The misdiagnosis of a rectal adenoma by biopsy and subsequent finding of invasive cancer after transanal excision causes a number of problems.
In this study, investigators from the United States determined the utility of endorectal ultrasound (ERUS) in the diagnosis of rectal adenomas.
The team compared diagnosis made by biopsy alone to diagnosis made by a combination of biopsy and ERUS.
The investigators conducted a systematic review of the literature using PubMed.
A total of 5 studies met the team's criteria. These studies provided data for 258 adenomas.
The team determined that of the 258 biopsy-negative rectal adenomas, 24% had focal carcinoma on histopathology.
However, they found that ERUS correctly established a cancer diagnosis in 81% of these misdiagnosed lesions.
|ERUS correctly diagnosed 81% of misdiagnosed lesions.|
|American Journal of Surgery|
They calculated that ERUS could reduce the proportion of misdiagnosis from 24% to 5%.
Dr Stewart Worrell and colleagues concluded, "ERUS is a useful adjunct to biopsy in the preoperative workup of rectal villous adenomas, and we recommend its routine use".
"Accurate preoperative assessment allows the surgeon to counsel the patient appropriately regarding the best operation, the perioperative risks, and the chances of local recurrence".