultrasound: All T 3 rectal cancers are not equal.  J Gastroenterol Hepatol. 2004;  19 750-755
    Search in Google Scholar
  • 31 Willett C G, Badizadegan K, Ancukiewicz M. et al . Prognostic factors in stage T 3N0 rectal cancer: do all patients require postoperative pelvic irradiation and chemotherapy?.  Dis Colon Rectum. 1999;  42 167-173
    Search in Google Scholar
  • 32 Bianchi P P, Ceriani C, Rottoli M. et al . Endoscopic ultrasonography and magnetic resonance in preoperative staging of rectal cancer: comparison with histologic findings.  J Gastrointest Surg. 2005;  9 (9) 1222-1227
    Search in Google Scholar
  • 33 Kwok H, Bissett I P, Hill G L. Preoperative staging of rectal cancer.  Int J Colorectal Dis. 2000;  15 9-20
    Search in Google Scholar
  • 34 Beets-Tan R G, Beets G L. Rectal cancer: review with emphasis on MR imaging.  Radiology. 2004;  232 335-346
    Search in Google Scholar
  • 35 Gualdi G F, Casciani E, Guadalaxara A. et al . Local staging of rectal cancer with transrectal ultrasound and endorectal magnetic resonance imaging: comparison with histologic findings.  Dis Colon Rectum. 2000;  43 338-345
    Search in Google Scholar
  • 36 Meyenberger C, Huch Boni R A, Bertschinger P. et al . Endoscopic ultrasound and endorectal magnetic resonance imaging: a prospective, comparative study for preoperative staging and follow-up of rectal cancer.  Endoscopy. 1995;  27 469-479
    Search in Google Scholar
  • 37 Hunerbein M, Pegios W, Rau B. et al . Prospective comparison of endorectal ultrasound, three-dimensional endorectal ultrasound, and endorectal MRI in the preoperative evaluation of rectal tumors. Preliminary results.  Surg Endosc. 2000;  14 1005-1009
    Search in Google Scholar
  • 38 Nagtegaal I D, Marijnen C A, Kranenbarg E K. et al . Circumferential margin involvement is still an important predictor of local recurrence in rectal carcinoma: not one millimeter but two millimeters is the limit.  Am J Surg Pathol. 2002;  26 350-357
    Search in Google Scholar
  • 39 Brown G, Radcliffe A G, Newcombe R G. et al . Preoperative assessment of prognostic factors in rectal cancer using high-resolution magnetic resonance imaging.  Br J Surg. 2003;  90 355-364
    Search in Google Scholar
  • 40 Bissett I P, Fernando C C, Hough D M. et al . Identification of the fascia propria by magnetic resonance imaging and its relevance to preoperative assessment of rectal cancer.  Dis Colon Rectum. 2001;  44 259-265
    Search in Google Scholar
  • 41 MERCURY Study group . Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study.  BMJ. 2006;  333 (7572) 779
    Search in Google Scholar
  • 42 Martling A, Holm T, Bremmer S. et al . Prognostic value of preoperative magnetic resonance imaging of the pelvis in rectal cancer.  Br J Surg. 2003;  90 1422-1428
    Search in Google Scholar
  • 43 Slater A, Halligan S, Taylor S A. et al . Distance between the rectal wall and mesorectal fascia measured by MRI: Effect of rectal distension and implications for preoperative prediction of a tumour-free circumferential resection margin.  Clin Radiol. 2006;  61 65-70
    Search in Google Scholar
  • 44 Beynon J, Mortensen N J, Foy D M. et al . Pre-operative assessment of local invasion in rectal cancer: digital examination, endoluminal sonography or computed tomography?.  Br J Surg. 1986;  73 1015-1017
    Search in Google Scholar
  • 45 Rifkin M D, Ehrlich S M, Marks G. Staging of rectal carcinoma: prospective comparison of endorectal US and CT.  Radiology. 1989;  170 319-322
    Search in Google Scholar
  • 46 Osti M F, Padovan F S, Pirolli C. et al . Comparison between transrectal ultrasonography and computed tomography with rectal inflation of gas in preoperative staging of lower rectal cancer.  Eur Radiol. 1997;  7 26-30
    Search in Google Scholar
  • 47 Guinet C, Buy J N, Ghossain M A. et al . Comparison of magnetic resonance imaging and computed tomography in the preoperative staging of rectal cancer.  Arch Surg. 1990;  125 385-388
    Search in Google Scholar
  • 48 Kim N K, Kim M J, Yun S H. et al . Comparative study of transrectal ultrasonography, pelvic computerized tomography, and magnetic resonance imaging in preoperative staging of rectal cancer.  Dis Colon Rectum. 1999;  42 770-775
