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In rectal tumours,preoperative biopsies frequently fail to diagnose an invasive carcinoma. Endorectal ultrasonography is considered a useful adjunct inpreoperative staging of rectal tumors. The accuracy of tumor staging depends on the experience and expertise of the operators and on the equipment used.Endorectal ultrasound was performed in 108 patients referred for local excision because biopsies showed tubulovillous adenoma. Ultrasound staging, using the most recent endosonicprobe, was compared with definite histopathologic findings. To determine thepresence of a learning curve, the first 55 patients were compared with the last 54 patients investigated.Definite histopathology showed invasive carcinoma in 22 of 108 patients withpresumed benign tumors (20%). With endorectal ultrasound, the rate ofpreoperative missed carcinomas could be reduced to 6%. For the first 55 patients, in diagnosing tubulovillous adenomas the sensitivity and specificity of endorectal ultrasound was 72% and 58%, respectively. For the last 54 patients, sensitivity and specificity was 91% and 80%, respectively (P < 0.05).Endorectal ultrasound is very reliable in diagnosing tubulovillous adenomas. There was a clear learning curve with the introduction of a new endosonicprobe.