Abstract
One hundred thirteen patients with carcinoma of the rectum were evaluated for lymph node metastases by endorectal ultrasound. With the use of 7.5 MHz and based on different echo patterns, two main groups of lymph nodes can be differentiated: hypoechoic and hyperechoic lymph nodes. Compared with pathologic findings, hypoechoic lymph nodes represent metastases, whereas hyperechoic lymph nodes are visualized due to unspecific inflammation. Lymph node metastases can be predicted with a sensitivity of 72 percent and inflammatory lymph nodes with a specificity of 83 percent. The physical basis of the differentiation of lymph nodes was assessed in vitro by the determination of ultrasound parameters (speed of sound, acoustic impedance, attenuation, and backscattered amplitude). The attenuation coefficient of benign lymph nodes [2.5 dB/(MHz×cm)] is significantly higher than the mean value of lymph node metastases [1.3 db/(MHz×cm)]. The results demonstrate that involved nodes can principally be differentiated from not involved nodes. Micrometastases, mixed lymph nodes, and changing echo patterns within inflammatory nodes explain the accuracy rate of 78 percent.
Similar content being viewed by others
References
Dukes CE, Bussey HJ. The spread of rectal cancer and its effect on prognosis. Br J Cancer 1958;12:309–20.
Bucci L, Salfi R, Meraviglia F, Mazzeo F. Rectal lymphoscintigraphy. Dis Colon Rectum 1984;27:370–75.
Reasbeck PG, Manktelow A, Mc Arthur AM, Packer SG, Berkeley BB. An evaluation of pelvic lymphoscintigraphy in the staging of colorectal carcinoma. Br J Surg 1984;71:936–40.
Kramann B, Hildebrandt U. Computed tomography versus endosonography in the staging of rectal carcinoma: a comparative study. Int J Color Dis 1986;1:216–18.
Feifel G, Hildebrandt U, Dhom G: Assessment of depth invasion in rectal cancer by endosonography. Endoscopy 1987;19:64–7.
Beynon J, Foy DM, Roe AM, Temple LN, Mortensen NJ. Endoluminal ultrasound in the assessment of local invasion in rectal cancer. Br J Surg 1986;73:474–77.
Hildebrandt U, Feifel G. Preoperative staging of rectal cancer by intrarectal ultrasound. Dis Colon Rectum 1985;28:42–6.
Saitoh N, Okui K, Sarashina H, Suzuki M, Arai T, Nunomura M. Evaluation of echographic diagnosis of rectal cancer using intrarectal ultrasonic examination. Dis Colon Rectum 1986;29:234–42.
Rifkin MD, Wechsler RI. A comparison of computed tomography and endorectal ultrasound in staging rectal cancer. Int J Color Dis 1986;1:219–23.
Holdsworth PJ, Johnston D, Chalmers AG, et al. Endoluminal ultrasound and computed tomography in the staging of rectal cancer. Br J Surg 1988;75:1019–22.
Feifel G, Hildebrandt U, Dhom G. Die endorektale Sonographie beim Rektumkarzinom. Chirurg 1985;56:398–402.
Dixon AK, Kelsey FI, Morson BC, Nicholls RJ, Mason AY. Preoperative computed tomography of carcinoma of the rectum. Br J Radiol 1981;54:655–9.
Grabbe E, Lierse W, Winkler R. The perirectal fascia: morphology and use in staging of rectal carcinoma. Radiology 1983;149:241–6.
Hildebrandt U, Feifel G, Dhom G. The evaluation of the rectum by transrectal ultrasonography. Ultrasound Quart 1988;6:167–79.
Author information
Authors and Affiliations
Additional information
Supported by a grant from the Deutsche Forschungsgemeinschaft Hi 385/1-1
About this article
Cite this article
Hildebrandt, U., Klein, T., Feifel, G. et al. Endosonography of pararectal lymph nodes. Dis Colon Rectum 33, 863–868 (1990). https://doi.org/10.1007/BF02051923
Issue Date:
DOI: https://doi.org/10.1007/BF02051923