Effectiveness of preoperative staging in rectal cancer: digital rectal examination, endoluminal ultrasound or magnetic resonance imaging?
Author(s)
Type
Journal Article
Abstract
In rectal cancer, preoperative staging should identify early tumours suitable for treatment by surgery alone and locally advanced tumours that require therapy to induce tumour regression from the potential resection margin. Currently, local staging can be performed by digital rectal examination (DRE), endoluminal ultrasound (EUS) or magnetic resonance imaging (MRI). Each staging method was compared for clinical benefit and cost-effectiveness. The accuracy of high-resolution MRI, DRE and EUS in identifying favourable, unfavourable and locally advanced rectal carcinomas in 98 patients undergoing total mesorectal excision was compared prospectively against the resection specimen pathological as the gold standard. Agreement between each staging modality with pathology assessment of tumour favourability was calculated with the chance-corrected agreement given as the kappa statistic, based on marginal homogenised data. Differences in effectiveness of the staging modalities were compared with differences in costs of the staging modalities to generate cost effectiveness ratios. Agreement between staging and histologic assessment of tumour favourability was 94% for MRI (κ=0.81, s.e.=0.05; κW=0.83), compared with very poor agreements of 65% for DRE (κ=0.08, s.e.=0.068, κW=0.16) and 69% for EUS (κ=0.17, s.e.=0.065, κW=0.17). The resource benefits resulting from the use of MRI rather than DRE was £67164 and £92244 when MRI was used rather than EUS. Magnetic resonance imaging dominated both DRE and EUS on cost and clinical effectiveness by selecting appropriate patients for neoadjuvant therapy and justifies its use for local staging of rectal cancer patients.
Date Issued
2004-07-05
Date Acceptance
2004-03-26
Citation
British Journal of Cancer, 2004, 91 (1), pp.23-29
ISSN
1532-1827
Publisher
Cancer Research UK
Start Page
23
End Page
29
Journal / Book Title
British Journal of Cancer
Volume
91
Issue
1
Copyright Statement
From twelve months after its original publication, this work is licensed under the Creative Commons Attribution-NonCommercial-Share Alike 3.0 Unported License.
To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/3.0/
To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/3.0/
Subjects
Science & Technology
Life Sciences & Biomedicine
Oncology
ONCOLOGY
rectal neoplasm staging
endosonography
magnetic resonance imaging
comparative study
cost-benefit analysis
rectal neoplasms therapy
radiotherapy
surgery
pathology
TOTAL MESORECTAL EXCISION
CIRCUMFERENTIAL MARGIN INVOLVEMENT
PROGNOSTIC-FACTORS
COLORECTAL-CANCER
LOCAL RECURRENCE
RADIOTHERAPY
CARCINOMA
ULTRASONOGRAPHY
IRRADIATION
SURVIVAL
Publication Status
Published