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Murad-Regadas SM, Regadas FSP, Dealcanfreitas ID, Regadas Filho FSP, Fernandes GODS, Albuquerque MCF, Regadas CM, Regadas MM. Establishing the normal ranges of female and male anal canal and rectal wall vascularity with color Doppler anorectal ultrasonography. JOURNAL OF COLOPROCTOLOGY 2021. [DOI: 10.1016/j.jcol.2018.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Abstract
Study objectives To evaluate blood supply in the anal canal, rectal wall and mesorectal fat of men and women, using color Doppler endorectal sonography to establish normal ranges for vascular parameters.
Methods A prospective cross-sectional study conducted at a tertiary-care hospital recruited asymptomatic volunteers (≤50 years). Vascularity percentage and index were calculated for defined regions.
Results Vascularity percentage and index were significantly higher in the puborectalis, mid-level external and upper internal anal sphincter compared to the low anal canal; these parameters were higher in men than in women at upper and middle levels of the inner anal canal structures. At mid-level, vascularity was greater in the external compared to the internal anal sphincter in both sexes; however, at the upper level it was greater in the puborectalis compared to the internal anal sphincter in women. Vascularity was greater in the rectal wall compared to the mesorectal fat, with no difference between middle and lower levels.
Conclusions Blood supply is highest at upper levels of the anal canal; however, inner structures are better irrigated in men. Moreover, the rectal wall is better irrigated than the mesorectal fat. Establishing normal ranges may permit future comparisons of the studied structures in disease states as well as the hormonal and age related changes.
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Affiliation(s)
- Sthela M. Murad-Regadas
- Universidade Federal do Ceará (UFC), Faculdade de Medicina, Departamento de Cirurgia, Fortaleza, CE, Brazil
- Universidade Federal do Ceará (UFC), Hospital das Clínicas, Unidade de Fisiologia Anorretal e Assoalho Pélvico, Fortaleza, CE, Brazil
- Hospital São Carlos, Departamento de Cirurgia Colorretal, Unidade de Fisiologia Anorretal e Assoalho Pélvico, Fortaleza, CE, Brazil
| | | | - Iris Daiana Dealcanfreitas
- Universidade Federal do Ceará (UFC), Faculdade de Medicina, Departamento de Cirurgia, Fortaleza, CE, Brazil
| | - Francisco Sergio Pinheiro Regadas Filho
- Universidade Federal do Ceará (UFC), Faculdade de Medicina, Departamento de Cirurgia, Fortaleza, CE, Brazil
- Hospital São Carlos, Departamento de Cirurgia Colorretal, Unidade de Fisiologia Anorretal e Assoalho Pélvico, Fortaleza, CE, Brazil
| | | | | | - Carolina Murad Regadas
- Hospital São Carlos, Departamento de Cirurgia Colorretal, Unidade de Fisiologia Anorretal e Assoalho Pélvico, Fortaleza, CE, Brazil
| | - Marina Murad Regadas
- Hospital São Carlos, Departamento de Cirurgia Colorretal, Unidade de Fisiologia Anorretal e Assoalho Pélvico, Fortaleza, CE, Brazil
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Nuernberg D, Saftoiu A, Barreiros AP, Burmester E, Ivan ET, Clevert DA, Dietrich CF, Gilja OH, Lorentzen T, Maconi G, Mihmanli I, Nolsoe CP, Pfeffer F, Rafaelsen SR, Sparchez Z, Vilmann P, Waage JER. EFSUMB Recommendations for Gastrointestinal Ultrasound Part 3: Endorectal, Endoanal and Perineal Ultrasound. Ultrasound Int Open 2019; 5:E34-E51. [PMID: 30729231 PMCID: PMC6363590 DOI: 10.1055/a-0825-6708] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 11/23/2018] [Accepted: 12/01/2018] [Indexed: 02/07/2023] Open
Abstract
This article represents part 3 of the EFSUMB Recommendations and Guidelines for Gastrointestinal Ultrasound (GIUS). It provides an overview of the examination techniques recommended by experts in the field of endorectal/endoanal ultrasound (ERUS/EAUS), as well as perineal ultrasound (PNUS). The most important indications are rectal tumors and inflammatory diseases like fistula and abscesses in patients with or without inflammatory bowel disease (IBD). PNUS sometimes is more flexible and convenient compared to ERUS. However, the technique of ERUS is quite well established, especially for the staging of rectal cancer. EAUS also gained ground in the evaluation of perianal diseases like fistulas, abscesses and incontinence. For the staging of perirectal tumors, the use of PNUS in addition to conventional ERUS could be recommended. For the staging of anal carcinomas, PNUS can be a good option because of the higher resolution. Both ERUS and PNUS are considered excellent guidance methods for invasive interventions, such as the drainage of fluids or targeted biopsy of tissue lesions. For abscess detection and evaluation, contrast-enhanced ultrasound (CEUS) also helps in therapy planning.
