Qualitative elastography by endoscopic ultrasound in the restaging of the irradiated rectal tumor
Keywords:
elastography, endoscopic ultrasound, rectal tumor.Abstract
Introduction: Qualitative endoscopic ultrasound elastography can identify fibrosis and differentiate it from residual tumor in the re-staging of patients with irradiated rectal tumors.Objective: To determine the usefulness of qualitative endoscopic ultrasound elastography in the re-staging of the irradiated rectal tumor.
Methods: An observational and descriptive study (series of cases) was carried out in 31 patients with irradiated rectal tumor, restaged by means of Qualitative elastography by endoscopic ultrasound. To determine the usefulness of elastography, the following were calculated: sensitivity, specificity, positive predictive value, negative predictive value, Youden index and diagnostic agreement according to kappa, elastography and endoscopic ultrasound separately; these results were compared in both diagnostic tests. The histological study of the surgical specimen was the reference standard.
Results: The concordance index of endoscopic ultrasound (77.4%), that obtained by elastography (87.1%). Endoscopic ultrasound showed greater sensitivity and negative predictive value than elastography, so the possibility of ruling out the presence of a tumor with a negative result was higher. Elastography had greater specificity (77.78%) and positive predictive value (90.91%) than endoscopic ultrasound (22.22 and 75.86%); it was most helpful in confirming the tumor diagnosis.
Conclusions: The usefulness of qualitative elastography associated with endoscopic ultrasound, in the re-staging of the irradiated rectal tumor, consists in increasing the specificity of the study, thus allowing a better discernment between fibrosis and residual tumor.
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References
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25. Bettoni F, Masotti C, Correa B, Donnard E, Dos Santos F, São Julião G. The effects of neoadjuvant chemoradiation in locally advanced rectal cancer. The impact in Intratumoral heterogeneity. Rev Front Oncol. 2019; 9:974. DOI: 10.3389/fonc.2019.00974
26. Asensio C. Efectividad diagnóstica y seguridad de distintas modalidades de elastografía en indicaciones oncológicas. Una revisión de revisiones sistemáticas y meta-análisis. Madrid: Red Española de Agencias de Evaluación de Tecnologías y Prestaciones del SNS; 2018. [acceso: 21/02/2019]. Disponible en: http://gesdoc.isciii.es/gesdoccontroller?action=download&id=22/01/2019-eb30fa4555
27. Mezzi G, Arcidiacono PG, Carrara S, Bohemo C, Testoni PA. Elastosonography in malignant rectal disease: preliminary data. Endoscopy. 2007; 39(4): 375. DOI: 10.1055/s-2007-966220
28. Palacios LJ, Naranjo AM, Serna CA, Mosqueda DA, Arbeláez LM, Gómez LM. Evaluación de la respuesta patológica al tratamiento neoadyuvante en cáncer de recto. Experiencia del Instituto de Cancerología de Medellín (Colombia, 2011-2017). Revista de Gastroenterología de México. 2020 [acceso: 28/08/2020]; 86(1): 13-20. Disponible en: http://www.revistagastroenterologiamexico.org/es-evaluacion-respuesta-patologica-al-tratamiento-articulo-S0375090620300124
29. Vanagunas A, Lin DE, Stryker SJ. Accuracy of endoscopic ultrasound for restaging rectal cancer following neoadjuvant chemoradiation therapy. Am J Gastroenterol. 2004 [acceso: 31/07/2019]; 99(1):109-112. Disponible en: https://pubmed.ncbi.nlm.nih.gov/14687151/
30. Ayuso J, Pagés M, Ayuso C. Estadificación del cáncer de recto. Radiología. 2010 [acceso: 02/05/2019]; 52(1):18-29. Disponible en: https://www.webcir.org/revistavirtual/articulos/mayo10/esp_05.pdf
