| Objective: To assess the accuracy and limitations of endoluminal ultrasonotraphy (EUS) in preoperative staging of rectal cancinoma.Methods: 60 patients of rectal cancer ,who have been examinated by Biopsy enteroscope before rectectomy , were took endo-luminal ultrasound examination. Acconrding to TNM classification criteria, combine with CT presentation, in order to classified before operation and compared with the operation and the pathological classification. To find out the sensitivity and accuracy of the endo-luminal ultrasound staging for rectal cancer. We can define the property and Differentiation of the tumor through pathological section attained by enteroscope. After the EUS examination , normal bowels have 5 layer architecture . Acconrding to the 5 layer architecture of rectum and vicinity organic alter to judge the depth of encroachment.pT2 carcinomas were divided into two groups (being correctly diagnosed by EUS),B group (being overestimated by EUS),the depth of inflammatory cell infiltration and involvement of fibrosis peritumor were compared between two groups.Results: The overall accuracy of EUS in T stage was 75%.The sensitivity of EUS for pTl,pT2,pT3 and pT4 carcinoma was 100%,56.2%,80%,83.3%, respectively. We misdiagnosis 15 patients, 7 patients with ulcerated adenocarcinoma , 6 patients were overestimated, the rest one was underestimation. 8 patients with elevated adenocarcinoma were all underestimation. The sensitivity for pT2 carcinoma was the lowest. The depth of tumor invasion with less than one-third of muscularis propria occurred in 4 of A group, 6 patients with the depth of tumor invasion were more than one-third of muscularis propria in B group . Misdiagnostic rate is high (43.2%) when tumor was located in superior segment of rectum, misdiagnosis rate(15.9%).Conclusion: The EUS should become an important imaging tool in the preoperative assessment of the depth of tumor invasion. The overstaging is an important unfavourable factor in assessing the invasion depth with EUS, In addition, rectal stenosis caused by carcinoma and tumor locating in the superior segment of rectum also decrease the accuracy of EUS. Objective: To conclude the accuracy of EUS in predicting lymph node metastasis analyzing factors resulting in missed diagnoses and misdiagnosis.Methods: EUS was performed preoperatively in 60 patients with rectal catcinoma, in which no preoperative treatment was given. The results of EUS were correlated with operative and pathologic findings. Lymph node with a maximum diameter of 5mm or greater metastatic. The pathology inspection detect lymph nodes in 54 of 60 patients.Results: Swollen lymph nodes were found in 54 cases. Number of lymph nodes were 10 or greater in 53.7% of 54 cases. Lymph node were not found in 31.4% of 54 cases, and number of lymph nodes were 10 or greater in 5.5% with EUS. The sensitivity, specificity and accuracy of EUS in lumph node metastasis were 85.7% 65.3% 75.9%, respectively. The masculine gender rate is 72.7%, the negative rate is 80.9%. Lymph nodes metastasis occurred in 28 of 54 patients and incidence of metastasis was 51.8%. Lymph node metastases were not diagnosed in 4 cases, among them no lymph node was found in 2 cases by EUS , lymph nodes were all smaller than 5mm in the other 2 cases. Of the 9 cases of false palse positive diagnosis, the diameter of the largest lymph nodes was 5-7mm in 3 cases 8-9mm in 4 cases, larger than 10mm in 2 cases.Conclusion: Number of lymph nodes detected by EUS was less than that detected by pathologic findings. Size of lymph node, location of tumor, rectal stenosis, US condition affected lymph node detection and lymph node metastasis diagnosis by EUS .As a better method for TNM classification preoperative , EUS should take more cases and more experience to reduce false-negative and enhance its clinical application value.
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