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Sumiyama F, Hamada M, Kobayashi T, Matsumi Y, Inada R, Kurokawa H, Uemura Y. Why did we encounter a pCRM-positive specimen whose preoperative MRI indicates negative mesorectal fascia involvement in middle to low rectal cancer? Tech Coloproctol 2025; 29:81. [PMID: 40095215 PMCID: PMC11914298 DOI: 10.1007/s10151-025-03117-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 01/30/2025] [Indexed: 03/19/2025]
Abstract
BACKGROUND This study aims to examine why we encounter a pathological circumferential resection margin (pCRM)-positive specimen whose preoperative MRI indicates negative mesorectal fascia involvement in middle to low rectal cancer. METHODS Forty-four consecutive patients included in this study had c(yc)T1-3 primary rectal adenocarcinoma without mesorectal fascia involvement and underwent laparoscopic total mesorectal excision (TME) with curative intent in the Department of Gastrointestinal Surgery of Kansai Medical University Hospital from January 2014 to April 2018. We adopted three checkpoints to investigate the misleading point causing positive pCRM (≤ 1 mm). (1) c(yc)CRM diagnosis by two radiologists with more than 20 and 15 years of experience in rectal cancer MRI diagnosis. (2) The specimen was assessed using the TME score presented by Nagtegaal. (3) We compared the standard sectioning according to UK guidelines (group A; n = 26) with the specimen MRI image navigation-based section (group B; n = 18) in terms of estimation of pCRM by c(yc)CRM. RESULTS We achieved a "complete" resection specimen in all cases. A simple correlation coefficient in group B revealed a significant correlation between c(yc)CRM and pCRM (r = 0.663, p = 0.00513); this correlation was not significant in group A (r = 0.261, p = 0.19824). However, tests for differences between linear regression coefficients in groups A and B showed no significant differences (p = 0.12596). There were five cases of pCRM ≤ 1 mm: three in group A and two in group B. An anterior lesion caused pCRM ≤ 1 mm in three cases; the tumor deposits or extramural vascular invasion caused the other cases. CONCLUSION The cause of misleading pCRM was the inaccurate preoperative MRI diagnosis of c(yc)CRM.
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Affiliation(s)
- F Sumiyama
- Department of Gastrointestinal Surgery, Kansai Medical University Hospital, 2-3-1, Shinmachi, Hirakata, Osaka, 573-1191, Japan
| | - M Hamada
- Department of Gastrointestinal Surgery, Kansai Medical University Hospital, 2-3-1, Shinmachi, Hirakata, Osaka, 573-1191, Japan.
| | - T Kobayashi
- Department of Gastrointestinal Surgery, Kansai Medical University Hospital, 2-3-1, Shinmachi, Hirakata, Osaka, 573-1191, Japan
| | - Y Matsumi
- Department of Gastrointestinal Surgery, Kansai Medical University Hospital, 2-3-1, Shinmachi, Hirakata, Osaka, 573-1191, Japan
| | - R Inada
- Department of Gastrointestinal Surgery, Kansai Medical University Hospital, 2-3-1, Shinmachi, Hirakata, Osaka, 573-1191, Japan
| | - H Kurokawa
- Department of Radiology, Kansai Medical University Hospital, Hirakata, Japan
| | - Y Uemura
- Department of Pathology, Kansai Medical University Medical Center, Moriguchi, Japan
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Bastian S, Joerger M, Holer L, Bärtschi D, Guckenberger M, Jochum W, Koeberle D, Siebenhüner AR, Wicki A, Berger MD, Winterhalder RC, Largiadèr CR, Löffler M, Mosna-Firlejczyk K, Maranta AF, Pestalozzi BC, Csajka C, von Moos R. Neoadjuvant Treatment With Regorafenib and Capecitabine Combined With Radiotherapy in Locally Advanced Rectal Cancer: A Multicenter Phase Ib Trial (RECAP)-SAKK 41/16. Clin Colorectal Cancer 2025; 24:82-88.e1. [PMID: 39537446 DOI: 10.1016/j.clcc.2024.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/19/2024] [Accepted: 10/17/2024] [Indexed: 11/16/2024]
Abstract
