1Colorectal Multidisciplinary Team, Hospital Clinico Universitario, University of Valencia, Valencia, Spain 2Department of General Surgery, Colorectal Unit, Hospital La Fe, University of Valencia, Valencia, Spain 3Imaging Department, ERESA, Valencia, Spain.
Dis Colon Rectum. 2013 Dec;56(12):1332-8. doi: 10.1097/DCR.0b013e3182a69a3b.
Douglas Wong proposed a new classification of tumor penetration in the rectal wall (T stage) in an attempt to incorporate the prognostic heterogeneity of T3 rectal cancers into the preoperative staging.
This study aimed to evaluate if the accuracy of endorectal ultrasound and MRI in predicting rectal cancer T staging improves when using a modified Wong's classification.
This prospective series compares local standard TN staging and a modified Wong's classification.
This study was conducted by a specialized Colorectal Multidisciplinary Team at a tertiary teaching hospital.
Seventy patients underwent surgery for middle or low rectal cancer between 2002 and 2008 without neoadjuvant radiochemotherapy. We compared the preoperative staging with the pathological staging to determine the preoperative accuracy of endorectal ultrasound and MRI when using a modified Wong's classification vs the standard TN classification.
A modified version of Wong's classification was used for preoperative and pathological staging.
The primary outcome measured was the accuracy in the preoperative T staging.
The overall accuracy of endorectal ultrasound and MRI in assessing T staging was 68.6% and 72.9% (uT1/2, 90%; uT3, 58.3%; and uT4, 100% and rT1/2, 88%; rT3, 63.4%; and rT4, 75%). By using the proposed modified Wong's classification, the overall accuracy of endorectal ultrasound and MRI improved to 82.9% and 90%.
The interobserver variability in radiological assessment was not evaluated.
With use of the modified Wong's classification proposed in this study, the overall accuracy of preoperative imaging in assessing T staging of rectal cancer is substantially improved, especially when endorectal ultrasound and MRI stage match, enhancing the selection of patients for neoadjuvant radiochemotherapy.
道格拉斯·黄（Douglas Wong）提出了一种新的直肠壁肿瘤穿透（T 期）分类方法，试图将 T3 直肠癌的预后异质性纳入术前分期。
本研究旨在评估在使用改良 Wong 分类法时，直肠内超声和 MRI 预测直肠癌 T 分期的准确性是否提高。
本前瞻性系列研究比较了局部标准 TN 分期和改良 Wong 分类法。
本研究由一家三级教学医院的肛肠多学科团队进行。
2002 年至 2008 年间，70 例中低位直肠癌患者未接受新辅助放化疗而行手术治疗。我们比较了术前分期和病理分期，以确定改良 Wong 分类法与标准 TN 分类法在术前评估时对直肠内超声和 MRI 的准确性。
术前和病理分期采用改良 Wong 分类法。
主要观察指标为术前 T 分期的准确性。
直肠内超声和 MRI 评估 T 分期的总体准确性分别为 68.6%和 72.9%（uT1/2，90%；uT3，58.3%；uT4，100%和 rT1/2，88%；rT3，63.4%；rT4，75%）。使用提出的改良 Wong 分类法，直肠内超声和 MRI 的总体准确性分别提高至 82.9%和 90%。
未评估放射学评估的观察者间变异性。
使用本研究提出的改良 Wong 分类法，术前影像学评估直肠癌 T 分期的总体准确性显著提高，尤其是当直肠内超声和 MRI 分期一致时，可增强患者选择新辅助放化疗的能力。
