Accurate locoregional staging is essential for optimal management of rectal cancer. Both endoscopic ultrasound (EUS) and pelvic magnetic resonance imaging (MRI) are widely used, but their comparative performance in routine clinical practice remains debated. This study aimed to evaluate and compare the accuracy of EUS and MRI for T and N staging in a consecutive cohort of rectal cancer patients.  

Thirty consecutive patients with histologically confirmed rectal cancer underwent both EUS and pelvic MRI prior to definitive treatment. Staging results were compared to surgical pathology as the reference standard. The primary endpoints were the accuracy of T and N staging for each modality.  

The accuracy of EUS for T staging was 73%, while the accuracy for N staging was 66%. These findings are consistent with published data, where EUS and MRI demonstrate similar accuracy for T staging (typically 70–89%) and N staging (65–90%), with some studies reporting a slight advantage for EUS in overall T staging and for MRI in N staging.[1][4][5] The American College of Radiology and the World Society of Emergency Surgery recommend both modalities as complementary, with EUS favored for early-stage tumors and MRI for advanced disease and assessment of mesorectal fascia involvement.[2][3]  

In this single-center cohort, EUS and MRI demonstrated comparable accuracy for T and N staging of rectal cancer, supporting their complementary use in clinical practice. These results reinforce current guideline recommendations for a multimodal approach to locoregional staging.