BACKGROUND The multi tyrosine kinase inhibitor regorafenib is active in metastatic colorectal cancer. Improvement in clinical outcome by adding regorafenib to long-course chemoradiotherapy (LcCRT) was investigated in molecularly undefined LARC. METHODS Patients with T3-4 and/or N+ but M0 rectal cancer were included. Neoadjuvant LcRCT consisted in capecitabine (C) 825mg/m2 d1-d38 and 28 fractions of 1.8Gy (50.4Gy). Regorafenib was added d1-14 and d22-35 in 3 dose escalation (DE) cohorts (40mg/80mg/120mg). The recommended dose (RD) was used for the expansion (EXP) cohort. Primary endpoints were dose-limiting toxicity (DLT) for DE and pathological response (near-complete regression [npCR] or complete regression [pCR]) for EXP. RESULTS Overall, 25 patients were included. Two DLTs occurred at the regorafenib dose level of 120 mg, thereby establishing the RD at 80mg daily. Among the 19 patients who were treated at the RD, 8 (42.1%; 1-sided 80% confidence interval [CI] (lower bound): 30.7%; 95% CI, 20.3%-66.5%) reached the primary endpoint (5 [26.3%] had npCR and 3 [15.8%] pCR). One additional patient received no surgery due to clinical complete response. All patients had R0 resections and clear circumferential margins. Postoperative complications occurred in 6 patients (35.3%). The most common grade ≥ 3 treatment-related adverse event in the EXP cohort was diarrhea (2 patients). CONCLUSION Adding regorafenib 80 mg to LcCRT in LARC resulted in both primary endpoints being met and yielded an expected pathological response rate. Toxicity was manageable, and postoperative complications were as expected.
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Affiliation(s)
- Sara Bastian
- Department of Oncology/Hematology, Kantonsspital Graubuenden, Chur, Switzerland.
| | - Markus Joerger
- Department of Medical Oncology/Hematology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Lisa Holer
- Swiss Group for Clinical Cancer Research (SAKK), Competence Center, Bern, Switzerland
| | - Daniela Bärtschi
- Swiss Group for Clinical Cancer Research (SAKK), Competence Center, Bern, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital of Zurich, Zurich, Switzerland
| | - Wolfram Jochum
- Institute of Pathology, Kantonsspital St.Gallen, St. Gallen, Switzerland
| | - Dieter Koeberle
- Department of Oncology, Claraspital Basel, Basel; Medical Faculty, University of Bern, Bern, Switzerland
| | - Alexander R Siebenhüner
- Department of Medical Oncology and Hematology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Andreas Wicki
- Department of Oncology, University Hospital Basel, Basel, Switzerland
| | - Martin D Berger
- Department of Medical Oncology, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Carlo R Largiadèr
- Department of Clinical Chemistry, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Melanie Löffler
- Department of Oncology, Claraspital Basel, Basel; Medical Faculty, University of Bern, Bern, Switzerland
| | - Katarzyna Mosna-Firlejczyk
- Department of Radiation Oncology, Claraspital Basel, Basel; Medical Faculty, University of Bern, Switzerland
| | | | - Bernhard C Pestalozzi
- Department of Medical Oncology and Hematology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Chantal Csajka
- Institute of Pharmacy, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Roger von Moos
- Department of Oncology/Hematology, Kantonsspital Graubuenden, Chur, Switzerland
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Medina YF, Mendieta CV, Prieto N, Acosta Felquer ML, Soriano ER. A Systematic Scoping Review of Essential Methodological Elements for Developing a Tool to Improve the Reporting of Consensus Studies in Classification, Diagnostic Criteria, and Guidelines Development. J Multidiscip Healthc 2024; 17:5813-5830. [PMID: 39668887 PMCID: PMC11636244 DOI: 10.2147/jmdh.s484715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 11/15/2024] [Indexed: 12/14/2024] Open
Abstract
Introduction A consensus is a general agreement among group members that is pivotal in gathering expert input for classification, diagnostic criteria, and guideline development. However, the absence of established methodological standards presents challenges in conducting and analyzing these studies. Objective This scoping review explored the evidence on essential elements in consensus studies to create a list of candidate items for a standardized reporting tool. This tool is intended to improve the critical appraisal and methodological rigor of consensus studies. Methods A systematic scoping review was conducted using predetermined criteria for study selecting studies and extracting data. A comprehensive literature search was performed without imposing date restrictions, covering