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Affiliation(s)
- Dieter Nuernberg
- Medical School Brandenburg Theodor Fontane, Gastroenterology, Neuruppin, Germany
| | - Adrian Saftoiu
- Research Center in Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Ana Paula Barreiros
- Deutsche Stiftung Organtransplantation, Head of Organisation Center Middle, Frankfurt, Germany
| | - Eike Burmester
- Department of Internal Medicine/Gastroenterology, Sana-Kliniken Lübeck, Lübeck, Germany
| | - Elena Tatiana Ivan
- Research Center in Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Dirk-André Clevert
- Department of Clinical Radiology, Interdisciplinary Ultrasound-Center, University of Munich-Grosshadern Campus, Munich, Germany
| | | | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Torben Lorentzen
- Ultrasound Section, Division of Surgery, Department of Gastroenterology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Giovanni Maconi
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, “L.Sacco” University Hospital, Milan, Italy
| | - Ismail Mihmanli
- Istanbul University – Cerrahpasa, Cerrahpasa Medical Faculty, Department of Radiology and ALKA Radyoloji Tani Merkezi, Istanbul, Turkey
| | - Christian Pallson Nolsoe
- Ultrasound Section, Division of Surgery, Department of Gastroenterology, Herlev Hospital and Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen, Denmark
| | - Frank Pfeffer
- Department of Surgery, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Søren Rafael Rafaelsen
- Colorectal Centre of Excellence, Clinical Cancer Centre, University Hospital of Southern Denmark, Vejle, Denmark
| | - Zeno Sparchez
- 3rd Medical Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Peter Vilmann
- Endoscopy Department, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Jo Erling Riise Waage
- Department of Surgery, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, Bergen, Norway
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3
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Kin C. So Now My Patient Has Squamous Cell Cancer: Diagnosis, Staging, and Treatment of Squamous Cell Carcinoma of the Anal Canal and Anal Margin. Clin Colon Rectal Surg 2018; 31:353-360. [PMID: 30397394 DOI: 10.1055/s-0038-1668105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Squamous cell carcinomas of the anal canal and the anal margin are rare malignancies that are increasing in incidence. Patients with these tumors often experience delayed treatment due to delay in diagnosis or misdiagnosis of the condition. Distinguishing between anal canal and anal margin tumors has implications for staging and treatment. Chemoradiation therapy is the mainstay of treatment for anal canal squamous cell, with abdominoperineal resection reserved for salvage treatment in cases of persistent or recurrent disease. Early anal margin squamous cell carcinoma can be treated with wide local excision, but more advanced tumors require a combination of chemoradiation therapy and surgical excision.
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Affiliation(s)
- Cindy Kin
- Department of Surgery, Stanford University School of Medicine, Stanford, California
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4
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Valero M, Robles-Medranda C. Endoscopic ultrasound in oncology: An update of clinical applications in the gastrointestinal tract. World J Gastrointest Endosc 2017; 9:243-254. [PMID: 28690767 PMCID: PMC5483416 DOI: 10.4253/wjge.v9.i6.243] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 04/10/2017] [Accepted: 05/05/2017] [Indexed: 02/06/2023] Open
Abstract
An accurate staging is necessary to select the best treatment and evaluate prognosis in oncology. Staging usually begins with noninvasive imaging such as computed tomography, magnetic resonance imaging or positron emission tomography. In the absence of distant metastases, endoscopic ultrasound plays an important role in the diagnosis and staging of gastrointestinal tumors, being the most accurate modality for local-regional staging. Its use for tumor and nodal involvement in pre-surgical evaluation has proven to reduce unnecessary surgeries. The aim of this article is to review the current role of endoscopic ultrasound in the diagnosis and staging of esophageal, gastric and colorectal cancer.
