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Lokale Diagnostik beim Rektumkarzinom

Wie sieht die Realität aus?

Local diagnostics for rectal cancer

What is realistic?

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Zusammenfassung

Das prätherapeutische Staging beim Rektumkarzinom ist entscheidend für die Therapie im multimodalen Setting. Für das lokale Staging werden mit der Endosonographie (EUS) und der Magnetresonanztomographie (MRT) die höchsten Genauigkeiten in der Vorhersage der T- und N-Kategorien erreicht, wobei die Genauigkeit der Vorhersage eines nodalen Befalls allgemein schlecht ist. Mit der MRT kann darüber hinaus mit hoher Genauigkeit eine Aussage zum Abstand des Tumors zur mesorektalen Faszie erfolgen. Die Computertomographie (CT) ist weniger gut für das lokale Staging geeignet.

In der flächendeckenden Versorgung des Rektumkarzinoms ist die EUS das führende diagnostische Tool in der prätherapeutischen lokalen Diagnostik. Dabei ist die Genauigkeit der EUS in der Bestimmung der T-Kategorie in der breiten Anwendung weniger hoch, als es die Literaturdaten vorgeben und von der Anwendungsfrequenz abhängig. Die MRT kommt für die prätherapeutische Diagnostik des Rektumkarzinoms in der flächendeckenden Versorgung derzeit noch vergleichsweise selten zur Anwendung. Bei jedem 5. Rektumkarzinom erfolgt derzeit noch das lokale Staging mit der CT.

Abstract

Accurate pretherapeutic staging of rectal cancer is crucial for further therapeutic management and important for prognosis. The most accurate diagnostic tools in the assessment of T and N categories of rectal cancer are endorectal ultrasound (EUS) and magnetic resonance imaging (MRI). Furthermore, MRI can accurately predict the distance of the tumor to the colorectal membrane (CRM) and computed tomography (CT) is more suitable for detecting distant metastases.

In the routine care of rectal cancer EUS is the most frequently used diagnostic tool for local staging. The achieved accuracy for determining T category by EUS in routine clinical staging is lower than results reported in the literature. Furthermore, the accuracy of EUS depends on the experience of the examiner. Currently the frequency of using MRI for routine clinical staging of rectal cancer is low and in one out of five cases the local staging of rectal cancer is exclusively carried out by CT.

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Authors and Affiliations

  1. An-Institut für Qualitätssicherung in der operativen Medizin gGmbH, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland

    H. Ptok, I. Gastinger & H. Lippert

  2. Chirurgische Klinik, Carl-Thiem-Klinikum Cottbus, Thiemstr. 111, 03048, Cottbus, Deutschland

    H. Ptok

  3. Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland

    H. Lippert

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  1. H. Ptok
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  2. I. Gastinger
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  3. H. Lippert
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Correspondence to H. Ptok.

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Ptok, H., Gastinger, I. & Lippert, H. Lokale Diagnostik beim Rektumkarzinom. Chirurg 83, 448–451 (2012). https://doi.org/10.1007/s00104-011-2206-5

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