Keywords: Rectal cancer, Locoregional staging, Endosonography, Fine-needle aspiration Organ-preserving treatment for rectal cancer is widespread in the Netherlands and includes local excision and/or chemoradiotherapy (CRT). During the initial oncological staging and/or follow-up, locoregional tumor growth (LRTG) may be suspected on magnetic resonance imaging (MRI), which is the standard of care for initial locoregional rectal cancer staging and follow-up after organ-preserving treatment [1].