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Reginelli A, Granata V, Fusco R, Granata F, Rega D, Roberto L, Pellino G, Rotondo A, Selvaggi F, Izzo F, Petrillo A, Grassi R. Diagnostic performance of magnetic resonance imaging and 3D endoanal ultrasound in detection, staging and assessment post treatment, in anal cancer. Oncotarget 2017; 8:22980-22990. [PMID: 28152518 PMCID: PMC5410279 DOI: 10.18632/oncotarget.14946] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 12/27/2016] [Indexed: 01/27/2023] Open
Abstract
We compared Magnetic Resonance Imaging (MRI) and 3D Endoanal Ultrasound (EAUS) imaging performance to confirm anal carcinoma and to monitor treatment response.58 patients with anal cancer were retrospectively enrolled. All patients underwent clinical examination, anoscopic examination; EAUS and contrast-enhanced MRI study before and after treatment. Four radiologists evaluated the presence of lesions, using a 4-point confidence scale, features of the lesion and nodes on EAUS images, T1-weighted (T1-W), T2-weighted (T2-W) and diffusion-weighted images (DWI) signal intensity (SI), the apparent diffusion coefficient (ADC) map for nodes and lesion, as well as enhancement pattern during dynamic MRI were assessed.All lesions were detected by EAUS while MRI detected 93.1% of anal cancer. MRI showed a good correlation with EAUS, anoscopy and clinical examination. The residual tissue not showed significant difference in EAUS assessment and T2-W SI in pre and post treatment. We found significant difference in dynamic study, in SI of DWI, in ADC map and values among responder's patients in pre and post treatment. The neoplastic nodes were hypoecoic on EAUS, with hyperintense signal on T2-W sequences and hypointense signal on T1-W. The neoplastic nodes showed SI on DWI sequences and ADC value similar to anal cancer. We found significant difference in nodes status in pre and post therapy on DWI data.3D EAUS and MRI are accurate techniques in anal cancer staging, although EAUS is more accurate than MRI for T1 stage. MRI allows correct detection of neoplastic nodes and can properly stratify patients into responders or non responders.
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Affiliation(s)
- Alfonso Reginelli
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Naples, Italy
| | - Vincenza Granata
- Department of Diagnostic Imaging, Radiant and Metabolic Therapy, “Istituto Nazionale Tumori Fondazione Giovanni Pascale – IRCCS”, Naples, Italy
| | - Roberta Fusco
- Department of Diagnostic Imaging, Radiant and Metabolic Therapy, “Istituto Nazionale Tumori Fondazione Giovanni Pascale – IRCCS”, Naples, Italy
| | - Francesco Granata
- Departement of Civil and Mechanical Engineering, University of Cassino and Southern Lazio, Cassino, Italy
| | - Daniela Rega
- Department of Colorectal Surgical Oncology, “Istituto Nazionale Tumori Fondazione Giovanni Pascale – IRCCS”, Naples, Italy
| | - Luca Roberto
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Naples, Italy
| | - Gianluca Pellino
- Department of Medical, Surgical, Neurological, Metabolic and Ageing Sciences, Second University of Naples, Naples, Italy
| | - Antonio Rotondo
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Naples, Italy
| | - Francesco Selvaggi
- Department of Medical, Surgical, Neurological, Metabolic and Ageing Sciences, Second University of Naples, Naples, Italy
| | - Francesco Izzo
- Department of Surgical Oncology, “Istituto Nazionale Tumori Fondazione Giovanni Pascale – IRCCS”, Naples, Italy
| | - Antonella Petrillo
- Department of Diagnostic Imaging, Radiant and Metabolic Therapy, “Istituto Nazionale Tumori Fondazione Giovanni Pascale – IRCCS”, Naples, Italy
| | - Roberto Grassi
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Naples, Italy
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Granata V, Fusco R, Reginelli A, Roberto L, Granata F, Rega D, Rotondo A, Grassi R, Izzo F, Petrillo A. Radiological assessment of anal cancer: an overview and update. Infect Agent Cancer 2016; 11:52. [PMID: 27752279 PMCID: PMC5062854 DOI: 10.1186/s13027-016-0100-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 09/27/2016] [Indexed: 12/27/2022] Open
Abstract
Anal cancer is uncommon neoplasm with an incidence of 2 new cases per 100,000 per year in the USA, accounting approximately 0.4 % of all tumors and 2.5 % of gastrointestinal malignancies. An early detection of the anal cancer is crucial for the patient management, whereas the diagnosis at an early stage allows conservative management with sphincter sparing, on the contrary a delays in diagnosis might lead to an advance cancer stage at presentation with worst survival. According to National Comprehensive Cancer Network (NCCN) Anal Carcinoma guidelines the patients should be subjected to a careful clinical examination, including a digital rectal examination (DRE), an anoscopic examination, and palpation of inguinal nodes. The guidelines recommended for the assessment of T stage, only a clinical examination, while the role of imaging techniques, as Magnetic Resonance imaging (MRI) is limited to the identification of regional nodes. Instead, the endoanal ultrasound (EAUS) is not recommended. This paper presents an overview and some updates about 3D EAUS and MRI in detection, staging and assessment post therapy of anal cancer patients.
