Anal Carcinoma

Tumors appear as hypoechoic areas and can be seen penetrating the different layers of the anal canal. Ultrasound can measure tumor size on screen and evaluate the invasion of surrounding structures. In imaging the anal canal, endoanal ultrasonography can stage an anal mass by evaluating the depth of infiltration in relation to the normal distinct layers of the anal canal. Typically, it is based on the penetration of the submucosa, the IAS, the EAS, the perianal tissues, or through and into adjacent structures. This is an accurate preoperative staging method that facilitates the choices for treatment.

Tarantino and Bernstein22 correlated pathologic staging after abdominoperineal resection in five patients to the preoperative endoanal ultrasound staging. Seven other patients were staged by ultrasound but underwent chemoradiation. In this subgroup, they used the endoanal ultrasound to evaluate the patient after their medical therapy and on follow-up. All seven patients showed no evidence of residual tumor, and, on subsequent follow-up, showed no trace of the disease. Others have confirmed that ultrasonography can be used to determine the depth of tumor infiltration, to direct treatment options, and to evaluate tumor response to chemoradiation.23

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