BACKGROUND: Evaluating patients for recurrent anal cancer after primary treatment can be difficult owing to distorted anatomy and scarring. Many institutions incorporate endoscopic ultrasound to improve detection, but the effectiveness is unknown. OBJECTIVE: The aim of this study is to compare the effectiveness of digital rectal examination and endoscopic ultrasound in detecting locally recurrent disease during routine follow-up of patients with anal cancer. DESIGN: This study is a retrospective, single-institution review. SETTINGS: This study was conducted at an oncologic tertiary referral center. PATIENTS: Included were 175 patients with nonmetastatic anal squamous-cell cancer, without persistent disease after primary chemoradiotherapy, who had at least 1 posttreatment ultrasound and examination by a colorectal surgeon. MAIN OUTCOME MEASURES: The primary outcomes measured were the first modality to detect local recurrence, concordance, crude cancer detection rate, sensitivity, specificity, and predictive value. RESULTS: Eight hundred fifty-five endoscopic ultrasounds and 873 digital rectal examinations were performed during 35 months median follow-up. Overall, ultrasound detected 7 (0.8%) mesorectal and 32 (3.7%) anal canal abnormalities; digital examination detected 69 (7.9%) anal canal abnormalities. Locally recurrent disease was found on biopsy in 8 patients, all detected first or only with digital examination. Four patients did not have an ultrasound at the time of diagnosis of recurrence. The concordance of ultrasound and digital examination in detecting recurrent disease was fair at 0.37 (SE, 0.08; 95% CI, 0.21-0.54), and there was no difference in crude cancer detection rate, sensitivity, specificity, and negative or positive predictive values. LIMITATIONS: The heterogeneity of follow-up timing and examinations is not standardized in this study but is reflective of general practice. CONCLUSIONS: Endoscopic ultrasound did not provide any advantage over digital rectal examination in identifying locally recurrent anal cancer, and should not be recommended for routine surveillance.
BACKGROUND: Evaluating patients for recurrent anal cancer after primary treatment can be difficult owing to distorted anatomy and scarring. Many institutions incorporate endoscopic ultrasound to improve detection, but the effectiveness is unknown. OBJECTIVE: The aim of this study is to compare the effectiveness of digital rectal examination and endoscopic ultrasound in detecting locally recurrent disease during routine follow-up of patients with anal cancer. DESIGN: This study is a retrospective, single-institution review. SETTINGS: This study was conducted at an oncologic tertiary referral center. PATIENTS: Included were 175 patients with nonmetastatic anal squamous-cell cancer, without persistent disease after primary chemoradiotherapy, who had at least 1 posttreatment ultrasound and examination by a colorectal surgeon. MAIN OUTCOME MEASURES: The primary outcomes measured were the first modality to detect local recurrence, concordance, crude cancer detection rate, sensitivity, specificity, and predictive value. RESULTS: Eight hundred fifty-five endoscopic ultrasounds and 873 digital rectal examinations were performed during 35 months median follow-up. Overall, ultrasound detected 7 (0.8%) mesorectal and 32 (3.7%) anal canal abnormalities; digital examination detected 69 (7.9%) anal canal abnormalities. Locally recurrent disease was found on biopsy in 8 patients, all detected first or only with digital examination. Four patients did not have an ultrasound at the time of diagnosis of recurrence. The concordance of ultrasound and digital examination in detecting recurrent disease was fair at 0.37 (SE, 0.08; 95% CI, 0.21-0.54), and there was no difference in crude cancer detection rate, sensitivity, specificity, and negative or positive predictive values. LIMITATIONS: The heterogeneity of follow-up timing and examinations is not standardized in this study but is reflective of general practice. CONCLUSIONS: Endoscopic ultrasound did not provide any advantage over digital rectal examination in identifying locally recurrent anal cancer, and should not be recommended for routine surveillance.
Authors: Jo A Lund; Stein H Sundstrom; Rune Haaverstad; Arne Wibe; Morten Svinsaas; Helge E Myrvold Journal: Dis Colon Rectum Date: 2004-04-19 Impact factor: 4.585
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Authors: Ramin Roohipour; Sujata Patil; Karyn A Goodman; Bruce D Minsky; W Douglas Wong; José G Guillem; Philip B Paty; Martin R Weiser; Heather B Neuman; Jinru Shia; Deborah Schrag; Larissa K F Temple Journal: Dis Colon Rectum Date: 2008-01-08 Impact factor: 4.585
Authors: Robert P Akbari; Philip B Paty; Jose G Guillem; Martin R Weiser; Larissa K Temple; Bruce D Minsky; Leonard Saltz; W Douglas Wong Journal: Dis Colon Rectum Date: 2004-05-28 Impact factor: 4.585
Authors: Alfonso Reginelli; Vincenza Granata; Roberta Fusco; Francesco Granata; Daniela Rega; Luca Roberto; Gianluca Pellino; Antonio Rotondo; Francesco Selvaggi; Francesco Izzo; Antonella Petrillo; Roberto Grassi Journal: Oncotarget Date: 2017-04-04
Authors: Vincenza Granata; Roberta Fusco; Alfonso Reginelli; Luca Roberto; Francesco Granata; Daniela Rega; Antonio Rotondo; Roberto Grassi; Francesco Izzo; Antonella Petrillo Journal: Infect Agent Cancer Date: 2016-10-12 Impact factor: 2.965