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Affiliation(s)
- Vincenza Granata
- Division of Radiology, Department of Diagnostic Imaging, Radiant and Metabolic Therapy, "Istituto Nazionale Tumori Fondazione Giovanni Pascale - IRCCS", Naples, Italy
| | - Roberta Fusco
- Division of Radiology, Department of Diagnostic Imaging, Radiant and Metabolic Therapy, "Istituto Nazionale Tumori Fondazione Giovanni Pascale - IRCCS", Naples, Italy
| | - Alfonso Reginelli
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Naples, Italy
| | - Luca Roberto
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Naples, Italy
| | - Francesco Granata
- Department of Civil and Mechanical Engineering, University of Cassino and Southern Lazio, Cassino, Italy
| | - Daniela Rega
- Department of Colorectal Surgical Oncology, "Istituto Nazionale Tumori Fondazione Giovanni Pascale - IRCCS", Naples, Italy
| | - Antonio Rotondo
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Naples, Italy
| | - Roberto Grassi
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Naples, Italy
| | - Francesco Izzo
- Department of Surgical Oncology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, Italy
| | - Antonella Petrillo
- Division of Radiology, Department of Diagnostic Imaging, Radiant and Metabolic Therapy, "Istituto Nazionale Tumori Fondazione Giovanni Pascale - IRCCS", Naples, Italy
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7
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Squamous Cell Carcinoma of the Anal Canal. Surg Oncol 2015. [DOI: 10.1007/978-1-4939-1423-4_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Poggio JL. Premalignant lesions of the anal canal and squamous cell carcinoma of the anal canal. Clin Colon Rectal Surg 2012; 24:177-92. [PMID: 22942800 DOI: 10.1055/s-0031-1286002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Squamous cell carcinoma of the anus (SCCA) is a rare tumor. However, its incidence has been increasing in men and women over the past 25 years worldwide. Risk factors associated with this cancer are those behaviors that predispose individuals to human papillomavirus (HPV) infection and immunosuppression. Anal cancer is generally preceded by high-grade anal intraepithelial neoplasia (HGAIN), which is most prevalent in human immunodeficiency virus-positive men who have sex with men. High-risk patients may benefit from screening. The most common presentation is rectal bleeding, which is present in nearly 50% of patients. Twenty percent of patients have no symptoms at the time of presentation. Clinical staging of anal cancer requires a digital rectal exam and a positron emission tomography/computed tomography scan of the chest, abdomen, and pelvis. Endorectal/endoanal ultrasound appears to add more-specific staging information when compared with digital rectal examination alone. Treatment of anal cancer prior to the 1970s involved an abdominoperineal resection. However, the current standard of care for localized anal cancer is concurrent chemoradiation therapy, primarily because of its sphincter-saving and colostomy-sparing potential. Studies have addressed alternative chemoradiation regimens to improve the standard protocol of fluorouracil, misogynic, and radiation, but no alternative regimen has proven superior. Surgery is reserved for those patients with residual disease or recurrence.
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9
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Positron Emission Tomography/Computed Tomography in the Staging and Treatment of Anal Cancer. Int J Radiat Oncol Biol Phys 2012; 83:134-41. [DOI: 10.1016/j.ijrobp.2011.06.1955] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 05/19/2011] [Accepted: 06/03/2011] [Indexed: 11/22/2022]
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10
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Murad-Regadas SM, Regadas FSP, Rodrigues LV, Fernandes GODS, Buchen G, Kenmoti VT, Soares GDSD, Holanda EDC. Anatomic characteristics of anal fistula on three-dimensional anorectal ultrasonography. Dis Colon Rectum 2011; 54:460-6. [PMID: 21383567 DOI: 10.1007/dcr.0b013e3182060c84] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Surgery for anal fistula is often associated with continence disorders due to the transection of sphincter muscles. Extensive knowledge of anal canal anatomy and anal fistula can help prevent this outcome. OBJECTIVE This study aimed to correlate the anatomical conformation of the anal canal, the fistula track, and the internal opening according to sex and hemicircumference (anterior vs posterior) by use of 3-dimensional ultrasonography. METHODS One hundred sixty-five patients with fistula were evaluated with 3-dimensional ultrasound and grouped according to sex, fistula type, internal opening, and track position. Fistulas were transsphincteric in 128 subjects and intersphincteric in 37 subjects. The study measured the external and internal anal sphincter, the puborectalis, the distance from the internal opening to the distal edge of the external and internal sphincter, the length of the internal and external sphincter compromised by the track, and the percentage of compromised muscle. RESULTS The anal canal muscles were longer in males. The distance from the internal opening to the internal sphincter was greater for the posterior hemicircumference. The point where the fistulous track crossed the anterior external sphincter was similar for the 2 sexes, but the percentage of compromised muscle was greater in females. The point where the fistulous track crossed the internal sphincter was similar for the 2 sexes, but the percentage of compromised internal sphincter was greater in males for the posterior hemicircumference. The study was limited by the absence of testing for interobserver and intraobserver agreement. CONCLUSION The anal canal muscles are longer in males and the pectinate line is asymmetrical. In females, the percentage of compromised external sphincter was greater in the anterior hemicircumference because of the shorter external sphincter, whereas in males the percentage of compromised internal sphincter was greater in the posterior hemicircumference.
