ABSTRACT
Rectal cancer is projected to have the 10th highest incidence of cancer in the United States in 2009, with 40 870 estimated new cases this year. The prognosis for patients with rectal cancer is directly related to several factors, with the most important, based on current data, the extent of primary tumor invasion, the number of lymph nodes involved, involvement of the circumferential resection margin, and the presence of metastases. Contemporary therapy is dependent upon pre-surgical diagnostic imaging modalities, which influence the indication for neoadjuvant therapy and the decision process concerning the appropriate surgical approach. A comprehensive overview based on the currently available evidence of endoscopic ultrasound imaging in the loco-regional assessment of primary de novo rectal cancer evaluation following neoadjuvant therapy and post operative disease surveillance is presented. Relevant ano-rectal anatomy, staging systems for rectal cancer and alternative radiological staging strategies are also presented.
Subject(s)
Endosonography , Rectal Neoplasms , Biopsy , Humans , Incidence , Logistic Models , Lymph Nodes/pathology , Lymphatic Metastasis/diagnosis , Lymphatic Metastasis/diagnostic imaging , Magnetic Resonance Imaging , Neoadjuvant Therapy , Neoplasm Recurrence, Local , Neoplasm Staging , Positron-Emission Tomography , Prognosis , Rectal Neoplasms/diagnosis , Rectal Neoplasms/diagnostic imaging , Rectal Neoplasms/epidemiology , Rectal Neoplasms/pathology , Rectal Neoplasms/surgery , Rectum/pathology , Tomography, X-Ray ComputedSubject(s)
Cystadenoma, Mucinous/diagnosis , Cysts/diagnosis , Pancreatic Neoplasms/diagnosis , Spleen/abnormalities , Splenic Diseases/diagnosis , Abdominal Pain/diagnosis , Abdominal Pain/etiology , Adult , Biopsy, Fine-Needle , Cystadenoma, Mucinous/pathology , Cysts/pathology , Diagnosis, Differential , Endosonography/methods , Female , Follow-Up Studies , Humans , Pancreatectomy , Pancreatic Neoplasms/pathology , Pancreatic Neoplasms/surgery , Risk Assessment , Spleen/pathology , Splenectomy , Splenic Diseases/pathology , Splenic Diseases/surgery , Treatment OutcomeABSTRACT
Endoscopic ultrasound (EUS) has evolved from a purely diagnostic imaging modality to one that allows therapeutic intervention. It now serves as a viable alternative, and at times is preferred, to percutaneous and surgical techniques for obtaining biliary and pancreatic duct access and for providing drainage. EUS guided intervention is usually performed following failed endoscopic retrograde cholangiopancreatography (ERCP) or as an option for patients who decline surgical intervention or in poor operative candidates. Published data demonstrate overall technical success in 83% of patients with 12% experiencing a procedure related complication. New techniques and equipment must be developed to simplify and abbreviate the procedures, to limit complications, and improve outcomes. In addition, longitudinal data are needed to determine the long-term outcomes and role of EUS guided pancreaticobiliary intervention.
Subject(s)
Bile Duct Diseases/diagnostic imaging , Bile Duct Diseases/therapy , Endosonography , Pancreatic Diseases/diagnostic imaging , Pancreatic Diseases/therapy , Aged, 80 and over , Endosonography/methods , Humans , MaleSubject(s)
Cholangitis, Sclerosing/surgery , Device Removal/methods , Endoscopy, Digestive System/methods , Foreign-Body Migration/therapy , Stents/adverse effects , Adult , Biliary Tract Surgical Procedures/adverse effects , Biliary Tract Surgical Procedures/methods , Cholangitis, Sclerosing/diagnosis , Female , Follow-Up Studies , Foreign-Body Migration/diagnostic imaging , Humans , Prosthesis Failure , Risk Assessment , Sensitivity and Specificity , Treatment Outcome , UltrasonographySubject(s)
Biopsy, Fine-Needle/methods , Endosonography/methods , Lymphoma/diagnostic imaging , Lymphoma/pathology , Pancreatic Neoplasms/diagnostic imaging , Pancreatic Neoplasms/pathology , Abdominal Pain/diagnosis , Abdominal Pain/etiology , Female , Follow-Up Studies , Humans , Immunohistochemistry , Jaundice, Obstructive/diagnosis , Jaundice, Obstructive/etiology , Middle Aged , Risk Assessment , Sensitivity and Specificity , Tomography, X-Ray ComputedSubject(s)
Carcinoma, Renal Cell/diagnostic imaging , Endosonography , Incidental Findings , Kidney Neoplasms/diagnostic imaging , Acute Disease , Biopsy, Needle , Carcinoma, Renal Cell/diagnosis , Carcinoma, Renal Cell/surgery , Female , Follow-Up Studies , Humans , Immunohistochemistry , Kidney Neoplasms/diagnosis , Kidney Neoplasms/surgery , Middle Aged , Nephrectomy/methods , Pancreatitis/diagnosis , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
BACKGROUND AND STUDY AIMS: Celiac ganglia can be visualized by endoscopic ultrasound (EUS). It is unknown how often ganglia are visualized during EUS, and what clinical factors are associated with ganglion visualization. The aim of this study was to prospectively evaluate the frequency of visualization of presumed celiac ganglia by EUS and to identify factors that predict their visualization. PATIENTS AND METHODS: Clinical, demographic, EUS, and cytologic data were collected prospectively from 200 unselected patients who were undergoing EUS in a tertiary referral centre. When presumed celiac ganglia were visualized, their size, number, location, and echo features were noted. When presumed ganglia were aspirated, the results of cytology were recorded. RESULTS: The most common indication for EUS was investigation of a pancreatic mass or cyst (25 %). Presumed celiac ganglia were identified in 81 % of patients overall. Logistic regression analysis determined that female sex and having no prior history of gastrointestinal surgery were independently associated with ganglion visualization. Among patients whose ganglia were visualized, more ganglia were seen per patient with linear echo endoscopes (2, range 0 - 5) than with radial echo endoscopes (1, range 0 - 4) ( P = 0.001). Presumed celiac ganglia were aspirated in 10 patients; and cytologic examination revealed neural ganglia in all of these. CONCLUSIONS: Celiac ganglia can be visualized by EUS in most patients who undergo upper gastrointestinal EUS examinations, and are best seen with linear-array echo endoscopes. Ganglia can usually be differentiated from lymph nodes on the basis of their endosonographic appearance.
