{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T13:43:10Z","timestamp":1783690990353,"version":"3.55.0"},"reference-count":25,"publisher":"International College of Surgeons","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2014]]},"abstract":"Abstract<\/jats:title>\n In the last 20 years, endorectal ultrasound (ERUS) has been one of the main diagnostic methods for locoregional staging of rectal cancer. ERUS is accurate modality for evaluating local invasion of rectal carcinoma into the rectal wall layers (T category). Adding the three-dimensional modality (3-D) increases the capabilities of this diagnostic tool in rectal cancer patients. We review the literature and report our experience in preoperative 3-D ERUS in rectal cancer staging. In the group of 71 patients, the staging of preoperative 3-D endorectal ultrasonography was compared with the postoperative morphologic examination. Three-dimensional ERUS preoperative staging was confirmed with morphologic evaluation in 66 out of 71 cases (92.9%). The detection sensitivities of rectal cancer with 3-D ERUS were as follows: T1, 92.8%; T2, 93.1%; T3, 91.6%; and T4, 100.0%; with specificity values of T1, 98.2%; T2, 95.4%; T3, 97.8%; and T4, 98.5%. Three-dimensional ERUS correctly categorized patients with T1, 97.1%; T2, 94.3%; T3, 95.7%; and T4, 98.5%. The percentage of total overstaged cases was 2.75% and that of understaged cases was 6.87%. The metastatic status of the lymph nodes was determined with a sensitivity of 79.1% (19 of 24), specificity of 91.4% (43 of 47), and diagnostic accuracy of 87.3% (62 of 71). In our experience, 3-D ERUS has the potential to become the diagnostic modality of choice for the preoperative staging of rectal cancer.<\/jats:p>","DOI":"10.9738\/intsurg-d-13-00227.1","type":"journal-article","created":{"date-parts":[[2014,3,26]],"date-time":"2014-03-26T20:44:34Z","timestamp":1395866674000},"page":"106-111","source":"Crossref","is-referenced-by-count":17,"title":["The Role of 3-D Endorectal Ultrasound in Rectal Cancer: Our Experience"],"prefix":"10.9738","volume":"99","author":[{"given":"Nikola Y.","family":"Kolev","sequence":"first","affiliation":[{"name":"Clinic of surgery, St. Marina University Hospital, Medical University of Varna, Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anton Y.","family":"Tonev","sequence":"additional","affiliation":[{"name":"Clinic of surgery, St. Marina University Hospital, Medical University of Varna, Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentin L.","family":"Ignatov","sequence":"additional","affiliation":[{"name":"Clinic of surgery, St. Marina University Hospital, Medical University of Varna, Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksander K.","family":"Zlatarov","sequence":"additional","affiliation":[{"name":"Clinic of surgery, St. Marina University Hospital, Medical University of Varna, Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasil M.","family":"Bojkov","sequence":"additional","affiliation":[{"name":"Clinic of surgery, St. Marina University Hospital, Medical University of Varna, Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanya D.","family":"Kirilova","sequence":"additional","affiliation":[{"name":"Division of gastroenterology, St. Marina University Hospital, Medical University of Varna, Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elitsa","family":"Encheva","sequence":"additional","affiliation":[{"name":"Radiotherapy Department, St. Marina University Hospital, Medical University of Varna, Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krasimir","family":"Ivanov","sequence":"additional","affiliation":[{"name":"Clinic of surgery, St. Marina University Hospital, Medical University of Varna, Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4721","reference":[{"issue":"12","key":"i0020-8868-99-2-106-b01","series-title":"Dis Colon Rectum","first-page":"1189","article-title":"Preoperative staging of rectal cancer by endoluminal ultrasound vs. magnetic resonance imaging: preliminary results of a prospective, comparative study","volume":"37","author":"Thaler\n W,","year":"1994","unstructured":"Thaler\n W, \n \n Watzka\n S, \n \n Martin\n F, \n \n La Guardia\n G, \n \n Psenner\n K, \n \n Bonatti\n G\n \n et al\n . Preoperative staging of