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Affiliation(s)
- Sthela M Murad-Regadas
- Department of Surgery, School of Medicine of the Federal University of Ceará, Ceará, Brazil.
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Salinas H, Bordeianou L. Endoanal Ultrasound: Staging and Follow-Up of Squamous Cell Carcinoma of the Anal Canal. SEMINARS IN COLON AND RECTAL SURGERY 2010. [DOI: 10.1053/j.scrs.2010.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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12
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Schizas AMP, Williams AB, Meenan J. Endosonographic staging of lower intestinal malignancy. Best Pract Res Clin Gastroenterol 2009; 23:663-70. [PMID: 19744631 DOI: 10.1016/j.bpg.2009.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Accepted: 06/22/2009] [Indexed: 02/08/2023]
Abstract
The use of EUS in the assessment of rectal pathology is well established. The accurate staging of lower intestinal tumours predicts prognosis and guides the planning of individual patient treatment. Increased experience and the development of high resolution three-dimensional EUS has lead to the greater accuracy of rectal staging with EUS of rectal tumours now considered the gold standard showing T stage accuracy that ranges from 75% to 95%, with N stage accuracy ranging from 65% to 80%. The use of EUS in the staging of colonic pathology, however, is not so well established though advances in miniprobe EUS has improved the assessment of colonic tumours. EUS is also of benefit in the assessment of anal pathology though here, accurate correlation with histology has not been firmly established.
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Affiliation(s)
- Alexis M P Schizas
- Department of Colo-rectal Surgery, Guy's and St. Thomas' Hospital, London, UK
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13
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Interobserver and intraobserver variation of two-dimensional and three-dimensional anal endosonography in the evaluation of recurrent anal cancer. Dis Colon Rectum 2009; 52:484-8. [PMID: 19333050 DOI: 10.1007/dcr.0b013e318197d73e] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This study was designed to evaluate the interobserver and intraobserver agreement of two-dimensional (2-D) and three-dimensional (3-D) anal endosonography for the detection of local recurrence anal carcinoma. METHODS Thirty-six patients were treated for anal carcinoma, and seven had recurrent disease. They were investigated by using 3-D endosonography at Rigshospitalet from July 2001 to January 2005 because of suspected local recurrence. The 3-D endosonographic examinations were reviewed from the hard disc by two observers who twice reviewed all 2-D examinations (the axial projection) as well as all 3-D examinations (the axial, as well as the reconstructed coronal and sagittal projections). The observers scored each examination according to the following scale regarding presence of local recurrence: 1 = no finding/benign findings; 2 = properly benign findings; 3 = suspicious findings/malignant findings. Kappa statistic-statistic was used to evaluate interobserver and intraobserver variation. RESULTS Three-dimensional endosonography achieved better interobserver agreement than 2-D endosonography: kappa 3-D 0.34-047 vs. kappa 2-D 0.15-0.28 and better intraobserver agreement: kappa 3-D 0.34-0.62 vs. kappa 2-D 0.22-0.28. These differences showed P < 0.05. CONCLUSIONS Three-dimensional endosonography proved to have significantly better interobserver and intraobserver agreement than 2-D endosonography concerning detection of recurrent anal cancer. Three-dimensional endosonography seems to be less dependent of the individual examiner than 2-D endosonography.
