Endoscopy
DOI: 10.1055/a-2632-4341
Innovations and brief communications

Diagnostic accuracy of the muscle-retracting sign for determining deep submucosal invasion in early rectal cancer: a prospective observational study

1   Gastrointestinal and Hepatology, University Hospital Ghent, Ghent, Belgium (Ringgold ID: RIN60200)
2   Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium (Ringgold ID: RIN26656)
,
1   Gastrointestinal and Hepatology, University Hospital Ghent, Ghent, Belgium (Ringgold ID: RIN60200)
3   Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy (Ringgold ID: RIN9304)
,
Michele Montori
1   Gastrointestinal and Hepatology, University Hospital Ghent, Ghent, Belgium (Ringgold ID: RIN60200)
4   Gastroenterology, Hepatology and Emergency Digestive Endoscopy, Università Politecnica delle Marche, Ancona, Italy (Ringgold ID: RIN9294)
,
1   Gastrointestinal and Hepatology, University Hospital Ghent, Ghent, Belgium (Ringgold ID: RIN60200)
2   Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium (Ringgold ID: RIN26656)
5   Gastroenterology and Hepatology, UZ Brussel, Brussels, Belgium (Ringgold ID: RIN60201)
,
1   Gastrointestinal and Hepatology, University Hospital Ghent, Ghent, Belgium (Ringgold ID: RIN60200)
2   Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium (Ringgold ID: RIN26656)
,
Tamas Tornai
1   Gastrointestinal and Hepatology, University Hospital Ghent, Ghent, Belgium (Ringgold ID: RIN60200)
,
Anne Hoorens
6   Pathology, University Hospital Ghent, Ghent, Belgium (Ringgold ID: RIN60200)
,
1   Gastrointestinal and Hepatology, University Hospital Ghent, Ghent, Belgium (Ringgold ID: RIN60200)
2   Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium (Ringgold ID: RIN26656)
5   Gastroenterology and Hepatology, UZ Brussel, Brussels, Belgium (Ringgold ID: RIN60201)
,
Lobke Desomer
1   Gastrointestinal and Hepatology, University Hospital Ghent, Ghent, Belgium (Ringgold ID: RIN60200)
2   Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium (Ringgold ID: RIN26656)
7   Gastroenterology and Hepatology, AZ Delta vzw, Roeselare, Belgium (Ringgold ID: RIN192827)
,
1   Gastrointestinal and Hepatology, University Hospital Ghent, Ghent, Belgium (Ringgold ID: RIN60200)
2   Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium (Ringgold ID: RIN26656)
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Abstract

Background

This study aimed to determine the accuracy of the muscle-retracting sign (MRS) for the detection of deep submucosal invasion (SMI) in early rectal cancer.

Methods

In this prospective observational single-center study, consecutive rectal lesions that underwent endoscopic resection using the pocket-detection method (PDM) between August 2023 and March 2025 were included. Directionality of the initial submucosal dissection targeted any morphologic or surface vascular pattern at risk of deep SMI to attempt MRS identification. Histopathology was the reference standard for MRS diagnostic accuracy in detecting deep SMI.

Results

38 rectal lesions (median size 30 mm [interquartile range 20]) were included. The PDM for detection of the MRS was successful in all cases, with MRS positivity in 15/38 cases (39.5%). Deep SMI was confirmed in 15/38 cases (39.5%). The accuracy of MRS positivity for deep SMI detection was 84.2% (95%CI 69.6%–92.6%), with a sensitivity of 80.0% (95%CI 54.8%–92.9%), specificity of 87.0% (95%CI 67.9%–95.5%), positive likelihood ratio of 6.13, negative likelihood ratio of 0.23, and area under the receiver operating characteristic curve of 0.83 (95%CI 0.71–0.96). The rate of R0 resection was 92.1% (35/38).

Conclusions

The MRS detected using the PDM demonstrated moderate-to-high accuracy for the prediction of deep SMI in early rectal cancer. This finding may allow the precise selection of an endoscopic resection strategy based on invasion depth for the minimally invasive treatment of early rectal cancer.

Supplementary Material



Publikationsverlauf

Eingereicht: 27. März 2025

Angenommen nach Revision: 10. Juni 2025

Accepted Manuscript online:
10. Juni 2025

Artikel online veröffentlicht:
08. August 2025

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