The Value of Magnetic Resonance Imaging and Endorectal Ultrasound for the Accurate Preoperative T-staging of Rectal Cancer

Magnetic resonance imaging (MRI) and endorectal ultrasound (ERUS) are essential imaging modalities to assess the depth of tumour invasion (T-staging) in rectal cancer preoperative staging. Accurate T-staging is critical for rectal cancer prognosis and has substantial importance in the determination of appropriate treatment strategies for rectal tumours. There seems to be a knowledge gap in the published literature regarding the most appropriate imaging modality for the preoperative staging of rectal cancer. The purpose of this study was to determine the most appropriate imaging technique for the preoperative T-staging of rectal cancer by comparing the MRI and ERUS staging. In this study, we performed a literature review of studies published in the last 10 years and compared the accuracy, sensitivity, and specificity of ERUS and MRI for the preoperative T-staging of rectal cancer with the aim of identifying the most appropriate imaging modality. The studies reviewed were selected by a rigorous literature search of academic databases. Three electronic databases (PubMed, CINAHL, and Scopus) were searched, and articles were identified. Further rescreening of the articles for those that met the inclusion criteria and searching of the citations of the articles produced eleven journal articles used in this research. Endorectal ultrasound produces accurate results for the T-staging of early rectal cancer, particularly T1 and T2, and has the ability to show the layers of the bowels more clearly in early-stage rectal cancer. However, MRI shows more accurate results for the staging of locally advanced tumours such as advanced T3 and T4 and is particularly important when estimating tumour invasion into the mesorectum, which is very important for the prognostication and survival of patients with rectal cancer. MRI has low accuracy for differentiating early T3 tumours from T1 or T2 with desmoplastic reactions, and therefore, is more likely to overstage these tumours.