Abstract
Fifty consecutive patients with anal canal epidermoid carcinoma were evaluated by transanorectal ultrasonography (TRUS) at diagnosis. Forty-six patients were treated with primary radiotherapy plus bleomycin. Twenty-eight of the last 30 patients underwent, in addition, planimetric volume determination. The ultrasound findings were compared with clinical stage as assessed by digital palpation. Tumours in clinical stages T1–2 showed evidence of penetration through the anorectal muscular wall at ultrasound (UT3–4) in two-thirds of the cases. This was the case in all tumours in clinical stages T3–4. A clear correlation between tumour size, depth of invasion, and tumour volume, respectively, and residual tumour after a “pre-operative” dose of 40 Gy plus bleomycin was found. When combining clinical stage with TRUS, all tumours classified as T1–2/UT1–2 and had a complete response (CR) after the first radiotherapy period, whereas the corresponding figures for those with deep invasion ultrasonographically (T1–2/UT3–4 and T3–4/UT3–4) were 64 percent and 0 percent, respectively. It thus appears that TRUS could complement digital palpation in staging anal canal carcinoma.
Résumé
50 patients consécutifs présentant un cancer épidermoïde du canal anal ont eu une évaluation diagnostique par ultrasonographie transanorectale. 46 malades ont été traités par radiothérapie première plus bléomycine. 28 des 30 derniers malades eurent en supplément une détermination planimétrique du volume. Les résultats de l'ultrasonographie ont été comparés avec le stade clinique évalué par la palpation digitale. Les stades cliniques T1-T2 montraient une évidence de pénétration dans le muscle ano-rectal à l'ultrasonographie (UT3–4) dans 2/3 des cas. Ce fait était le cas de toutes les tumeurs des stades T3-T4. Une corrélation évidente entre le volume de la tumeur, la profondeur de l'invasion, la dimension de la tumeur respectivement et la tumeur résiduelle après une dose pré-opératoire de 40 grays plus bléomycine a été trouvée. En combinant l'évaluation clinique avec l'échographie endo-rectale, toutes les tumeurs classifiées comme T1-T2-(UT1–2) eurent une réponse totale après la première période de radiothérapie, tandis que des résultats semblables pour les tumeurs avec une invasion profonde à l'ultrasonographie (T1–2/UT3–4) furent de 64% et de 0% respectivement. Il est ainsi évident que l'échographie endo-rectale complète la palpation digitale pour évaluer le stade du canal anal.
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Goldman, S., Norming, U., Svensson, C. et al. Transanorectal ultrasonography in the staging of anal epidermoid carcinoma. Int J Colorect Dis 6, 152–157 (1991). https://doi.org/10.1007/BF00341236
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DOI: https://doi.org/10.1007/BF00341236