Preoperative Staging of Colorectal Cancer with a Balloon-Sheathed Miniprobe

 

 Buy Article Permissions and Reprints

Background and Study Aims: Conventional endoscopic ultrasonography (EUS) is a valuable modality for staging the depth of invasion of colorectal cancer. However, there are difficulties with this technique in reaching as far as the cecal area, traversing tight strictures, and obtaining clear images of smaller lesions. Due to these factors, mis-staging often occurs. The literature shows that the miniprobe is superior to EUS, because of its easy manipulation and better diagnostic accuracy. We therefore conducted a prospective study using a balloon-sheathed miniprobe for colorectal cancer staging.
Patients and Methods: Eighty-six patients underwent preoperative staging using a miniprobe combined with an outer balloon sheath. Six patients were excluded from lymph-node examination due to local tumor resection. Acoustic coupling was achieved with or without water immersion. The results were compared with the histopathological findings in the resected specimens.
Results: The balloon-sheathed miniprobe had an overall accuracy rate of 85 % for T staging, with 100 % in T1; 78 % in T2; 90 % in T3; and 40 % in T4. Lymph-node metastasis was correctly diagnosed in 73 % of cases, with sensitivity and specificity rates of 74 % and 71 %, respectively. It was not possible to obtain clear cross-sectional images using the miniprobe in three patients.
Conclusions: The balloon-sheathed miniprobe is a good alternative for evaluating colorectal tumor lesions, since it can usually obtain cross-sectional images even in markedly stenosed lesions, and the examination can be performed easily with endoscopy, with or without water-infusion techniques. One major limitation with the probe is the difficulty in evaluating deeper structures, such as lymph-node groups and contiguous organ involvement.

References

• 1 Tsuda S, Hoashi T, Yao T. Endoscopic ultrasonography versus probe for diagnosis of depth of infiltration of colorectal cancer.  Endoscopy. 1998;  30 A85-A87
  PubMedGoogle Scholar
• 2 Akasu T, Sunouchi K, Sawada T. et al . Preoperative staging of rectal carcinoma: prospective comparison of transrectal ultrasonography and computed tomography [abstract].  Gastroenterology. 1990;  98 268
  PubMedGoogle Scholar
• 3 Beynon J, Mortensen N J, Foy D MA. et al . Preoperative assessment of local invasion in rectal cancer: digital examination, endoluminal sonography or computed tomography?.  Br J Surg. 1986;  73 1015-1017
  PubMedGoogle Scholar
• 4 Rifkin M D, Ehrlich S M, Marks G. Staging of rectal carcinoma: prospective comparison of endorectal US and CT.  Radiology. 1989;  170 319-322
  PubMedGoogle Scholar
• 5 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
  CrossrefPubMedGoogle Scholar
• 6 Saitoh Y, Obara T, Einami K. et al . Efficacy of high-frequency ultrasound probes for the preoperative staging of invasion depth in flat and depressed colorectal tumors.  Gastrointest Endosc. 1996;  44 34-39
  PubMedGoogle Scholar
• 7 Rösch T. The new TNM classification in gastroenterology.  Endoscopy. 1998;  30 643-649
  PubMedGoogle Scholar
• 8 Kudo S. Endoscopic mucosal resection of flat and depressed types of early colorectal cancer.  Endoscopy. 1993;  25 455-461
  Article in Thieme ConnectPubMedGoogle Scholar
• 9 Karita M, Tada M, Okita K, Kodama T. Endoscopic therapy for early colon cancer: the strip biopsy resection technique.  Gastrointest Endosc. 1991;  37 128-132
  CrossrefPubMedGoogle Scholar
• 10 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
  PubMedGoogle Scholar
• 11 Glaser F, Schlag P, Herfarth C. Endorectal ultrasonography for the assessment of invasion of rectal tumors and lymph node involvement.  Br J Surg. 1990;  77 883-887
  PubMedGoogle Scholar
• 12 Feifel G, Hildebrandt U, Dhom G. Assessment of depth of invasion in rectal cancer by endosonography.  Endoscopy. 1987;  19 64-67
  Article in Thieme ConnectPubMedGoogle Scholar
• 13 Konishi F, Ugajiu H, Ito K, Kanazawa K. Endorectal ultrasonography with a 7.5 MHz linear array scanner for the assessment of invasion of rectal carcinoma.  Int J Colorect Dis. 1990;  5 15-20
  CrossrefPubMedGoogle Scholar
• 14 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
  PubMedGoogle Scholar
• 15 Tio T L, Tytgat G N. Comparison of blind transrectal ultrasonography with endoscopic transrectal ultrasonography in assessing rectal and peri-rectal disease.  Scand J Gastroenterol. 1986;  123 104-111
  PubMedGoogle Scholar
• 16 Boyce G A, Sivak M V , Lavery I C. et al . Endoscopic ultrasound in the preoperative staging of rectal carcinoma.  Gastrointest Endosc. 1992;  38 468-471
  PubMedGoogle Scholar
• 17 Cho E, Nakajima M, Yasuda K. et al . Endoscopic ultrasonography in the diagnosis of colorectal cancer invasion.  Gastrointest Endosc. 1993;  39 521-527
  CrossrefPubMedGoogle Scholar
• 18 Hamada S, Akahoshi K, Chijiiwa Y. et al . Preoperative staging of colorectal cancer by a 15 MHz ultrasound miniprobe.  Surgery. 1998;  123 264-269
  CrossrefPubMedGoogle Scholar
• 19 Yoshida M, Tsukamoto Y, Niwa Y. et al . Endoscopic assessment of invasion of colorectal tumors with a new high-frequency ultrasound probe.  Gastrointest Endosc. 1994;  41 587-592
  PubMedGoogle Scholar
• 20 Hunerbein M, Totkas S, Ghadimi B M, Schlag P M. Preoperative evaluation of colorectal neoplasms by colonoscopic miniprobe ultrasonography.  Ann Surg. 2000;  232 46-50
  CrossrefPubMedGoogle Scholar
• 21 Williams D B, Sahai A V, Aabakken L. et al . Endoscopic ultrasound guided fine needle aspiration biopsy: a large single center experience.  Gut. 1999;  44 720-724
  CrossrefPubMedGoogle Scholar

L.-R. Mo, M.D.

Division of Gastroenterology · Dept. of Internal Medicine · Tainan Municipal Hospital ·

670, Chung Te Road · Tainan, 701 · Taiwan

Fax: +886-6-290-5491

Email: shchiu@kgh.com.tw