Frontiers in surgery · 2026
Case Report: Transrectal contrast-enhanced ultrasonography on preoperative evaluation of rectal neuroendocrine tumors: a 17-case preliminary study.
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Jing Jigang, Wu Yuting, Zhuang Hua
Аннотация
OBJECTIVE: To evaluate the feasibility of transrectal ultrasound (TRUS) in the sonographic characterization and preoperative assessment of rectal neuroendocrine neoplasms (NENs).
METHODS: Retrospective analysis was performed on the transrectal ultrasound manifestations and clinical data of 17 patients with pathologically and immunohistochemically confirmed rectal NENs [8 cases of rectal neuroendocrine tumors [NETs, G1/G2] and 9 cases of rectal neuroendocrine carcinomas [NECs, G3]] between June 2020 and June 2025. These TRUS findings were compared with the ultrasound features of 31 contemporaneous cases of middle- and lower-segment rectal cancer.
RESULTS: All 8 rectal NETs (G1, G2) showed hypoechoic masses in the rectal mucosal and submucosal layers on TRUS, with clear borders in 8 cases, point-stripe blood flow signals in 7 cases, and round-shaped lymph nodes with a short diameter > 5 mm in 3 cases; contrast-enhanced ultrasound (CEUS) was performed in 6 cases, showing inhomogeneous hyperenhancement in 2 cases and homogeneous isoenhancement in 4 cases. Among the 9 rectal NECs (G3), 8 presented with localized irregular thickening of the rectal wall, 7 invaded perirectal tissues or organs, all lesions were hypoechoic or heteroechoic with muscularis propria infiltration, and 4 cases had enlarged local lymph nodes. Compared with rectal cancer, the distribution of T stage (T1 vs. T2-4) differed significantly (P = 0.016), whereas no significant differences were noted in gender, age, distance from the lower margin of the lesion to the intersphincteric sulcus, lesion length, lesion thickness, or N stage (all P > 0.05). The overall concordance rate between ultrasonographic staging and surgical pathological staging was 70.6% (12/17) for all rectal NENs, with 87.5% (7/8) for NETs and 55.6% (5/9) for NECs. A limitation of this retrospective feasibility study is its relatively small sample size (n = 17), which needs further verification in future multi-center large-sample studies.
CONCLUSIONS: Rectal NETs exhibit characteristic TRUS manifestations and require differentiation from polyps, adenocarcinomas, and inflammatory lesions. Transrectal contrast-enhanced ultrasonography (TR-CEUS), though not widely adopted, is feasible for the preoperative assessment of rectal NENs and may be valuable for follow-up after endoscopic resection to monitor recurrence.
METHODS: Retrospective analysis was performed on the transrectal ultrasound manifestations and clinical data of 17 patients with pathologically and immunohistochemically confirmed rectal NENs [8 cases of rectal neuroendocrine tumors [NETs, G1/G2] and 9 cases of rectal neuroendocrine carcinomas [NECs, G3]] between June 2020 and June 2025. These TRUS findings were compared with the ultrasound features of 31 contemporaneous cases of middle- and lower-segment rectal cancer.
RESULTS: All 8 rectal NETs (G1, G2) showed hypoechoic masses in the rectal mucosal and submucosal layers on TRUS, with clear borders in 8 cases, point-stripe blood flow signals in 7 cases, and round-shaped lymph nodes with a short diameter > 5 mm in 3 cases; contrast-enhanced ultrasound (CEUS) was performed in 6 cases, showing inhomogeneous hyperenhancement in 2 cases and homogeneous isoenhancement in 4 cases. Among the 9 rectal NECs (G3), 8 presented with localized irregular thickening of the rectal wall, 7 invaded perirectal tissues or organs, all lesions were hypoechoic or heteroechoic with muscularis propria infiltration, and 4 cases had enlarged local lymph nodes. Compared with rectal cancer, the distribution of T stage (T1 vs. T2-4) differed significantly (P = 0.016), whereas no significant differences were noted in gender, age, distance from the lower margin of the lesion to the intersphincteric sulcus, lesion length, lesion thickness, or N stage (all P > 0.05). The overall concordance rate between ultrasonographic staging and surgical pathological staging was 70.6% (12/17) for all rectal NENs, with 87.5% (7/8) for NETs and 55.6% (5/9) for NECs. A limitation of this retrospective feasibility study is its relatively small sample size (n = 17), which needs further verification in future multi-center large-sample studies.
CONCLUSIONS: Rectal NETs exhibit characteristic TRUS manifestations and require differentiation from polyps, adenocarcinomas, and inflammatory lesions. Transrectal contrast-enhanced ultrasonography (TR-CEUS), though not widely adopted, is feasible for the preoperative assessment of rectal NENs and may be valuable for follow-up after endoscopic resection to monitor recurrence.