Aplicação do ultrassom anorretal tridimensional na conduta terapêutica de pacientes com neoplasia no reto médio e inferior

• Ano de defesa: 2015
• Autor(a) principal: Monteiro, Francisco Coracy Carneiro
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Palavras-chave em Português: Ultrassonografia; Neoplasias Colorretais; Radiologia
• Link de acesso: http://www.repositorio.ufc.br/handle/riufc/36627

Three-dimensional anorectal ultrasound (3-DAUS) is a useful method for local staging of rectal cancer, with high accuracy. However, it presents questionable restaging after neoadjuvant chemotherapy and radiotherapy (CRT). Technological advances have made possible a better evaluation of tumor response to neoadjuvant treatment. The purpose of this study is to determine the function of the 3-DAUS in the treatment of patients with tumor in the rectum comparing imaging with histopathological (HP) findings. A multicenter, prospective, descriptive, involving 94 patients submitted to the 3-DAUS was performed. After this initial evaluation, they were divided into two groups. Group I: 18 patients operated without previous CRT. Group II: 76 patients submitted to CRT. The patients in Group II were reassessed by the 3-DAUS and then forwarded to surgical treatment. It was observed the US-3D involvement of the anal canal in 34 patients, who underwent abdominoperineal resection of the rectum (APR); and 44 patients were treated with sphincter preservation (SP), because there was no involvement of the anal canal by 3-DAUS. Eight patients with complete clinical and ultrasound response were included in Watch and Wait program. Statistical analysis was performed using the Student t test and the Lee Kappa test. On Group I, the correlation between the findings observed in 3-DAUS and HP was almost perfect for T0 (K = 0.87), T2, T3 and N1 (K = 1) and substantial to T1 (K = 0.77). There was no recurrence or death. The agreement between HP and the post-CT / RT 3-DAUS was substantial for the residual tumor identification or complete response (K = 0.63). The accuracy of post-CT / RT 3-DAUS to identify residual tumor or complete response was 88%. The agreement between HP and post-CT / RT 3-DAUS was moderate for lymph node (K = 0.42). The most important parameter for the selection of patients for SP was the distance between the tumor and the sphincter (≥ 1.5 cm). 3-DAUS was a reproducible method to assess patients with rectal cancer and showed good results when performed in a well-established protocol.