ArticleJournal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine2026
Transrectal Biplane Ultrasound Features and Clinical Characteristics Associated With T3-T4 Staging of Rectal Cancer: A Retrospective Study.
Article in Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo evaluate the predictive value of transrectal biplane ultrasound (TRBUS) imaging features and clinical characteristics for distinguishing T3-T4 stage rectal cancer (RC) and to improve preoperative staging accuracy and guide treatment planning.
methodsA retrospective analysis of 170 RC patients who underwent preoperative TRBUS was conducted. We assessed 10 clinical variables (eg, age, body mass index, carcinoembryonic antigen [CEA] levels) and 7 ultrasound features (eg, lesion thickness, outer membrane spiculation [defined as spiky edges indicating tumor breakthrough of the serosal layer or outer membrane], vessel penetration [defined as color Doppler flow signal extending beyond the outer membrane]). Univariate and multivariate logistic regression analyses were performed to identify independent predictors of T3-T4 stage, and receiver operating characteristic curve analysis was subsequently used to assess their diagnostic performance.
resultsAmong 170 RC patients, 87 were diagnosed with T3-T4 stage and 83 with T1-T2 stage. Univariate analysis linked T3-T4 stage with clinical symptoms, higher histologic grade (P ≤ .031), elevated CEA levels (24.1% versus 12.0%, P = .041), the outer membrane spiculation sign (89.7% versus 19.3%, P < .001), thicker lesions (18.8 ± 10.9 versus 14.0 ± 4.6 mm, P = .012), the presence of ulcers (14.9% versus 4.8%, P = .028), and the vessel penetration sign (86.2% versus 2.4%, P < .001). Stepwise regression analysis confirmed CEA (B = 0.111, P = .022), the outer membrane spiculation sign (B = .183, P < .001), and the vessel penetration sign (B = .698, P < .001) as independent predictors. Combining spiculation and vessel penetration achieved AUC = 0.985 (sensitivity 94.3%, specificity 80.7%). TRBUS staging showed good agreement with pathology (kappa = 0.702, P < .001).
conclusionTRBUS features, the outer membrane spiculation sign and the vessel penetration sign, are critical predictive markers for T3-T4 stage RC. These imaging biomarkers significantly improve the accuracy of preoperative T staging, providing clinicians with robust evidence to guide therapeutic decision-making.
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