    Search in Google Scholar
  • 49 Kim C K, Kim S H, Choi D. et al . Comparison Between 3-T Magnetic Resonance Imaging and Multi-Detector Row Computed Tomography for the Preoperative Evaluation of Rectal Cancer.  J Comput Assist Tomogr. 2007;  31 853-859
    Search in Google Scholar
  • 50 Wolberink S V, Beets-Tan R G, Haas-Kock D F. et al . Conventional CT for the prediction of an involved circumferential resection margin in primary rectal cancer.  Dig Dis. 2007;  25 80-85
    Search in Google Scholar
  • 51 Kim J C, Kim H C, Yu C S. et al . Efficacy of 3-dimensional endorectal ultrasonography compared with conventional ultrasonography and computed tomography in preoperative rectal cancer staging.  Am J Surg. 2006;  192 89-97
    Search in Google Scholar
  • 52 Giovannini M, Bories E, Pesenti C. et al . Three-dimensional endorectal ultrasound using a new freehand software program: results in 35 patients with rectal cancer.  Endoscopy. 2006;  38 339-343
    Search in Google Scholar
  • 53 Hunerbein M, Totkas S, Ghadimi B M. et al . Preoperative evaluation of colorectal neoplasms by colonoscopic miniprobe ultrasonography.  Ann Surg. 2000;  232 46-50
    Search in Google Scholar
  • 54 Swanson R S, Compton C C, Stewart A K. et al . The prognosis of T 3N0 colon cancer is dependent on the number of lymph nodes examined.  Ann Surg Oncol. 2003;  10 65-71
    Search in Google Scholar
  • 55 Tepper J E, O’Connell M J, Niedzwiecki D. et al . Impact of number of nodes retrieved on outcome in patients with rectal cancer.  J Clin Oncol. 2001;  19 157-163
    Search in Google Scholar
  • 56 Bittner R, Burghardt J, Gross E. et al . Qualitätsindikatoren bei Diagnostik und Therapie des Rektumkarzinoms.  Zentralbl Chir. 2007;  132 85-94
    Search in Google Scholar
  • 57 Liersch T, Rothe H, Roedel C. et al . Chirurgie des Rektumkarzinoms - Qualitätssicherung.  Viszeralchirurgie. 2007;  42 66-72
    Search in Google Scholar
  • 58 Andreola S, Leo E, Belli F. et al . Manual dissection of adenocarcinoma of the lower third of the rectum specimens for detection of lymph node metastases smaller than 5 mm.  Cancer. 1996;  77 607-612
    Search in Google Scholar
  • 59 Dworak O. Number and size of lymph nodes and node metastases in rectal carcinomas.  Surg Endosc. 1989;  3 96-99
    Search in Google Scholar
  • 60 Spinelli P, Schiavo M, Meroni E. et al . Results of EUS in detecting perirectal lymph node metastases of rectal cancer: the pathologist makes the difference.  Gastrointest Endosc. 1999;  49 754-758
    Search in Google Scholar
  • 61 Beynon J, Mortensen N J, Foy D M. et al . Preoperative assessment of mesorectal lymph node involvement in rectal cancer.  Br J Surg. 1989;  76 276-279
    Search in Google Scholar
  • 62 Catalano M F, Sivak M V, Rice Jr T. et al . Endosonographic features predictive of lymph node metastasis.  Gastrointest Endosc. 1994;  40 442-446
    Search in Google Scholar
  • 63 Gleeson C F, Levy M J, Alberts F. Prospective Evaluation of Perirectal and Iliac Lymph Node EUS Criteria for Predicting Malignant Infiltration.  Gastrointest Endosc. 2007;  65 AB189
    Search in Google Scholar
  • 64 Nemoto Y, Kakemura T, Fujinama S. et al . Efficacy of 3-dimensional endorectal ultrasonography for diagnosis of lymph node metastasis with patients of rectal carcinoma compared with computed tomography.  Gastrointest Endosc. 2007;  65 AB189
    Search in Google Scholar
  • 65 Harewood G C, Wiersema M J, Nelson H. et al . A prospective, blinded assessment of the impact of preoperative staging on the management of rectal cancer.  Gastroenterology. 2002;  123 24-32
    Search in Google Scholar
  • 66 Shami V M, Parmar K S, Waxman I. Clinical impact of endoscopic ultrasound and endoscopic ultrasound-guided fine-needle aspiration in the management of rectal carcinoma.  Dis Colon Rectum. 2004;  47 59-65
    Search in Google Scholar
  • 67 Levy M J, Norton I D, Clain J E. et al . Prospective study of bacteremia and complications With EUS FNA of rectal and perirectal lesions.  Clin Gastroenterol Hepatol. 2007;  5 684-689
    Search in Google Scholar
