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Diagnostic accuracy of endoscopy in determining rectal tumor proximity to the peritoneal reflection

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Abstract

Purpose

Treatment of invasive rectal adenocarcinoma is stratified into upfront surgery versus neoadjuvant chemoradiotherapy, in part, based on tumor distance from the anal verge (AV). This study examines the correlation between tumor distance measurements (endoscopic and MRI) and relationship to the anterior peritoneal reflection (aPR) on MRI.

Methods

A single-center retrospective study was performed at a tertiary center accredited by the National Accreditation Program for Rectal Cancer (NAPRC). 162 patients with invasive rectal cancer were seen between October of 2018 and April of 2022. Sensitivity and specificity were determined for MRI and endoscopic measurements in their ability to predict tumor location relative to the aPR.

Results

One hundred nineteen patients had tumors endoscopically and radiographically measured from the AV. Pelvic MRI characterized tumors as above (intraperitoneal) or at/straddles/below the aPR (extraperitoneal). True positives were defined as extraperitoneal tumors \(\le\) 10 cm. True negatives were defined as intraperitoneal tumors > 10 cm. Endoscopy was 81.9% sensitive and 64.3% specific in predicting tumor location with respect to the aPR. MRI was 86.7% sensitive and 92.9% specific. Utilizing a 12 cm cutoff, sensitivity of both modalities increased (94.3%, 91.4%) but specificity decreased (50%, 64.3%).

Conclusion

For locally invasive rectal cancers, tumor position relative to the aPR is an important factor in determining the role of neoadjuvant therapy. These results suggest endoscopic tumor measurements do not accurately predict tumor location relative to the aPR, and may lead to incorrect treatment stratification recommendation. When the aPR is not identified, MRI-reported tumor distance may be a better predictor of this relationship.

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Data availability

The data supporting this research are available from the corresponding author on reasonable request.

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Author information

Authors and Affiliations

  1. Department of Surgery, Cooper University Health Care, Ste 411, 3 Cooper Plaza, Camden, NJ, 08103, USA

    Georgianna Sandilos, Keshav Kooragayala, Clara Zhu, Danica N. Giugliano, Michael E. Kwiatt & Steven J. McClane

  2. Department of Statistics, University of Connecticut, Storrs, CT, USA

    Austin Menger

  3. Cooper Medical School of Rowan University, Camden, NJ, USA

    Saba Daneshpooy

  4. Department of Radiology, Cooper University Health Care, Camden, NJ, USA

    Ron Gefen & James Kovacs

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  1. Georgianna Sandilos
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Contributions

SM, JK, CZ and GS contributed to the design of this study. SM, RG, JK processed the data. AM performed statistical analysis and assisted SM, DG, MK and GS in interpretation of the results. GS, KK, SD and SM wrote the manuscript. All authors reviewed and edited the manuscript.

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Correspondence to Steven J. McClane.

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Sandilos, G., Menger, A., Kooragayala, K. et al. Diagnostic accuracy of endoscopy in determining rectal tumor proximity to the peritoneal reflection. Int J Colorectal Dis 38, 109 (2023). https://doi.org/10.1007/s00384-023-04392-y

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