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Comparative Study Between the Role of Trans rectal Ultrasound and Magnetic Resonance Imaging in Preoperative Staging of Rectal Carcinoma

Aim of the study: Evaluation of the accuracy and agreement of trans rectal ultrasound and MRI in preoperative staging of rectal carcinoma in comparison with postoperative histopathology.

Background: Accurate staging of rectal carcinoma is an important issue in preoperative planning for the management.

Patients and methods: Twenty seven patients, 17 males and 10 females were included in the study their ages ranging between 25 to 65 years. These patients were diagnosed by PR, colonoscopy and histopathology to have rectal carcinoma. Preoperative MRI and trans rectal ultrasound were done. Rectal wall invasion (T stag), lymph node status (N stag), relation of the tumor to the anal sphincter complex and circumferential resection margin (CRM) were assessed by MRI and trans rectal U/S. The imaging results were compared with the histopathology regarded as the gold standard of the local staging.

Results: Constipation was the mean complaint in 11 cases, bleeding in 10 cases. Low anterior resection was done in 16 cases; abdominoperineal resection was done in 9 cases. Neoadjuvant was taken in 13 cases for down staging. Comparison between U/S and histopathology in rectal wall invasion and lymph nodes is statistically significant (p value >0.005). Comparison between MRI and histopathology in rectal wall invasion is statistically insignificant (p value = 0.999) in contrary to the lymph node status p value is >0.005. Comparison between MRI and U/S in rectal wall invasion and lymph node status is statistically significant (p value >0.001).

Conclusion: Trans rectal U/S and MRI rectum and anal canal are complementary for proper preoperative local staging of rectal cancer.

Author(s): Abdrabou N. Mashhour, Ahmed MS Marzouk, Ahmed Gamal, Hany MS Mikhaeal

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