Center for Colon and Rectal Surgery, Florida Hospital, Orlando, Florida.
Department of Surgery, Manchester Royal Infirmary, Manchester, United Kingdom.
Dis Colon Rectum. 2018 Oct;61(10):1163-1169. doi: 10.1097/DCR.0000000000001168.
Local excision may be curative for benign and malignant rectal neoplasms. Because many early rectal cancers are discovered incidentally after local excision of clinically benign lesions, it is unclear whether preoperative imaging with transrectal ultrasound or MRI affects management.
The purpose of this study was to determine the diagnostic characteristics and effect of preoperative imaging on the incidence of malignancy in benign rectal lesions undergoing local excision.
Prospective data from 2 institutions were included. Coarsened exact matching created a balanced cohort comparing imaging and no-imaging groups.
The study was conducted at high-volume specialist referral hospitals.
Adult patients undergoing local excision via transanal endoscopic surgery between 1997 and 2016 for clinically benign rectal neoplasms were included.
The study intervention included preoperative imaging with transrectal ultrasound and/or MRI.
We measured the incidence of malignancy and diagnostic accuracy of preoperative imaging.
A total of 620 patients were included (272 with preoperative imaging and 348 without). There were 250 patients undergoing transrectal ultrasound, and 24 patients undergoing MRI (2 patients underwent both). Transrectal ultrasound and MRI correctly identified malignant polyps in 50% (11/22) and 44% (8/18). Overall agreement for benign versus malignant polyps between preoperative imaging and final pathology was κ = 0.30 (95% CI, 0.18-0.41) for transrectal ultrasound and 0.29 (95% CI, 0.01-0.57) for MRI. In both the overall and unmatched cohorts, the incidence of malignancy, margin involvement, and proportion of patients requiring salvage surgery was similar.
Data were obtained from 2 institutions with different equipment over a long time period.
Preoperative imaging did not accurately identify malignancy in clinically benign rectal lesions and did not affect the incidence of malignancy, margin involvement, or proportion of patients requiring salvage surgery. Therefore, preoperative imaging may not be necessary for clinically benign lesions undergoing local excision. See Video Abstract at http://links.lww.com/DCR/A695.
局部切除可能对良性和恶性直肠肿瘤具有治愈作用。由于许多早期直肠癌是在对临床良性病变进行局部切除后意外发现的，因此尚不清楚术前直肠超声或 MRI 检查是否会影响治疗决策。
本研究旨在确定术前影像学检查对接受局部切除的良性直肠病变的恶性肿瘤发生率的诊断特征和影响。
本研究纳入了 2 家机构的前瞻性数据。通过粗化精确匹配创建了一个平衡的队列，比较了有影像学检查和无影像学检查组。
本研究在高容量的专科转诊医院进行。
1997 年至 2016 年间，通过经肛门内镜手术接受局部切除的临床良性直肠肿瘤的成年患者。
研究干预措施包括术前直肠超声和/或 MRI 检查。
我们测量了恶性肿瘤的发生率和术前影像学检查的诊断准确性。
共纳入 620 例患者（272 例接受术前影像学检查，348 例未接受）。其中 250 例行直肠超声检查，24 例行 MRI 检查（2 例同时行两种检查）。直肠超声和 MRI 正确识别恶性息肉的比例分别为 50%（11/22）和 44%（8/18）。术前影像学检查与最终病理检查对良性与恶性息肉的总体一致性 κ 值分别为直肠超声 0.30（95%CI，0.18-0.41）和 MRI 0.29（95%CI，0.01-0.57）。在总队列和未匹配队列中，恶性肿瘤的发生率、切缘累及情况以及需要挽救性手术的患者比例均相似。
数据来自 2 家具有不同设备且时间跨度较长的机构。
术前影像学检查未能准确识别临床良性直肠病变中的恶性肿瘤，也未影响恶性肿瘤的发生率、切缘累及情况或需要挽救性手术的患者比例。因此，对于接受局部切除的临床良性病变，术前影像学检查可能不是必需的。详见视频摘要，网址：http://links.lww.com/DCR/A695。