31. Páez D, Brizuela RA, Descalzo Y, Anido V, García-Menocal JL, Morera M. Eficacia de la ultrasonografía endoscópica en la estadificación de tumores del recto. Rev Cub Med Mil. 2017 [acceso: 22/06/2019]; 46(4): [aprox. 10 p.]. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0138-65572017000400007
32. Waage JE, Havre RF, Odegaard S, Leh S, Eide GE, Baatrup G. Endorectal elastography in the evaluation of rectal tumours. Colorectal Disease. 2011[acceso: 22/06/2019]; 13(10):1130-37. Disponible en: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1463-1318.2010.02440.x
33. Waage JE, Leh S, Røsler C, Pfeffer F, Bach SP, Havre RF, et al. Endorectal ultrasonography, strain elastography and MRI differentiation of rectal adenomas and adenocarcinomas. Colorectal Disease. 2015[acceso: 22/06/2019]; 17(2):124-131. Disponible en: https://onlinelibrary.wiley.com/doi/full/10.1111/codi.1284 5
34. Zhao RS, Wang H, Zhou ZY, Zhou Q, Mulholland MW. Restaging of locally advanced rectal cancer with magnetic resonance imaging and endoluminal ultrasound after preoperative chemoradiotherapy: a systemic review and meta-analysis. Dis Colon Rectum. 2014; 57(3):388-395. DOI: 10.1097/DCR.0000000000000022
2. Siegel RL, Kimberly D, Ahmedin J. Cancer statistics, 2019. Cancer J Clin. 2019 [acceso: 21/05/2019]; 69(1):7-34. Disponible en: https://pubmed.ncbi.nlm.nih.gov/30620402/
3. Albertengo JC. Opciones Terapéuticas en el Cáncer de Recto Inferior: Actualización. Rev argent coloproct. 2019 [acceso: 21/05/2019]; 30(4):75-79. Disponible en: https://sacp.org.ar/revista/30-ultima-edicion/volumen-30-numero-4/251-opciones-terapeuticas-en-el-cancer-de-recto-inferior-actualizacion
4. Reyes H, Villanueva JA, Jiménez B. Eficacia del ultrasonido endorrectal posneoadyuvante en la evaluación de la regresión tumoral en el cáncer de recto. Rev Meduas. 2019 [acceso: 21/05/2019]; 9(1): 21-32. Disponible en: http://hospital.uas.edu.mx/revmeduas/articulos/v9/n1/ultrasonidoendorrectal.pdf
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6. Aluja F, Upegui D. Estadificación del cáncer colorrectal mediante resonancia magnética. Revista Colombiana de Gastroenterología. 2016 [acceso: 21/05/2019]; 31(3): 273-82. Disponible en: http://www.scielo.org.co/pdf/rcg/v31n3/v31n3a11
7. Barreras JE, Barreras EJ, Cáceres HH. De la resección abdominoperineal a las técnicas conservadoras de esfínteres en la cirugía laparoscópica del cáncer del recto. Rev Cub Cir. 2017 [acceso: 8/6/2020]; 56(1): [aprox. 5 pant.]. Disponible en: http://www.revcirugia.sld.cu/index.php/cir/article/view/485
8. Chiorean L, Cui XW, Klein SA, Budjan J, Sparchez Z, Radzina N. Clinical value of imaging for lymph nodes evaluation with particular emphasis on ultrasonography. Z Gastroenterol. 2016 [acceso: 8/6/11]; 54:774‑90. Disponible en: https://www.thieme-connect.de/products/ejournals/abstract/10.1055/s-0042-108656
9. Lv H, Zhu G, Zhou L. Diagnostic value of endoscopic ultrasound elastography for benign and malignant digestive system tumors. Pak J Med Sci. 2019 [acceso: 02/11/2018]; 35(5): 1461-5. Disponible en: https://doi.org/10.12669/pjms.35.5.1075
10. Li XT, Zhang XY, Sun YS, Tang L, Cao K. Evaluating rectal tumor staging with magnetic resonance imaging, computed tomography, and endoluminal ultrasound: A meta-analysis. Rev Medicine. 2016 [acceso: 25/10/2019]; 95(44): 5333. Disponible en: https://journals.lww.com/md-journal/Fulltext/2016/11010/Evaluating_rectal_tumor_staging_with_magnetic.81.aspx
11. Díaz AD, Beltrán JP, Cueva JE. Are the performance indicators of a test or diagnostic test sufficient to evaluate performance? Rev Cubana Med Gen Integr. 2018 [acceso: 22/06/2019]; 34(3): 94-109. Disponible en: https://www.medigraphic.com/pdfs/revcubmedgenint/cmi-2018/cmi183k.pdf
