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Canadian Journal of Gastroenterology
Volume 23, Issue 9, Pages 639-641
http://dx.doi.org/10.1155/2009/750979
Brief Communication

The Use of Endoscopic Ultrasonography and Other Imaging Modalities in the Preoperative Staging of Rectal Villous Tumours: A Case of Overstaging by Magnetic Resonance Imaging

Michelle Buresi,1 Iman Zandieh,1 Alexander G Nagy,2 Audrey Spielmann,2 William C Yee,3 Alan A Weiss,1 and Eric M Yoshida1

1Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
2Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
3Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada

Received 1 June 2008; Accepted 25 September 2008

Copyright © 2009 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A case of a 60-year-old man with recurrent rectal villous adenoma is described. Preoperative staging with endoscopic ultrasound (EUS) and magnetic resonance imaging (MRI) revealed very discordant results. EUS showed a tumour present in the mucosa with no submucosal invasion, while MRI revealed invasion of the muscularis propria consistent with an invasive stage T2 carcinoma. Based on the MRI findings, the patient underwent a low anterior resection of the tumour. The surgical pathology specimen revealed a villous adenoma with low-grade dysplasia but no carcinoma and no extension into the muscularis propria. The present case highlights the uncertainty that currently exists as to which imaging modality provides the greatest accuracy in the staging of rectal cancer and in guiding the type of surgical procedure performed. Two recent meta-analyses and a systematic review of the literature point to EUS as the imaging modality of choice for determining muscularis propria and perirectal tissue invasion, as well as nodal involvement.