multiple databases, including Medline, Embase, LILACS, SciELO, and up to March 2022. We included only English-language publications and excluded incomplete articles and conference reports. The risk of bias was assessed using the CASP checklist, and the study selection and data extraction were performed independently by two researchers in duplicate. Results We identified 8360 references; 20 publications were included for data extraction. The majority (70%) used the Delphi method, and the remainder (30%) employed the modified Delphi method. Inconsistencies in reporting conflicts of interest and consensus timing were observed. Other methodologies, such as RAND/UCLA and Nominal Group Technique were excluded due to methodological limitations. Most studies exhibited a low risk of bias. Discussion Our findings underscored the need for more standardization in definitions, methodology, and reporting within consensus studies. To address these gaps, we developed a checklist of key reporting items aimed at improving the planning, execution, and reporting consensus studies. Although the developed checklist requires validation, it offers a practical framework to enhance methodological transparency and reliability. Conclusion Deficiencies and variability in consensus methodologies reporting underscore the need for a standardized approach. We propose the adoption of a checklist to strengthen the robustness of consensus studies, supporting advances in classification, diagnostic criteria, and guideline development.
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Affiliation(s)
- Yimy F Medina
- Department of Clinical Epidemiology and Biostatistics, PhD Program in Clinical Epidemiology, Pontificia Universidad Javeriana, Bogotá, Colombia
- Department of Internal Medicine, Rheumatology Unit, Faculty of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Cindy V Mendieta
- Department of Clinical Epidemiology and Biostatistics, PhD Program in Clinical Epidemiology, Pontificia Universidad Javeriana, Bogotá, Colombia
- Nutrition and Biochemistry Department, Faculty of Sciences, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Natalia Prieto
- Department of Internal Medicine, Rheumatology Unit, Faculty of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
| | - María Laura Acosta Felquer
- Internal Medicine Department, Rheumatology Section, Internal Medicine Service, Instituto Universitario Hospital Italiano, Buenos Aires, Argentina
| | - Enrique R Soriano
- Internal Medicine Department, Rheumatology Section, Internal Medicine Service, Instituto Universitario Hospital Italiano, Buenos Aires, Argentina
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Rafaelsen SR. Implementation of template-based reporting for rectal cancer. Acta Radiol 2024; 65:1305-1306. [PMID: 39308407 DOI: 10.1177/02841851241285545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2024]
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Khasawneh H, Khatri G, Sheedy SP, Nougaret S, Lambregts DMJ, Santiago I, Kaur H, Smith JJ, Horvat N. MRI for Rectal Cancer: Updates and Controversies- AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2024. [PMID: 39320354 DOI: 10.2214/ajr.24.31523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2024]
Abstract
Rectal MRI is a critical tool in the care of patients with rectal cancer, having established roles for primary staging, restaging, and surveillance. The comprehensive diagnostic and prognostic information provided by MRI helps to optimize treatment decision-making. However, challenges persist in the standardization and interpretation of rectal MRI, particularly in the context of rapidly evolving treatment paradigms, including growing acceptance of nonoperative management. In this AJR Expert Panel Narrative Review, we address recent advances and key areas of contention relating to the use of MRI for rectal cancer. Our objectives include: to discuss concepts regarding anatomic localization of rectal tumors; review the evolving rectal cancer treatment paradigm and implications for MRI assessment; discuss updates and controversies regarding rectal MRI for locoregional staging, restaging, and surveillance; review current rectal MRI acquisition protocols; and discuss challenges in homogenizing and optimizing acquisition parameters.
