scholarly journals Occult adenocarcinoma in adenomas. Possibilities of diagnostic methods

2021 ◽  
Vol 20 (2) ◽  
pp. 10-16
Author(s):  
S. V. Chernyshov ◽  
E. A. Khomyakov ◽  
R. K. Sinitsyn ◽  
Yu. E. Vaganov ◽  
Yu. L. Trubacheva ◽  
...  
Keyword(s):  
Anal Verge ◽  
Digital Rectal Examination ◽  
Diagnostic Value ◽  
Diagnostic Methods ◽  
Pelvic Mri ◽  
Rectal Examination ◽  
Occult Malignancy ◽  
Endoscopic Microsurgery ◽  
Pair Wise Comparison

Aim: to analyze the diagnostic value of the digital rectal examination, colonoscopy, MRI and ERUS for detecting occult adenocarcinoma in rectal adenomas.Patients and methods: the study included 100 patients with newly identified epithelial rectal neoplasms, which undergone transanal endoscopic microsurgery from December 2019 to December 2020. All the patients underwent digital rectal examination, colonoscopy, ERUS with sonoelastography, and pelvic MRI. The diagnostics value of this methods was estimated with determination of sensitivity and specificity.Results: the study included 67 (67%) females and 33 (33%) males. The mean age of the patients was 64.4 ± 10.7 years. The median distance from the tumor to the anal verge was 6.0 ± 2.9 cm. The sensitivity of the digital rectal examination in the occult malignancy verification was 0.44 (95% CI 0.24–0.65), specificity — 0.93 (95% CI 0.85–0.97). The sensitivity of the colonoscopy — 0.56 (95% CI 0.34–0.75), the specificity — 0.84 (95% CI 0.73–0.91). The sensitivity of MRI — 0.40 (95% CI 0.21–0.61), specificity — 0.89 (95% CI 0.80–0.95). The sensitivity of ERUS was 0.48 (95% CI 0.27–0.68), the specificity — 0.73 (95% CI 0.61–0.82). Pair wise comparison of diagnostic methods revealed the absence of significant differences in their diagnostic value (p > 0.05).Conclusion: at least one of diagnostic methods allows to verify the presence of malignant transformation in 100% of cases. So, only combination of diagnostic methods can help to choose the optimal treatment option.

scholarly journals Early Rectal Cancer: Can Transanal Endoscopic Microsurgery (TEM) Become the Standard Treatment?

2016 ◽  
Vol 71 (4) ◽  
pp. 323-331 ◽  
Author(s):  
Y. A. Shelygin ◽  
S. V. Chernyshov ◽  
O. A. Mainovskaya ◽  
I. V. Zarodnyuk ◽  
L. P. Orlova ◽  
...  
Keyword(s):  
Transanal Endoscopic Microsurgery ◽  
Malignant Tumors ◽  
Anal Verge ◽  
Operating Time ◽  
Digital Rectal Examination ◽  
Morbidity Rate ◽  
Treatment Technique ◽  
Mean Size ◽  
Endoscopic Microsurgery ◽  
Preoperative Work Up

Aim. Transanal endoscopic microsurgery (TEM) is a main treatment technique for rectal adenomas, but can also be used for selected malignant tumors. This study presents TEM experience.Methods. The study enrolled patients with rectal adenomas, and selected adenocarcinomas. Preoperative work-up included: digital rectal examination, rectoscopy with biopsy, colonoscopy, EUS, pelvic MRI.Results. Three hundred and thirty patients [mean age of 61,4±10 (33–88)] underwent TEM. The mean size ± SD of tumors was 3.2±1.2 cm (0.6–10.0). Mean distance from anal verge was 6.7±2.6 cm (2.0–14.0). Preoperative biopsy revealed: adenoma ― 263/330 (79,7%), adenocarcinoma ― 67/330 (20,3%). The median operating time was 40 (15–220) min. Tumor-free margins were obtained in all operative specimens. In 5/330 (1.5%) cases tumors were fragmented. The morbidity rate was 19/330 (5.7%). Pathological investigation revealed: adenoma in 192/330 (58.1%) cases, adenocarcinoma stage Tis, T1, T2 and T3 in 138/330 (41.9%). Median follow-up lasted for 24 (1–57) months. Five patients (2.0%) with adenoma and four patients (5.2%) with adenocarcinoma had local recurrence.Conclusion. Transanal endoscopic microsurgery for rectal adenomas and selected malignant tumors is associated with low morbidity and low recurrents rates.

scholarly journals STRAIN ELASTOGRAPHY AS DIAGNOSTIC TOOL FOR EVALUATION OF RECTAL NEOPLASMS

2017 ◽  
pp. 60-66 ◽  
Author(s):  
Y. A. Shelygin ◽  
L. P. Orlova ◽  
T. V. Samsonova ◽  
O. A. Majnovskaja ◽  
S. V. Chernyshov ◽  
...  
Keyword(s):  
Predictive Value ◽  
Rectal Neoplasms ◽  
Strain Ratio ◽  
Diagnostic Value ◽  
Strain Elastography ◽  
Operative Specimen ◽  
Rectal Neoplasia ◽  
Occult Malignancy ◽  
Endoscopic Microsurgery ◽  
Invasive Carcinomas

AIM. To establish cut-off point of strain ratio for rectal adenocarciomas. PATIENTS AND METHODS. Forty-five patients (29 female) at mean age ± SD of 61 ± 9.5 (range, 38-80) years with histologically confirmed rectal neoplasia were included into study. Endorectal Ultrasonography accomplished by strain elastography was performed by Hitachi Hi Vision Preirus (Japan). All patients were treated by Transanal Endoscopic Microsurgery. RESULTS. Pathologic examination of operative specimen revealed 31 adenomas (5 intraepithelial carcinomas) and 14 invasive carcinomas. Cut-off point of Strain Ratio was 5,7 with sensitivity of 0.94 (95 °%CI 0,68-0,99), specificity of 0.92 (95 %oCI 0,74-0,98), positive predictive value of 0,90 (95 % CI 0,84-0,96) and negative predictive value of 0,96 (95 %CI 0,85-0,99). CONCLUSION. Obtained results testified high diagnostic value of strain elastography and made one perspective method for detection of occult malignancy in large rectal adenomas.

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