uT4 lesions are locally invasive into contiguous organs such as bladder, uterus, cervix, vagina, prostate and seminal vesicles. These advanced lesions are clinically fixed or tethered. Sonographi-cally there is a loss of the normal hyperechoic interface between tumour and the adjacent organ (Fig. 16). The inability of ERUS to distinguish between malignant infiltration or peritumoral inflammation results in a somewhat lower staging accuracy with regard to T4 cancers. Frank stenosis also precludes precise endosonographic evaluation and angulation of the probe to the tumour axis also can cause misinterpretation.
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