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14
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Murad-Regadas SM, Regadas FSP, Rodrigues LV, Souza MHLP, Lima DMR, Silva FRS, Filho FSPR. A novel procedure to assess anismus using three-dimensional dynamic anal ultrasonography. Colorectal Dis 2007; 9:159-65. [PMID: 17223941 DOI: 10.1111/j.1463-1318.2006.01157.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE This study aimed to determine the value of three-dimensional (3D) dynamic endosonography in the assessment of anismus. METHOD Sixty-one women submitted to anorectal manometry were enrolled including 40 healthy women and 21 patients with anismus diagnosed by manometry. Patients were submitted to 3D endosonography. Images were acquired at rest and during straining and analysed in axial and midline longitudinal planes. Sphincter integrity was quantified. The angle between the internal edge of the puborectalis with a vertical line according to the anal canal axis was calculated at rest and during straining. RESULTS The angle increased in 39 of the 40 normal individuals and decreased in all patients with anismus during straining compared with the angle at rest (88.36 degrees ) and straining (98.65 degrees ) in normal individuals. In the anismus group, the angle decreased at rest (90.91 degrees ) and straining (84.89 degrees ). The difference between angle sizes in normal and anismus patients during straining was statistically significant (P < 0.5). CONCLUSION Three-dimensional endosonography is a useful method to assess patients with anismus confirming the anorectal manometric results.
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Affiliation(s)
- S M Murad-Regadas
- Anorectal Physiology Unit, Clinic Hospital, Federal University of Ceara, Fortaleza, Ceara, Brazil.
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15
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de Parades V, Bauer P, Benbunan JL, Bouillet T, Cottu PH, Cuenod CA, Durdux C, Fléjou JF, Atienza P. Bilan préthérapeutique initial du carcinome épidermoïde invasif de l’anus. ACTA ACUST UNITED AC 2007; 31:157-65. [PMID: 17347624 DOI: 10.1016/s0399-8320(07)89348-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Anal epidermoid carcinoma is a rare malignant tumor, comprising less than 5% of all carcinomas of the colon, rectum, and anus. The primary therapy now includes radiotherapy, often in combination with chemotherapy. Radical surgery is now rarely indicated. Therapeutic indications are based on locoregional staging, the presence of visceral metastases and an evaluation of the medical history. Anorectal endosonography is helpful in evaluating locoregional extension. In addition, magnetic resonance imaging, positron emission tomography scanning and inguinal sentinel lymph node procedure should play a role in a more selective approach in patients with anal carcinoma.
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Affiliation(s)
- Vincent de Parades
- Service de Proctologie Médico-Interventionnelle, Groupe Hospitalier Diaconesses - Croix Saint-Simon, Paris.
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Christensen AF, Nielsen MB, Svendsen LB, Engelholm SA. Three-dimensional anal endosonography may improve detection of recurrent anal cancer. Dis Colon Rectum 2006; 49:1527-32. [PMID: 16988854 DOI: 10.1007/s10350-006-0661-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE In our center since 2001, follow-up examination has included three-dimensional endosonography in all patients with suspicion of local recurrence of anal cancer. This study was designed to investigate whether three-dimensional endosonography surpassed two-dimensional endosonography as a diagnostic tool for patients with suspected local recurrence. METHODS This prospective study included 38 consecutive patients who have had anal carcinoma and were investigated using three-dimensional endosonography in combination with anoscopy and digital rectal examination at Rigshospitalet from July 2001 to January 2005 under suspicion of local recurrence. All endosonographic examinations-two-dimensional, three-dimensional, and three-dimensional in combination with anoscopy and digital rectal examination-were evaluated by blinded observers. The observers scored each examination according to a five-point scale in which a score from 1 to 3 was regarded as benign endosonographic findings and a score from 4 to 5 was regarded as malignant endosonographic findings. The endosonographic diagnosis for each examination was compared with histologic evaluation or when no biopsy had been taken with a follow-up period of at least six months. If a patient showed no signs of local recurrence in the follow-up period, no local recurrence was considered to be present at the time of the investigation. RESULTS The sensitivity was 1.0 for three-dimensional endosonography in combination with palpation, 0.86 for three-dimensional endosonography alone, and 0.57 for two-dimensional endosonography. The differences between two-dimensional endosonography and three-dimensional endosonography alone as well as two-dimensional endosonography and three-dimensional endosonography + anoscopy and digital rectal examination both reached significance with P values <0.05. CONCLUSIONS This study indicates that three-dimensional endosonography surpasses two-dimensional endosonography in the evaluation of patients with suspicion of local recurrence of anal cancer especially in combination with anoscopy and digital rectal examination.
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Affiliation(s)
- Anders F Christensen
- Department of Radiology, Section of Ultrasound X4123, Copenhagen University Hospital, Blegdamsvej 9, DK 2100 Copenhagen, Denmark
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Salerno G, Sinnatamby C, Branagan G, Daniels IR, Heald RJ, Moran BJ. Defining the rectum: surgically, radiologically and anatomically. Colorectal Dis 2006; 8 Suppl 3:5-9. [PMID: 16813584 DOI: 10.1111/j.1463-1318.2006.01062.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The terminology used in relation to the rectum varies considerably, added to this there is the subjective nature of clinical assessment and variability in the anatomy of the rectum and anus. It is imperative that definitions are clarified and standardized for use by all members of the multidisciplinary team involved in the care of patients with rectal cancer.
