Kavita Dhamanaskar MD, PRESENTER: Nothing to Disclose

Abstract: HTML Purpose: TRUS is an accepted standard for local staging of rectal carcinoma. Limitations include stenotic and high cancers and inadequacies of equipment and probe design. Our objective is to evaluate the role of TVS in staging rectal cancers in women. Methods and Materials: Between Jan'2000 to March 2003, 45 women referred for endoluminal sonography of a rectal tumor had TVS. 20 (20/45) also had TRUS. There were 40 rectal carcinomas, 4 tubulo-villous adenomas, and 1 GIST. The final tumor stage of the 40 rectal cancers was T1 (n=7), T2 (n=9), T3 (n=21), T4 (n=3). Clinical correlation included surgical pathology (n=31), biopsy (n=13), and no confirmation (n=1). Imaging included CT scan (n=20) or MR (n=4). Sonograms were performed following fleet enema. TVS was performed on HDI 5000 or 3000 (Philips, Bothell WA) using conventional end-firing TVS probe. TRUS was performed using rotating radial and side-firing bi-plane probes (Bruel & kjaer instruments, Denmark). Tumor presence, size, depth of penetration, and nodal status according to the TNM staging criteria were documented. In the subset of 20 (20/45) patients with both TRUS and TVS, we evaluated images for rectal wall layer definition, tumor visibility, and staging. Results: Tumor staging of the 40 (40/45) rectal cancers with TVS as compared with pathology was accurate in 36 cases (90%). 2(5%)tumors were under staged as T3 instead of T4, a clinically inconsequential event and 2(5%)cancers were overstaged as T2 instead of T1. TRUS was suboptimal in assessing stenotic tumors (n=3) and those of large size (n=2) or high at the recto-sigmoid junction (n=4). In these 9 cases, TVS was successful in demonstrating the lesion and correctly predicting its stage. The 4 (4/45) noninvasive villous adenomas were overstaged as T1 on sonography and the 1 (1/45) GIST tumor showed an intramural mass consistent with this diagnosis. TVS was well tolerated and preferred by all patients. In 20 patients with both TRUS and TVS, TVS showed superior wall layer definition, tumor visibility and staging in all with improved visibility of the surrounding mesorectum and rectovaginal septum. TVS better assessed the intraluminal tumor as the fluid in the rectum from the Fleet enema outlined the tumor and the rectal wall. An inflated balloon used for TRUS, by comparison compressed polypoid tumors and obscured their outline. Conclusion: TVS is our preferred method for evaluation of women with rectal tumors showing superior imaging of the rectum and surrounding tissues, resolving rectal wall layers, and defining the extent of rectal cancer.       Questions about this event email: dayal_kavita@hotmail.com

Dhamanaskar MD, K, Transvaginal Sonography (TVS): A Better Technique than Transrectal Ultrasound (TRUS) for Staging Rectal Cancer in Women?.  Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL. http://archive.rsna.org/2003/3106920.html