THE VALUE OF ENDORECTAL ULTRASOUND IN THE ASSESSMENT OF ADENOMAS, T1-CARCINOMA AND T2-CARCINOMAS

In a prospective study we examined the value of endorectal ultrasound (ERUS) in the preoperative staging of potentially locally excisable ru mours. During the study period from 1.1.1991 to 1.3. 1996 a total of 1 60 rectal tumours in 152 patients were staged endosonographically (uT/ uN) and compared postoperatively with the histologic result (pT/pN) at the University Hospital of Wurzburg. Thirty-eight (pT/pN) patients ha d an adenoma and 15 (9%) a T1-carcinoma. In 29 (18%) cases a T2-cancer was diagnosed. further 67 (42%) and 11 (7%) patients presented with a T3 and T4 tumour. respectively. The sensitivity for adenomas and TI-C a (uT0/1) was 81%. the specificity 98%. For T2 tumours the sensitivity was only 41% and the specificity 92% as the majority (17 of 29) of pT 2 neoplasias were overstaged (uT3). The overall staging accuracy (T1-4 ) was 77.5%. Two patients with a pT1-Ca and seven with a pT2-Ca had ly mph node metastases which were detected preoperatively in five. The ac curacy for lymph node staging was 83%. We conclude that adenomas and T 1 rumours can be assessed with a high grade of accuracy using ERUS. In these rumours ERUS can be used to assist clinical decision-making (tr ansanal vs. abdominal operation). Owing to the lack of sensitivity. ER US is of no help in the assessment of T2 carcinomas.