rectal cancer by endoluminal ultrasound vs. magnetic resonance imaging: preliminary results of a prospective, comparative study. Dis Colon Rectum1994;37(12):1189\u20131193"},{"issue":"1","key":"i0020-8868-99-2-106-b02","series-title":"Br J Cancer","first-page":"23","article-title":"Effectiveness of preoperative staging in rectal cancer: digital rectal examination, endoluminal ultrasound or magnetic resonance imaging?","volume":"91","author":"Brown\n G,","year":"2004","unstructured":"Brown\n G, \n \n Davies\n S, \n \n Williams\n GT, \n \n Bourne\n MW, \n \n Newcombe\n RG, \n \n Radcliffe\n AG\n \n et al\n . Effectiveness of preoperative staging in rectal cancer: digital rectal examination, endoluminal ultrasound or magnetic resonance imaging?Br J Cancer2004;91(1):23\u201329"},{"issue":"1","key":"i0020-8868-99-2-106-b03","series-title":"Dis Colon Rectum","first-page":"10","article-title":"Accuracy of endorectal ultrasonography in preoperative staging of rectal tumors","volume":"45","author":"Garcia-Aguilar\n J,","year":"2002","unstructured":"Garcia-Aguilar\n J, \n \n Pollack\n J, \n \n Lee\n SH, \n \n Hernandez de Anda\n E, \n \n Mellgren\n A, \n \n Wong\n WD\n \n et al\n . Accuracy of endorectal ultrasonography in preoperative staging of rectal tumors. Dis Colon Rectum2002;45(1):10\u201315"},{"issue":"5","key":"i0020-8868-99-2-106-b04","series-title":"Endoscopy","first-page":"385","article-title":"Routine use of transrectal ultrasound in rectal carcinoma: results of a prospective multicenter study","volume":"34","author":"Marusch\n F,","year":"2002","unstructured":"Marusch\n F, \n \n Koch\n A, \n \n Schmidt\n U, \n \n Zippel\n R, \n \n Kuhn\n R, \n \n Wolff\n S\n \n et al\n . Routine use of transrectal ultrasound in rectal carcinoma: results of a prospective multicenter study. Endoscopy2002;34(5):385\u2013390"},{"issue":"10","key":"i0020-8868-99-2-106-b05","series-title":"Dis Colon Rectum","first-page":"863","article-title":"Endosonography of pararectal lymph nodes: in vitro and in vivo evaluation","volume":"33","author":"Hildebrandt\n U,","year":"1990","unstructured":"Hildebrandt\n U, \n \n Klein\n T, \n \n Feifel\n G, \n \n Schwarz\n HP, \n \n Koch\n B, \n \n Schmitt\n RM. \n \n Endosonography of pararectal lymph nodes: in vitro and in vivo evaluation. Dis Colon Rectum1990;33(10):863\u2013868"},{"issue":"5","key":"i0020-8868-99-2-106-b06","series-title":"Onkologie","first-page":"230","article-title":"Preoperative staging of rectal tumors: comparison of endorectal ultrasound, hydro-CT, and high-resolution endorectal MRI","volume":"31","author":"Dinter\n DJ,","year":"2008","unstructured":"Dinter\n DJ, \n \n Hofheinz\n RD, \n \n Hartel\n M, \n \n Kaehler\n GF, \n \n Neff\n W, \n \n Diehl\n SJ. \n \n Preoperative staging of rectal tumors: comparison of endorectal ultrasound, hydro-CT, and high-resolution endorectal MRI. Onkologie2008;31(5):230\u2013235"},{"issue":"7","key":"i0020-8868-99-2-106-b07","series-title":"World J Surg","first-page":"728","article-title":"Importance of extended lymphadenectomy with lateral node dissection for advanced lower rectal cancer","volume":"21","author":"Moriya\n Y,","year":"1997","unstructured":"Moriya\n Y, \n \n Sugihara\n K, \n \n Akasu\n T, \n \n Fujita\n S. \n \n Importance of extended lymphadenectomy with lateral node dissection for advanced lower rectal cancer. World J Surg1997;21(7):728\u2013732"},{"issue":"4","key":"i0020-8868-99-2-106-b08","series-title":"Surgeon","first-page":"222","article-title":"The role of imaging in the pre-operative staging and post-operative follow-up of rectal cancer","volume":"6","author":"Low\n G,","year":"2008","unstructured":"Low\n G, \n \n Tho\n LM, \n \n Leen\n E, \n \n Wiebe\n E, \n \n Kakumanu\n S, \n \n McDonald\n AC\n \n et al\n . The role of imaging in the pre-operative staging and post-operative follow-up of rectal cancer. Surgeon2008;6(4):222\u2013 231"},{"issue":"11","key":"i0020-8868-99-2-106-b09","series-title":"J Am Coll Radiol","first-page":"775","article-title":"ACR Appropriateness Criteria pretreatment staging of colorectal cancer","volume":"9","author":"Dewhurst\n C,","year":"2012","unstructured":"Dewhurst\n C, \n \n Rosen\n MP, \n \n Blake\n MA, \n \n Baker\n ME, \n \n Cash\n BD, \n \n Fidler\n JL\n \n et al\n . ACR Appropriateness