  • 68 Levy M J, Alberts S R, Clain J E. et al . Endoscopic Ultrasound Guided Fine Needle Aspiration (EUS FNA) Detection of Malignant Iliac Lymph Nodes in Rectal Cancer.  Gastrointest Endosc. 2006;  63 AB97
    Search in Google Scholar
  • 69 Abdel-Nabi H, Doerr R J, Lamonica D M. et al . Staging of primary colorectal carcinomas with fluorine-18 fluorodeoxyglucose whole-body PET: correlation with histopathologic and CT findings.  Radiology. 1998;  206 755-760
    Search in Google Scholar
  • 70 Llamas-Elvira J M, Rodriguez-Fernandez A, Gutierrez-Sainz J. et al . Fluorine-18 fluorodeoxyglucose PET in the preoperative staging of colorectal cancer.  Eur J Nucl Med Mol Imaging. 2007;  34 859-867
    Search in Google Scholar
  • 71 Napoleon B, Pujol B, Berger F. et al . Accuracy of endosonography in the staging of rectal cancer treated by radiotherapy.  Br J Surg. 1991;  78 785-788
    Search in Google Scholar
  • 72 Rau B, Hunerbein M, Barth C. et al . Accuracy of endorectal ultrasound after preoperative radiochemotherapy in locally advanced rectal cancer.  Surg Endosc. 1999;  13 980-984
    Search in Google Scholar
  • 73 Vanagunas A, Lin D E, Stryker S J. Accuracy of endoscopic ultrasound for restaging rectal cancer following neoadjuvant chemoradiation therapy.  Am J Gastroenterol. 2004;  99 109-112
    Search in Google Scholar
  • 74 Maor Y, Nadler M, Barshack I. et al . Endoscopic ultrasound staging of rectal cancer: diagnostic value before and following chemoradiation.  J Gastroenterol Hepatol. 2006;  21 454-458
    Search in Google Scholar
  • 75 Gavioli M, Bagni A, Piccagli I. et al . Usefulness of endorectal ultrasound after preoperative radiotherapy in rectal cancer: comparison between sonographic and histopathologic changes.  Dis Colon Rectum. 2000;  43 1075-1083
    Search in Google Scholar
  • 76 Habr-Gama A, Souza P M, Ribeiro de U. et al . Low rectal cancer: impact of radiation and chemotherapy on surgical treatment.  Dis Colon Rectum. 1998;  41 1087-1096
    Search in Google Scholar
  • 77 Frank C D, Ross W A, Prindiville Jr T. et al . Accuracy of EUS with and without Preoperative Chemoradiation in Correlation with Pet Staging of Gastrointestinal Cancers.  Gastrointest Endosc. 2006;  63 AB265
    Search in Google Scholar
  • 78 Harewood G C. Assessment of clinical impact of endoscopic ultrasound on rectal cancer.  Am J Gastroenterol. 2004;  99 623-627
    Search in Google Scholar
  • 79 Beets-Tan R G, Lettinga T, Beets G L. Pre-operative imaging of rectal cancer and its impact on surgical performance and treatment outcome.  Eur J Surg Oncol. 2005;  31 681-688
    Search in Google Scholar
  • 80 Novell F, Pascual S, Viella P. et al . Endorectal ultrasonography in the follow-up of rectal cancer. Is it a better way to detect early local recurrence?.  Int J Colorectal Dis. 1997;  12 78-81
    Search in Google Scholar
  • 81 Lohnert M S, Doniec J M, Henne-Bruns D. Effectiveness of endoluminal sonography in the identification of occult local rectal cancer recurrences.  Dis Colon Rectum. 2000;  43 483-491
    Search in Google Scholar
  • 82 Mascagni D, Corbellini L, Urciuoli P. et al . Endoluminal ultrasound for early detection of local recurrence of rectal cancer.  Br J Surg. 1989;  76 1176-1180
    Search in Google Scholar
  • 83 Hunerbein M, Totkas S, Moesta K T. et al . The role of transrectal ultrasound-guided biopsy in the postoperative follow-up of patients with rectal cancer.  Surgery. 2001;  129 164-169
    Search in Google Scholar
  • 84 Stelzner F, Mallek von D. Das untere kloakogene Rektumviertel.  Viszeralchirurgie. 2005;  40 418-424
    Search in Google Scholar
  • 85 Merkel S, Meyer T, Gohl J. et al . Late locoregional recurrence in rectal carcinoma.  Eur J Surg Oncol. 2002;  28 716-722
    Search in Google Scholar
  • 86 Davila R E, Rajan E, Adler D. et al . The role of endoscopy in the diagnosis, staging, and management of colorectal cancer.  Gastrointest Endosc. 2005;  61 1-7
    Search in Google Scholar

Dr. Christian Jürgensen

Klinik für Innere Medizin II, Klinikum Chemnitz

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09116 Chemnitz

Phone: ++ 40/3 71/33 33 32 32

Email: Ch.Juergensen@skc.de