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Affiliation(s)
- Hala Khasawneh
- Department of Radiology, University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Gaurav Khatri
- Department of Radiology, University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Shannon P Sheedy
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Stephanie Nougaret
- Department of Radiology, Montpellier Cancer Institute, Montpellier, France; Montpellier Research Cancer Institute, PINKcc Lab, U1194, Montpellier, France
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands
| | - Inês Santiago
- Department of Radiology, Hospital da Luz Lisboa, Av. Lusíada 100, 1500-650 Lisbon, Portugal
| | - Harmeet Kaur
- Department of Diagnostic Radiology, MD Anderson Cancer Center, 1400 Pressler St, Unit 1473, Houston, TX 77030
| | - J Joshua Smith
- Department of Surgery, Associate Member, Associate Attending Surgeon Colorectal Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Natally Horvat
- Department of Radiology, University of Sao Paulo, R. Dr. Ovidio Pires de Campos, 75-Cerqueira Cesar, Sao Paulo, 05403-010, SP, Brazil
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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Urbaniec-Stompór J, Michalak M, Godlewski J. Correlating Ultrastructural Changes in the Invasion Area of Colorectal Cancer with CT and MRI Imaging. Int J Mol Sci 2024; 25:9905. [PMID: 39337393 PMCID: PMC11432200 DOI: 10.3390/ijms25189905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 09/09/2024] [Accepted: 09/10/2024] [Indexed: 09/30/2024] Open
Abstract
The cancer invasion of the large intestine, a destructive process that begins within the mucous membrane, causes cancer cells to gradually erode specific layers of the intestinal wall. The normal tissues of the intestine are progressively replaced by a tumour mass, leading to the impairment of the large intestine's proper morphology and function. At the ultrastructural level, the disintegration of the extracellular matrix (ECM) by cancer cells triggers the activation of inflammatory cells (macrophages) and connective tissue cells (myofibroblasts) in this area. This accumulation and the functional interactions between these cells form the tumour microenvironment (TM). The constant modulation of cancer cells and cancer-associated fibroblasts (CAFs) creates a specific milieu akin to non-healing wounds, which induces colon cancer cell proliferation and promotes their survival. This review focuses on the processes occurring at the "front of cancer invasion", with a particular focus on the role of the desmoplastic reaction in neoplasm development. It then correlates the findings from the microscopic observation of the cancer's ultrastructure with the potential of modern radiological imaging, such as computer tomography (CT) and magnetic resonance imaging (MRI), which visualizes the tumour, its boundaries, and the tissue reactions in the large intestine.
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Affiliation(s)
- Joanna Urbaniec-Stompór
- Department of Diagnostic Imaging, Clinical Hospital of the Ministry of Internal Affairs and Administration with the Warmia-Mazury Oncology Centre, 10228 Olsztyn, Poland
| | - Maciej Michalak
- Department of Diagnostic Imaging, Clinical Hospital of the Ministry of Internal Affairs and Administration with the Warmia-Mazury Oncology Centre, 10228 Olsztyn, Poland
- Department of Oncology, Faculty of Medical Sciences, University of Warmia and Mazury, 10228 Olsztyn, Poland
| | - Janusz Godlewski
- Department of Human Histology and Embryology, Faculty of Medical Sciences, University of Warmia and Mazury, 10082 Olsztyn, Poland
- Clinical Surgical Oncology Department, Clinical Hospital of the Ministry of Internal Affairs and Administration with the Warmia-Mazury Oncology Centre, 10228 Olsztyn, Poland
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Alvfeldt G, Aspelin P, Blomqvist L, Sellberg N. Radiology reporting in rectal cancer using magnetic resonance imaging: Comparison of reporting completeness between different reporting styles and structure. Acta Radiol Open 2024; 13:20584601241258675. [PMID: 39044838 PMCID: PMC11265246 DOI: 10.1177/20584601241258675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 05/15/2024] [Indexed: 07/25/2024] Open
Abstract
Background The radiology report is vital for providing imaging information to guide patient treatment, and template-based reporting can potentially increase the reporting completeness. In 2014, a national reporting template for radiological staging of rectal cancer using magnetic resonance imaging (MRI) was implemented in Sweden. Purpose To evaluate the impact of the national reporting template by comparing and analysing differences in content and completeness in MRI reports between 2010 and 2016. Focus was to compare reporting completeness (i) between different reporting years and (ii) between three defined reporting styles. Material and Methods 493 MRI reports were gathered from 10 hospitals in four healthcare regions in Sweden, comprising 243 reports from 2010 and 250 reports from 2016. Reports were classified into three reporting styles: Expanded structured, Minimised structured, and Unstructured, and analysed using qualitative content analysis based on the national template. Results In 2010, all reports adhered to Unstructured reporting. In 2016, 44, 42, and 164 reports were conformant to Expanded structured, Minimised structured, and Unstructured reporting, respectively. A comparison between the years revealed a reporting completeness of 48% for 2010 reports and 72% for 2016 reports. Among the 2016 reporting styles, Unstructured reporting had the largest gap compared to the national template, with completeness at 64% versus 77.5% for Minimised structured reporting and 93% for Expanded structured reporting. Conclusion Implementation of template-based reporting according to Expanded structure is key to conform to national decided evidence-based practice for radiological staging of rectal cancer.
