The Impact of a Surgeon Led Endoluminal Ultrasonography Service

Introduction: Endoluminal ultrasonography is useful, for assessing pelvic floor dysfunction (PFD), which has functional or neoplastic manifestations. Ultrasonography has reported accuracy for assessing tumour invasion, and lymph node involvement of, 75%-94% and 71% respectively.

Aims: To evaluate endorectal ultrasonography(ERUS) and MRI in the preoperative staging of rectal cancer, and assess endoanal ultrasonography(EAUS) in evaluating PFD.

Materials and Methods: One hundred and eleven patients were studied. Fifty-one patients (mean age 63.7±12 years) with rectal tumours were assessed with ERUS for tumour and nodal staging. In addition to ERUS, 27 patients had pelvic MRI. Sixty-three incontinence patients were evaluated with EAUS, to detect anal sphincter defects.

Results: Fifty-one patients had ERUS. Of the 48 successful procedures, 27 had pelvic MRI in addition to ERUS. In the comparative group of ERUS and histology, 35patients were included with a concordance of both tests in 27patients, and of accuracy of 77%. The sensitivity of ERUS for depth of tumour invasion was 94%, specificity of 100%. Tumour invasion was correctly staged, under-staged and over-staged by ERUS in (74%), (17%) and (9%) of patients respectively. The accuracy of ERUS for nodal staging was 80%. MRI versus histology yielded accuracy of 61%. Tumour invasion was correctly staged, understaged and overstaged by MRI in (53%), (37%), and (11%) of patients respectively. Sixty-three incontinent patients were evaluated with EAUS. Thirteen (30.3%) and 5 (28%) of the faecal incontinence and combined faecal and urinary incontinence groups respectively had identifiable sphincter defects.

Conclusion: Surgeon led ultrasonography is a safe and efficient service with a high diagnostic yield.