Criteria pretreatment staging of colorectal cancer. J Am Coll Radiol2012;9(11):775\u2013781"},{"issue":"11","key":"i0020-8868-99-2-106-b10","series-title":"Surg Endosc","first-page":"1005","article-title":"Prospective comparison of endorectal ultrasound, three-dimensional endorectal ultrasound, and endorectal MRI in the preoperative evaluation of rectal tumors: preliminary results","volume":"14","author":"Hunerbein\n M,","year":"2000","unstructured":"Hunerbein\n M, \n \n Pegios\n W, \n \n Rau\n B, \n \n Vogl\n TJ, \n \n Felix\n R, \n \n Schlag\n PM. \n \n Prospective comparison of endorectal ultrasound, three-dimensional endorectal ultrasound, and endorectal MRI in the preoperative evaluation of rectal tumors: preliminary results. Surg Endosc2000;14(11):1005\u20131009"},{"issue":"2","key":"i0020-8868-99-2-106-b11","series-title":"Surgery","first-page":"164","article-title":"The role of transrectal ultrasound-guided biopsy in the postoperative follow-up of patients with rectal cancer","volume":"129","author":"Hunerbein\n M,","year":"2001","unstructured":"Hunerbein\n M, \n \n Totkas\n S, \n \n Moesta\n KT, \n \n Ulmer\n C, \n \n Handke\n T, \n \n Schlag\n PM. \n \n The role of transrectal ultrasound-guided biopsy in the postoperative follow-up of patients with rectal cancer. Surgery2001;129(2):164\u2013169"},{"issue":"1","key":"i0020-8868-99-2-106-b12","series-title":"Dis Colon Rectum","first-page":"47","article-title":"Three-dimensional endoluminal ultrasound: new staging technique in patients with rectal cancer","volume":"40","author":"Ivanov\n KD,","year":"1997","unstructured":"Ivanov\n KD, \n \n Diavoc\n CD. \n \n Three-dimensional endoluminal ultrasound: new staging technique in patients with rectal cancer. Dis Colon Rectum1997;40(1):47\u201350"},{"issue":"1","key":"i0020-8868-99-2-106-b13","series-title":"Am J Surg","first-page":"89","article-title":"Efficacy of 3-dimensional endorectal ultrasonography compared with conventional ultrasonography and computed tomography in preoperative rectal cancer staging","volume":"192","author":"Kim\n JC,","year":"2006","unstructured":"Kim\n JC, \n \n Kim\n HC, \n \n Yu\n CS, \n \n Han\n KR, \n \n Kim\n JR, \n \n Lee\n KH\n \n et al\n . Efficacy of 3-dimensional endorectal ultrasonography compared with conventional ultrasonography and computed tomography in preoperative rectal cancer staging. Am J Surg2006;192(1):89\u201397"},{"issue":"4","key":"i0020-8868-99-2-106-b14","series-title":"Endoscopy","first-page":"339","article-title":"Three-dimensional endorectal ultrasound using a new freehand software program: results in 35 patients with rectal cancer","volume":"38","author":"Giovannini\n M,","year":"2006","unstructured":"Giovannini\n M, \n \n Bories\n E, \n \n Pesenti\n C, \n \n Moutardier\n V, \n \n Lelong\n B, \n \n Delpero\n JR. \n \n Three-dimensional endorectal ultrasound using a new freehand software program: results in 35 patients with rectal cancer. Endoscopy2006;38(4):339\u2013343"},{"issue":"suppl 1","key":"i0020-8868-99-2-106-b15","series-title":"Tech Coloproctol","first-page":"14","article-title":"Accuracy of endorectal ultrasonography in the preoperative staging of rectal cancer","volume":"8","author":"Manger\n T,","year":"2004","unstructured":"Manger\n T, \n \n Stroh\n C. \n \n Accuracy of endorectal ultrasonography in the preoperative staging of rectal cancer. Tech Coloproctol2004;8(suppl 1):14\u201315"},{"issue":"1","key":"i0020-8868-99-2-106-b16","series-title":"Ann Ital Chir","first-page":"41","article-title":"A prospective comparison of endorectal ultrasound and pelvic magnetic resonance in the preoperative staging of rectal cancer","volume":"77","author":"Bianchi\n P,","year":"2006","unstructured":"Bianchi\n P, \n \n Ceriani\n C, \n \n Palmisano\n A, \n \n Pompili\n G, \n \n Passoni\n GR, \n \n Rottoli\n M\n \n et al\n . A prospective comparison of endorectal ultrasound and pelvic magnetic resonance in the preoperative staging of rectal cancer. Ann Ital Chir2006;77(1):41\u201346"},{"issue":"9","key":"i0020-8868-99-2-106-b17","series-title":"Surg Endosc","first-page":"1280","article-title":"Comparative study of three-dimensional and conventional endorectal ultrasonography used in rectal cancer staging","volume":"16","author":"Kim\n