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Affiliation(s)
- Gustav Alvfeldt
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Peter Aspelin
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Lennart Blomqvist
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Nina Sellberg
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Shao Z, Xu Y, Zhang X, Zou C, Xie R. Changes in serum uric acid, serum uric acid/serum creatinine ratio, and gamma-glutamyltransferase might predict the efficacy of neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer. Strahlenther Onkol 2024; 200:523-534. [PMID: 37286741 DOI: 10.1007/s00066-023-02096-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 04/23/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE The purpose of this study was to investigate the predictive value of changes in serum uric acid (SUA), the ratio of serum uric acid to serum creatinine (SUA/SCr), and serum gamma-glutamyltransferase (GGT) from before to after therapy in patients with locally advanced rectal cancer (LARC). METHODS Data from 114 LARC patients from January 2016 to December 2021 were included in this retrospective study. All patients received neoadjuvant chemoradiotherapy (nCRT) and total mesorectal excision (TME). The change in SUA was calculated as a ratio: (SUA level after nCRT-SUA level before nCRT)/SUA level before nCRT. The change ratios of SUA/SCr and GGT were calculated in the same way. The efficacy of nCRT was evaluated by magnetic resonance (MR) and postoperative pathological response. A nonlinear model was used to evaluate whether the change ratios of SUA, SUA/SCr, and GGT were associated with the efficacy of nCRT. The predictive power of the change ratios of SUA, SUA/SCr, and GGT was assessed by receiver operating characteristic (ROC) curves. Univariate and multivariate Cox regression analyses were employed to measure the associations between disease-free survival (DFS) and other predictive indicators. The Kaplan-Meier method was used to further compare DFS between groups. RESULTS The nonlinear model indicated that the change ratios of SUA, SUA/SCr, and GGT were associated with the efficacy of nCRT. The change ratios of SUA, SUA/SCr, and GGT were used to predict the area under the ROC curve of efficacy for nCRT (0.95, 0.91-0.99), which was better than the prediction by the change ratio of SUA (0.94, 0.89-0.99), SUA/SCr (0.90, 0.84-0.96), or GGT alone (0.86, 0.79-0.93; p < 0.05). The optimal cut-off values of SUA, SUA/SCr, and GGT change were 0.02, 0.01, and 0.04, respectively. The Kaplan-Meier method indicated that patients with SUA, SUA/SCr, or GGT changes greater than the cut-off values had shorter DFS (p < 0.05). CONCLUSION Change ratios of SUA, SUA/SCr, or GGT greater than the cut-off values implied a risk of poor pathological response after nCRT and shorter DFS in LARC patients.
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Affiliation(s)
- Zhenyong Shao
- Department of Radiotherapy, The First Affiliated Hospital of Wenzhou Medical University, 325000, Wenzhou, China
| | - Yuyan Xu
- Department of Radiotherapy, The First Affiliated Hospital of Wenzhou Medical University, 325000, Wenzhou, China
| | - Xuebang Zhang
- Department of Radiotherapy, The First Affiliated Hospital of Wenzhou Medical University, 325000, Wenzhou, China
| | - Changlin Zou
- Department of Radiotherapy, The First Affiliated Hospital of Wenzhou Medical University, 325000, Wenzhou, China.
| | - Raoying Xie
- Department of Radiotherapy, The First Affiliated Hospital of Wenzhou Medical University, 325000, Wenzhou, China.