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Affiliation(s)
- G Salerno
- Pelican Cancer Foundation, North Hampshire Hospital, Basingstoke, UK
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Kim JC, Kim HC, Yu CS, Han KR, Kim JR, Lee KH, Jang SJ, Lee SS, Ha HK. Efficacy of 3-dimensional endorectal ultrasonography compared with conventional ultrasonography and computed tomography in preoperative rectal cancer staging. Am J Surg 2006; 192:89-97. [PMID: 16769283 DOI: 10.1016/j.amjsurg.2006.01.054] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2005] [Revised: 01/30/2006] [Accepted: 01/30/2006] [Indexed: 12/17/2022]
Abstract
BACKGROUND This study was performed to verify reports of the decreased accuracy of endorectal ultrasonography (EUS) in preoperative staging of rectal cancer, and to compare the efficacy of 3-dimensional (3D) EUS with that of 2-dimensional (2D) EUS and computed tomography (CT). METHODS Eighty-six consecutive rectal cancer patients undergoing curative surgery were evaluated by 2D EUS, 3D EUS, and CT scan. RESULTS The accuracy in T-staging was 78% for 3D EUS, 69% for 2D EUS, and 57% for CT (P < .001-.002), whereas the accuracy in evaluating lymph node metastases was 65%, 56%, and 53%, respectively (P < .001-.006). Examiner errors were the most frequent cause of misinterpretation, occurring in 47% of 2D EUS examinations and in 65% of 3D EUS examinations. By eliminating examiner errors, the accuracy rates in T-staging and lymph node evaluation could be improved to 88% and 76%, respectively, for 2D EUS, and to 91% and 90%, respectively, for 3D EUS. Conical protrusions along the deep tumor border on 3D images were correlated closely with infiltration grade, advanced T-stage, and lymph node metastasis. CONCLUSIONS We found that 3D EUS showed greater accuracy than 2D EUS or CT in rectal cancer staging and lymph node metastases. Concrete 3D images based on tumor biology appear to provide more accurate information on tumor progression.
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Affiliation(s)
- Jin C Kim
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 388-1 Poongnap-2-Dong Songpa-Ku, Seoul 138-036, Korea.
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Caprioli F, Losco A, Viganò C, Conte D, Biondetti P, Forzenigo LV, Basilisco G. Computer-assisted evaluation of perianal fistula activity by means of anal ultrasound in patients with Crohn's disease. Am J Gastroenterol 2006; 101:1551-8. [PMID: 16863560 DOI: 10.1111/j.1572-0241.2006.00561.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Assessment of the activity of perianal fistulas may be of clinical relevance in patients with Crohn's disease. Fistula activity is currently evaluated by means of magnetic resonance imaging; anal ultrasound can also be used, but its diagnostic performance in this setting remains to be defined. Our aims were to evaluate the agreement between clinical examination, magnetic resonance imaging, and anal ultrasound in assessing perianal fistula activity, and to apply computerized analysis to improve the assessment of ultrasound images. METHODS Thirty-one consecutive patients with Crohn's perianal fistulas underwent clinical examination, and magnetic resonance and anal ultrasound imaging. Active fistulas were defined as the presence of active drainage or signs of local inflammation on clinical examination, and the definition was confirmed by surgical examination. Activity was assessed on the basis of T2 hyperintensity on magnetic resonance imaging and the degree of hypoechogenicity on anal ultrasound; the anal ultrasound images were also analyzed using dedicated computer image-analysis software. RESULTS Twenty-five patients had an active fistula at clinical examination. The agreement between clinical examination and magnetic resonance imaging was good (k-value = 0.739), whereas that with anal ultrasound was only fair (k-value = 0.266-0.294); computer-assisted analysis of the anal ultrasound images improved the agreement from fair to good (k-value = 0.608-0.670). CONCLUSIONS Anal ultrasound can be used to assess fistula track activity in patients with Crohn's disease. The diagnostic performance of the technique can be improved to values comparable with those of magnetic resonance imaging by using a computer-assisted evaluation of the anal ultrasound images.
