The John Goligher Department of Colorectal Surgery, St James's University Hospital, Leeds, UK.
Br J Surg. 2014 Apr;101(5):573-7. doi: 10.1002/bjs.9413.
Retrorectal tumours present diagnostic and surgical challenges. This study aimed to identify whether preoperative imaging and/or biopsy provide diagnostic accuracy.
A consecutive series of patients who had undergone excision of a retrorectal tumour were identified from a database (2002-2013). Details of patient demographics, preoperative presentation, imaging, biopsy, surgical procedure, and gross and microscopic pathology were reviewed. Preoperative imaging and/or biopsies were compared with eventual pathology findings.
In total, 76 patients were identified, all of whom had undergone preoperative cross-sectional imaging whereas only 22 had preoperative biopsy. Imaging correctly discriminated benign from malignant tumours in 72 of the 76 patients (specificity 97 per cent, sensitivity 88 per cent, positive predictive value 88 per cent and negative predictive value 97 per cent). The corresponding values for preoperative biopsy (benign versus malignant) were 100, 83, 100 and 93 per cent. None of the four patients who were assessed incorrectly as having benign or malignant disease on imaging would have undergone an alternative procedure had this been known before surgery. Preoperative biopsy did not significantly influence patient management, and the absence of preoperative biopsy had no detrimental effect; a definitive preoperative histological diagnosis would not have influenced subsequent management.
Preoperative imaging was accurate in the assessment of retrorectal tumours, whereas biopsy did not add to the surgical strategy.
直肠后肿瘤的诊断和手术具有挑战性。本研究旨在确定术前影像学检查和/或活检是否能提供准确的诊断。
从数据库（2002-2013 年）中确定了连续系列接受直肠后肿瘤切除术的患者。回顾了患者人口统计学、术前表现、影像学检查、活检、手术程序以及大体和显微镜病理检查的详细信息。比较了术前影像学检查和/或活检与最终的病理检查结果。
总共确定了 76 例患者，所有患者均接受了术前横断面影像学检查，而仅有 22 例患者接受了术前活检。影像学检查正确区分了 76 例患者中的良性和恶性肿瘤，特异性为 97%，敏感性为 88%，阳性预测值为 88%，阴性预测值为 97%。术前活检（良性与恶性）的相应值分别为 100%、83%、100%和 93%。如果在术前知道这一点，那么在影像学检查中被错误评估为良性或恶性疾病的 4 例患者中，没有一例会接受替代手术。术前活检并没有显著影响患者的管理，而没有进行术前活检也没有产生不利影响；明确的术前组织学诊断不会影响后续的管理。
术前影像学检查对直肠后肿瘤的评估是准确的，而活检并没有增加手术策略。
