The purpose of this study was to evaluate the accuracy of preoperative stag
ing by endorectal ultrasonography (EUS) and its contribution to treatment o
f early stage rectal cancer (ESRC). The results of EUS for 154 consecutive
patients with ESRC (pTis to pT2) were compared prospectively with histologi
c findings, assessed according to the TNM classification. Results of treatm
ent selection and long-term outcomes were analyzed retrospectively. There w
ere 35 patients histologically staged as pTis, 8 as pT1-slight (invasion co
nfined to the superficial one-third of the submucosa), 37 as pT1-massive (i
nvasion extending to the deeper submucosa), and 74 as pT2. The equipment us
ed was an echoendoscope GF-UM2 or GF-UM3 (Olympus, Tokyo, Japan). Sensitivi
ty/specificity/ overall accuracy rates for detection of slight submucosal i
nvasion, massive submucosal invasion, and muscularis propria invasion were
99%/ 74%/96%, 98%/88%/97%, and 97%/93%/96%, respectively. Incidences of lym
ph node metastasis in pTis, pTis to pT1-slight, pT1, pT1-massive, and pT2 c
ases were 0%, 0%, 18%, 22%, and 30%, respectively. Incidences of lymph node
metastasis in ESRCs staged by EUS (u) as uTis, uT1-slight, uT1-massive, uT
2, and uT3 by EUS were 0%, 0%, 26%, 36%, and 64%, respectively. Sensitivity
, specificity, and overall accuracy rates for detection of positive nodes i
n overall ESRCs were 53%, 77%, and 72%, respectively. Of the 43 patients wi
th pTis to pT1-slight tumors, 22 underwent endoscopic polypectomy or local
excision, 20 radical surgery, and 1 radical surgery after endoscopic polype
ctomy due to vascular invasion. All these patients are alive and all but on
e (who refused radical surgery due to vascular invasion after local excisio
n and developed liver and lung metastases) are disease-free, Of the 37 pati
ents with pT1-massive tumors, 34 underwent radical surgery and 3 transcoccy
geal segmental resection. All these patients are alive disease-free except
for one who died of peritoneal carcinomatosis after radical surgery. All pa
tients with pT2 tumors underwent radical surgery. The overall 5-year surviv
al rates for pTis, pT1, and pT2 cases were 100%, 98%, and 97%, respectively
. EUS is an accurate method for evaluating invasion depth in ESRC. Patients
with uTis or uT1-slight tumors staged by EUS are at low risk of positive n
odes and good candidates for endoscopic polypectomy or local excision. Thos
e with uT1-massive or uT2 lesions should be treated with a radical operatio
n because of the high incidence of positive nodes.