12. Abdelmoty MF, Elfeshawy MS, Elhawary AE. Role of MRI in diagnosis and preoperative staging of rectal carcinoma. Al-Azhar Assiut Medical Journal Molecular. 2019; 17(2): 163-72. DOI: 10.4103/AZMJ.AZMJ_44_19
13. González E, Losa F, Pericay C, Polo E, Roselló S, Safont MJ. SEOM Clinical Guideline of localized rectal cancer (2016). Clin Transl Oncol. 2016 [acceso: 02/08/2020]; 18: 1163-1171. Disponible en: https://link.springer.com/article/10.1007/s12094-016-1591-0
14. Tombazzi CR, Loy P, Bondar V, Ruiz JI, Bradford Waters B. Accuracy of endoscopic ultrasound in staging of early rectal cancer. Federal Practitioner. 2019 [acceso: 21/08/2020]; 23(Special Issue): S26-S29. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6719801/pdf/fp-36-05s-s26.pdf
15. Costache MI, Dumitrescu D, Săftoiu A. Technique of qualitative and semiquantitative EUS elastography in pancreatic examination. Endosc Ultrasound. 2017 [acceso: 21/05/2019]; 6(9):111-14. Disponible en: https://www.eusjournal.com/article.asp?issn=2303-9027;year=2017;volume=6;issue=9;spage=111;epage=114;aulast=Costache
16. Giovannini M, Téllez-Ávila FI. Basic aspects and clinical usefulness of Endoscopic sonoelastography. Rev Endoscopia. 2012 [acceso: 21/05/2019]; 24(1):17-22. Disponible en: https://www.elsevier.es/es-revista-endoscopia-335-articulo-basic-aspects-clinical-usefulness-endoscopic-X0188989312969157
17. Giovannini M, Hookey LC, Bories E, Pesenti C, Monges G, Delpero JR. Endoscopic ultrasound elastography: the first step towards virtual biopsy? preliminary results in 49 patients. Endoscopy. 2006 [acceso: 22/06/2019]; 38(4):344-8. Disponible en: https://www.thieme-connect.de/products/ejournals/abstract/10.1055/s-2006-925158
18. Kim MJ. Transrectal ultrasonography of anorrectal diseases: advantages and disadvantages. Ultrasonography. 2015 [acceso: 03/08/2020]; 34(1): 19-31. Disponible en: https://www.researchgate.net/publication/269416087_Transrectal_ultrasonography-_of_anorectal_diseases_Advantages_and_disadvantages
19. Giovannini M, Thomas B, Erwan B, Christian P, Fabrice C, Benjamin E, et al. Endoscopic ultrasound elastography for evaluation of lymph nodes and pancreatic masses: a multicenter study. World J Gastroenterol. 2009 [acceso: 22/06/2019]; 15(13): 1587-93. Disponible en: https://www.wjgnet.com/1007-9327/full/v15/i13/1587.htm
20. Latour J, Abraira V, Cabello J.B, López J. Las mediciones clínicas en cardiología: validez y errores de medición. Rev Esp Cardiol .1997 [acceso: 14/06/2020]; 50(2):117-128. Disponible en: https://doi.org/10.1016/S0300-8932(97)73190-7
21. Asociación Médica Mundial (AMM). Declaración de Helsinki de la AMM. Principios éticos para las investigaciones médicas en seres humanos. 64 a. Asamblea General; 2013 octubre. Fortaleza, Brasil: AMM; 2013. [acceso: 10/05/2019]. Disponible en: https://www.wma.net/wp-content/uploads/2016/11/DoH-Oct2013-JAMA.pdf
22. Smith FM, Wiland H, Mace A, Pai RK, Kalady MF. Depth and lateral spread of microscopic residual rectal cancer after neoadjuvant chemoradiation: implications for treatment decisions. Colorectal Disease. 2014 [acceso: 21/05/2020]; 16(8): 610-5. Disponible en: https://onlinelibrary.wiley.com/doi/abs/10.1111/codi.12608
23. Maurel J, Pedrosa L, Camps J. The controversy of neoadjuvant therapy in rectal câncer. Cirugía Española. 2017 [acceso: 11/05/2020]; 97(7): 361-3. Disponible en: https://www.elsevier.es/es-revista-cirugia-espanola-36-articulo-controversia-neoadyuvancia-cancer-recto-S0009739X19300053
