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Ann Coloproctol. 2019 Feb;35(1):24-29. doi: 10.3393/ac.2018.07.31. Epub 2019 Feb 28.

Variation in the Height of Rectal Cancers According to the Diagnostic Modalities.

Author information

1
Department of Colon and Rectal Surgery, Chonnam National University Hwasun Hospital, Hwasun, Korea.
2
Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
3
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
4
Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
5
Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Abstract

PURPOSE:

Although the height of a rectal tumor above the anal verge (tumor height) partly determines the treatment strategy, no practical standard exists for reporting this. We aimed to demonstrate the differences in tumor height according to the diagnostic modality used for its measurement.

METHODS:

We identified 100 patients with rectal cancers located within 15 cm of the anal verge who had recorded tumor heights measured by using magnetic resonance imaging (MRI), colonoscopy, and digital rectal examination (DRE). Tumor height measured by using MRI was compared with those measured by using DRE and colonoscopy to assess reporting inconsistencies. Factors associated with differences in tumor height among the modalities were also evaluated.

RESULTS:

The mean tumor heights were 77.8 ± 3.3, 52.9 ± 2.3, and 68.9 ± 3.1 mm when measured by using MRI, DRE, and colonoscopy, respectively (P < 0.001). Agreement among the 3 modalities in terms of tumor sublocation within the rectum was found in only 39% of the patients. In the univariate and the multivariate analyses, clinical stage showed a possible association with concordance among modalities, but age, sex, and luminal location of the tumor were not associated with differences among modalities.

CONCLUSION:

The heights of rectal cancer differed according to the diagnostic modality. Tumor height has implications for rectal cancer's surgical planning and for interpreting comparative studies. Hence, a consensus is needed for measuring and reporting tumor height.

KEYWORDS:

Colonoscopy; Digital rectal examination; Magnetic resonance imaging; Rectal neoplasms; Tumor height

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