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Affiliation(s)
- Flavio Caprioli
- Post-graduate School of Gastroenterology and Digestive Endoscopy (I), University of Milan, Milan, Italy
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Felt-Bersma RJF, Cazemier M. Endosonography in anorectal disease: an overview. SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY. SUPPLEMENT 2006:165-74. [PMID: 16782637 DOI: 10.1080/00365520600664292] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Anorectal endosonography (AE), which was introduced 20 years ago, derives from the study of urology. It was first used to evaluate rectal tumours and later also to investigate benign disorders of the anal sphincters and pelvic floor. The technique is easy to perform, it has a short learning curve and causes no more discomfort than a routine digital examination. A rotating probe with a 360 degrees radius and a frequency between 5 and 16 MHz is introduced to the rectum and then slowly withdrawn so that the pelvic floor and subsequently the sphincter complex are seen. Recently, it has become possible to reconstruct three-dimensional images. AE has been used for almost every possible disorder in the anal region and has increased our insight into anal pathology. The clinical indications for AE are: 1. Faecal incontinence in patients when surgery is an option. AE can show sphincter defects with excellent precision. There is a perfect correlation with surgical findings. Studies comparing AE with endoanal magnetic resonance imaging (MRI) have shown that both methods are equally good for demonstrating defects in the external anal sphincter; the internal anal sphincter is better visualized with AE. After sphincter repair, the effect is directly related to the decrease in the sphincter defect. 2. Perianal fistulae. AE has been shown to be accurate in staging perianal cryptoglandular fistulae and fistulae in Crohn's disease. When there is an external fistula opening, H2O2 can be introduced with a plastic infusion catheter. The tract then becomes visible as a hyperechoic lesion ("white"). It has been shown that this corresponds well with surgical findings. It is equally sensitive as endoanal MRI. Since recurrent cryptoglandular fistulae are complex in 50% and Crohn's fistula in 75%, it is mandatory to perform AE preoperatively in these patients to avoid missed tracts during surgery and subsequent recurrences. 3. Rectal tumors. In low tubulovillous adenomas or malignant polyps considered removable locally, confirming the local resectability (T0 or T1) is mandatory. Although larger rectal and more advanced tumours can be evaluated with AE, MRI is more sensitive in staging nodal involvement. 4. Anal carcinoma for staging. AE has been shown to stage better than the classical TNM classification for both local extension and prognosis. In conclusion, AE images the internal and external anal sphincter with high accuracy. It is easy to perform and is of particular value in the diagnosis of anal incontinence and perianal fistulae. It is excellent in staging anal carcinoma and can also be used in staging rectal carcinoma, especially very low large malignant polyps.
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Affiliation(s)
- R J F Felt-Bersma
- Department of Gastroenterology and Hepatology, VU University Hospital Amsterdam, The Netherlands.
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Regadas SMM, Regadas FSP, Rodrigues LV, Silva FR, Lima DMDR, Regadas-Filho FSP. Importância do ultra-som tridimensional na avaliação anorretal. ARQUIVOS DE GASTROENTEROLOGIA 2005; 42:226-32. [PMID: 16444377 DOI: 10.1590/s0004-28032005000400007] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
RACIONAL: A endosonografia anorretal constitui-se atualmente no principal exame de imagem para avaliar algumas das afecções anorretais. OBJETIVO: Demonstrar a importância do ultra-som tridimensional na avaliação anatômica do canal anal e no diagnóstico de afecções anorretais. MÉTODO: Foram realizados 74 exames, sendo 23 pacientes normais (13 mulheres) e 51 com afecções benignas e malignas (33 mulheres). Foi utilizado um aparelho de ultra-som com transdutor tridimensional 360°. Os indivíduos normais foram avaliados em plano sagital mediano, com relação ao comprimento do canal anal, do esfíncter anal interno, do esfíncter anal externo e do defeito anatômico, no quadrante anterior. RESULTADOS: Comparando homens normais com as mulheres, não houve diferenças no comprimento médio do canal anal e do esfíncter anal interno. Já o comprimento médio do esfíncter anal externo é maior no homem e o defeito anatômico anterior é maior na mulher. Nos doentes com afecções anorretais, foram diagnosticadas 11 lesões esfincterianas, 8 fístulas anais, 7 abscessos, 1 endometriose perirretal, 1 cisto pré-sacral, 3 tumores no canal anal e 10 no reto. Houve coincidência entre os achados cirúrgicos e ultra-sonográficos em todos os pacientes operados. CONCLUSÃO: A avaliação ultra-sonográfica tridimensional evidenciou as diferenças anatômicas entre os sexos, justificando a maior freqüência de distúrbios do assoalho pélvico no sexo feminino. Diagnosticou as afecções anorretais em múltiplos planos com elevada resolução espacial, adicionando informações importantes para a decisão terapêutica, assemelhando-se à ressonância nuclear magnética com bobina intra-retal, com a vantagem de ser mais fácil, mais rápido, de baixo custo e com melhor tolerância.
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