24. Jiménez M, Alonso JO, De la Mora JG, Sánchez JC, Manzano MC, Alonso A, et al. Ultrasonido endoscópico como predictor de la respuesta patológica completa en cáncer de recto. Acta Gastroenterol Latinoam. 2019 [acceso: 21/05/2019]; 49(1):44-53. Disponible en: http://actagastro.org/ultrasonido-endoscopico-como-predictor-de-la-respuesta-patologica-completa
25. Bettoni F, Masotti C, Correa B, Donnard E, Dos Santos F, São Julião G. The effects of neoadjuvant chemoradiation in locally advanced rectal cancer. The impact in Intratumoral heterogeneity. Rev Front Oncol. 2019; 9:974. DOI: 10.3389/fonc.2019.00974
26. Asensio C. Efectividad diagnóstica y seguridad de distintas modalidades de elastografía en indicaciones oncológicas. Una revisión de revisiones sistemáticas y meta-análisis. Madrid: Red Española de Agencias de Evaluación de Tecnologías y Prestaciones del SNS; 2018. [acceso: 21/02/2019]. Disponible en: http://gesdoc.isciii.es/gesdoccontroller?action=download&id=22/01/2019-eb30fa4555
27. Mezzi G, Arcidiacono PG, Carrara S, Bohemo C, Testoni PA. Elastosonography in malignant rectal disease: preliminary data. Endoscopy. 2007; 39(4): 375. DOI: 10.1055/s-2007-966220
28. Palacios LJ, Naranjo AM, Serna CA, Mosqueda DA, Arbeláez LM, Gómez LM. Evaluación de la respuesta patológica al tratamiento neoadyuvante en cáncer de recto. Experiencia del Instituto de Cancerología de Medellín (Colombia, 2011-2017). Revista de Gastroenterología de México. 2020 [acceso: 28/08/2020]; 86(1): 13-20. Disponible en: http://www.revistagastroenterologiamexico.org/es-evaluacion-respuesta-patologica-al-tratamiento-articulo-S0375090620300124
29. Vanagunas A, Lin DE, Stryker SJ. Accuracy of endoscopic ultrasound for restaging rectal cancer following neoadjuvant chemoradiation therapy. Am J Gastroenterol. 2004 [acceso: 31/07/2019]; 99(1):109-112. Disponible en: https://pubmed.ncbi.nlm.nih.gov/14687151/
30. Ayuso J, Pagés M, Ayuso C. Estadificación del cáncer de recto. Radiología. 2010 [acceso: 02/05/2019]; 52(1):18-29. Disponible en: https://www.webcir.org/revistavirtual/articulos/mayo10/esp_05.pdf
31. Páez D, Brizuela RA, Descalzo Y, Anido V, García-Menocal JL, Morera M. Eficacia de la ultrasonografía endoscópica en la estadificación de tumores del recto. Rev Cub Med Mil. 2017 [acceso: 22/06/2019]; 46(4): [aprox. 10 p.]. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0138-65572017000400007
32. Waage JE, Havre RF, Odegaard S, Leh S, Eide GE, Baatrup G. Endorectal elastography in the evaluation of rectal tumours. Colorectal Disease. 2011[acceso: 22/06/2019]; 13(10):1130-37. Disponible en: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1463-1318.2010.02440.x
33. Waage JE, Leh S, Røsler C, Pfeffer F, Bach SP, Havre RF, et al. Endorectal ultrasonography, strain elastography and MRI differentiation of rectal adenomas and adenocarcinomas. Colorectal Disease. 2015[acceso: 22/06/2019]; 17(2):124-131. Disponible en: https://onlinelibrary.wiley.com/doi/full/10.1111/codi.1284 5
34. Zhao RS, Wang H, Zhou ZY, Zhou Q, Mulholland MW. Restaging of locally advanced rectal cancer with magnetic resonance imaging and endoluminal ultrasound after preoperative chemoradiotherapy: a systemic review and meta-analysis. Dis Colon Rectum. 2014; 57(3):388-395. DOI: 10.1097/DCR.0000000000000022
Published
2021-08-28
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Martinez Romero M, Brizuela Quintanilla RA, Alfonso Contino N, Raventós Vaquer PM, Garcia-Menocal Hernández JL, Mendoza Romero AM. Qualitative elastography by endoscopic ultrasound in the restaging of the irradiated rectal tumor. Rev Cubana Med Milit [Internet]. 2021 Aug. 28 [cited 2025 Apr. 3];50(3):e02101387. Available from: https://revmedmilitar.sld.cu/index.php/mil/article/view/1387
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