Clinical application of endoscopic ultrasonography in the management of rectal neuroendocrine tumors
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The detection rate of gastrointestinal subepithelial lesions (SELs) has recently increased with the rise in screening endoscopies. Presumptive diagnoses can be made based on endoscopic features such as color, consistency, size, mobility, shape, and location, prior to definitive histologic diagnoses. For a more accurate differential diagnosis of SELs, endoscopic ultrasonography (EUS) may be necessary. EUS enables the identification of SEL characteristics like the layer of origin, exact size, depth of invasion, echogenicity, and borderline. It can also assess regional lymph node metastases. The behavior and treatment strategies for gastrointestinal SELs vary according to the characteristics of the tumor and the affected site. Neuroendocrine tumors (NETs), a type of SEL with malignant potential, can occur anywhere in the gastrointestinal tract, but are most commonly found in the rectum. Factors that increase the risk of local and distant metastases of rectal NETs include tumor size, involvement of the muscularis propria, differentiation index, and lymphovascular invasion. Therefore, EUS can assist in determining therapeutic strategies and predicting prognosis by measuring the size and depth of invasion of rectal NETs and regional lymph node metastases. However, its role in tissue acquisition is limited in the case of rectal NETs. This review focuses on the clinical applications of EUS imaging in diagnosing and treating rectal NETs.
Abstract
The detection rate of gastrointestinal subepithelial lesions (SELs) has recently increased with the rise in screening endoscopies. Presumptive diagnoses can be made based on endoscopic features such as color, consistency, size, mobility, shape, and location, prior to definitive histologic diagnoses. For a more accurate differential diagnosis of SELs, endoscopic ultrasonography (EUS) may be necessary. EUS enables the identification of SEL characteristics like the layer of origin, exact size, depth of invasion, echogenicity, and borderline. It can also assess regional lymph node metastases. The behavior and treatment strategies for gastrointestinal SELs vary according to the characteristics of the tumor and the affected site. Neuroendocrine tumors (NETs), a type of SEL with malignant potential, can occur anywhere in the gastrointestinal tract, but are most commonly found in the rectum. Factors that increase the risk of local and distant metastases of rectal NETs include tumor size, involvement of the muscularis propria, differentiation index, and lymphovascular invasion. Therefore, EUS can assist in determining therapeutic strategies and predicting prognosis by measuring the size and depth of invasion of rectal NETs and regional lymph node metastases. However, its role in tissue acquisition is limited in the case of rectal NETs. This review focuses on the clinical applications of EUS imaging in diagnosing and treating rectal NETs.
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