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Title: Prospective evaluation of the performance and interobserver variation in endoscopic ultrasound staging of rectal cancer
Authors: El Hajj, Ihab I
DeWitt, John
Sherman, Stuart
Imperiale, Thomas F
LeBlanc, Julia K
McHenry, Lee
Cote, Gregory A
Johnson, Cynthia S
Al-Haddad, Mohammad
Affiliations: Faculty of Medicine 
Keywords: Endoscopic ultrasound
Interobserver variation
Rectal cancer
Issue Date: 2018
Publisher: National Library of Medicine
Part of: European Journal of Gastroenterology and Hepatology
Volume: 30
Issue: 9
Start page: 1013
End page: 1018
Background: Treatment and prognosis of patients with rectal adenocarcinoma (RAC) are dependent on accurate locoregional staging.

Objectives: The aim of this study was to measure the performance characteristics of rectal endoscopic ultrasound (EUS) compared with surgical pathology, and to assess the interobserver variation of rectal EUS in the staging of RAC.

Patients and methods: Patients referred for rectal EUS staging of a recently diagnosed RAC were prospectively enrolled between 2012 and 2016. Tandem EUS exams were performed by two independent endosonographers (ES1 and ES2) blinded to each other's findings.

Results: Ninety-five patients were enrolled. Seventy-five (79%) underwent curative intent tumor resection, including 30 without neoadjuvant therapy. In this latter group, the sensitivity, specificity, and accuracy of transrectal ultrasonography staging were 75, 83, and 82% for uT1; 50, 65, and 58% for uT2; 56, 81, and 73% for T3; 72, 44, and 63% for N0, and 38, 75, and 63% for N1, respectively. Experienced operators rendered a more accurate N stage and were less likely to overstage compared with less experienced ones (P=0.01 and 0.02, respectively). Overall, T staging agreement between endosonographers was substantial (κ=0.61) and N stage agreement was moderate (κ=0.45).

Conclusion: Rectal EUS is more accurate in staging T1 and T3 tumors compared with T2 tumors. Interobserver agreement of rectal EUS in rectal cancer staging is generally good.
ISSN: 0954691X
DOI: 10.1097/MEG.0000000000001176
Open URL: Link to full text
Type: Journal Article
Appears in Collections:Faculty of Medicine

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