JC,","year":"2002","unstructured":"Kim\n JC, \n \n Cho\n YK, \n \n Kim\n SY, \n \n Park\n SK, \n \n Lee\n MG. \n \n Comparative study of three-dimensional and conventional endorectal ultrasonography used in rectal cancer staging. Surg Endosc2002;16(9):1280\u20131285"},{"issue":"4","key":"i0020-8868-99-2-106-b18","series-title":"Gastrointest Endosc","first-page":"897","article-title":"EUS-FNA assessment of extramesenteric lymph node status in primary rectal cancer","volume":"74","author":"Gleeson\n FC,","year":"2011","unstructured":"Gleeson\n FC, \n \n Clain\n JE, \n \n Rajan\n E, \n \n Topazian\n MD, \n \n Wang\n KK, \n \n Levy\n MJ. \n \n EUS-FNA assessment of extramesenteric lymph node status in primary rectal cancer. Gastrointest Endosc2011;74(4):897\u2013905"},{"issue":"3","key":"i0020-8868-99-2-106-b19","series-title":"Chirurg","first-page":"224","article-title":"Preoperative diagnostic procedures in locally advanced rectal carcinoma (> or =T3 or N+). What does endoluminal ultrasound achieve at staging and restaging (after neoadjuvant radiochemotherapy) in contrast to computed tomography? [In German]","volume":"74","author":"Liersch\n T,","year":"2003","unstructured":"Liersch\n T, \n \n Langer\n C, \n \n Jakob\n C, \n \n Muller\n D, \n \n Ghadimi\n BM, \n \n Siemer\n A\n \n et al\n . Preoperative diagnostic procedures in locally advanced rectal carcinoma (> or =T3 or N+). What does endoluminal ultrasound achieve at staging and restaging (after neoadjuvant radiochemotherapy) in contrast to computed tomography? [In German]. Chirurg2003;74(3):224\u2013234"},{"issue":"5","key":"i0020-8868-99-2-106-b20","series-title":"Am J Surg","first-page":"625","article-title":"Endorectal ultrasound detection of focal carcinoma within rectal adenomas","volume":"187","author":"Worrell\n S,","year":"2004","unstructured":"Worrell\n S, \n \n Horvath\n K, \n \n Blakemore\n T, \n \n Flum\n D. \n \n Endorectal ultrasound detection of focal carcinoma within rectal adenomas. Am J Surg2004;187(5):625\u2013629"},{"issue":"3","key":"i0020-8868-99-2-106-b21","series-title":"Colorectal Dis","first-page":"246","article-title":"Rectal endosonography can distinguish benign rectal lesions from invasive early rectal cancers","volume":"5","author":"Starck\n M,","year":"2003","unstructured":"Starck\n M, \n \n Bohe\n M, \n \n Simanaitis\n M, \n \n Valentin\n L. \n \n Rectal endosonography can distinguish benign rectal lesions from invasive early rectal cancers. Colorectal Dis2003;5(3):246\u2013250"},{"issue":"11","key":"i0020-8868-99-2-106-b22","series-title":"JAMA","first-page":"1444","article-title":"Adjuvant therapy for patients with colon and rectal cancer","volume":"264","year":"1990","unstructured":"NIH Consensus Conference. Adjuvant therapy for patients with colon and rectal cancer. JAMA1990;264(11):1444\u20131450"},{"issue":"3","key":"i0020-8868-99-2-106-b23","series-title":"Radiology","first-page":"773","article-title":"Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging\u2014a meta-analysis","volume":"232","author":"Bipat\n S,","year":"2004","unstructured":"Bipat\n S, \n \n Glas\n AS, \n \n Slors\n FJ, \n \n Zwinderman\n AH, \n \n Bossuyt\n PM, \n \n Stoker\n J. \n \n Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging\u2014a meta-analysis. Radiology2004;232(3):773\u2013783"},{"issue":"20","key":"i0020-8868-99-2-106-b24","series-title":"Chin Med J (Engl)","first-page":"3740","article-title":"Study of endorectal ultrasonography in the staging of rectal cancer","volume":"125","author":"Ren\n JH,","year":"2012","unstructured":"Ren\n JH, \n \n Guo\n FJ, \n \n Dai\n WD, \n \n Han\n XJ, \n \n Ma\n N. \n \n Study of endorectal ultrasonography in the staging of rectal cancer. Chin Med J (Engl)2012;125(20):3740\u20133743"},{"issue":"6","key":"i0020-8868-99-2-106-b25","series-title":"Surg Laparosc Endosc","first-page":"438","article-title":"Value and limits of endorectal ultrasonography for preoperative staging of rectal carcinoma","volume":"8","author":"Massari\n M,","year":"1998","unstructured":"Massari\n M, \n \n De Simone\n M, \n \n Cioffi\n U, \n \n Rosso\n L, \n \n Chiarelli\n M, \n \n Gabrielli\n F. \n \n Value and limits of endorectal ultrasonography for preoperative staging of rectal carcinoma. 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