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Crimì F, Cabrelle G, Campi C, Schillaci A, Bao QR, Pepe A, Spolverato G, Pucciarelli S, Vernuccio F, Quaia E. Nodal staging with MRI after neoadjuvant chemo-radiotherapy for locally advanced rectal cancer: a fast and reliable method. Eur Radiol 2024; 34:3205-3214. [PMID: 37930408 DOI: 10.1007/s00330-023-10265-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/02/2023] [Accepted: 08/09/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES In patients with locally advanced rectal carcinoma (LARC), negative nodal status after neoadjuvant chemoradiotherapy (nCRT) may allow for rectum-sparing protocols rather than total mesorectal excision; however, current MRI criteria for nodal staging have suboptimal accuracy. The aim of this study was to compare the diagnostic accuracy of different MRI dimensional criteria for nodal staging after nCRT in patients with LARC. MATERIALS AND METHODS Patients who underwent MRI after nCRT for LARC followed by surgery were retrospectively included and divided into a training and a validation cohort of 100 and 39 patients, respectively. Short-, long-, and cranial-caudal axes and volume of the largest mesorectal node and nodal status based on European Society of Gastrointestinal Radiology consensus guidelines (i.e., ESGAR method) were assessed by two radiologists independently. Inter-reader agreement was assessed in the training cohort. Histopathology was the reference standard. ROC curves and the best cut-off were calculated, and accuracies compared with the McNemar test. RESULTS The study population included 139 patients (median age 62 years [IQR 55-72], 94 men). Inter-reader agreement was high for long axis (κ = 0.81), volume (κ = 0.85), and ESGAR method (κ = 0.88) and low for short axis (κ = 0.11). Accuracy was similar (p > 0.05) for long axis, volume, and ESGAR method both in the training (71%, 74%, and 65%, respectively) and in the validation (83%, 78%, and 75%, respectively) cohorts. CONCLUSION Accuracy of the measurement of long axis and volume of the largest lymph node is not inferior to the ESGAR method for nodal staging after nCRT in LARC. CLINICAL RELEVANCE STATEMENT In MRI restaging of rectal cancer, measurement of the long axis or volume of largest mesorectal lymph node after preoperative chemoradiotherapy is a faster and reliable alternative to ESGAR criteria for nodal staging. KEY POINTS • Current MRI criteria for nodal staging in locally advanced rectal cancer after chemo-radiotherapy have suboptimal accuracy and are time-consuming. • Measurement of long axis or volume of the largest mesorectal lymph node on MRI showed good accuracy for assessment of loco-regional nodal status in locally advanced rectal cancer. • MRI measurement of the long axis and volume of largest mesorectal lymph node after chemo-radiotherapy could be a faster and reliable alternative to ESGAR criteria for nodal staging.
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Affiliation(s)
- Filippo Crimì
- Institute of Radiology, Department of Medicine-DIMED, University of Padova, Padua, Italy
| | - Giulio Cabrelle
- Department of Radiology, University Hospital of Padova, Via Niccolò Giustiniani N.2, 35128, Padua, Italy
| | - Cristina Campi
- Department of Mathematics, University of Genova, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessio Schillaci
- Institute of Radiology, Department of Medicine-DIMED, University of Padova, Padua, Italy
| | - Quoc Riccardo Bao
- General Surgery 3, Department of Surgical, Oncological, and Gastroenterological Sciences (DiSCOG), University of Padova, Padua, Italy
| | - Alessia Pepe
- Institute of Radiology, Department of Medicine-DIMED, University of Padova, Padua, Italy
| | - Gaya Spolverato
- General Surgery 3, Department of Surgical, Oncological, and Gastroenterological Sciences (DiSCOG), University of Padova, Padua, Italy
| | - Salvatore Pucciarelli
- General Surgery 3, Department of Surgical, Oncological, and Gastroenterological Sciences (DiSCOG), University of Padova, Padua, Italy
| | - Federica Vernuccio
- Department of Radiology, University Hospital of Padova, Via Niccolò Giustiniani N.2, 35128, Padua, Italy.
| | - Emilio Quaia
- Institute of Radiology, Department of Medicine-DIMED, University of Padova, Padua, Italy
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López Llobet E, Coronado Poggio M, Lancha Hernández C, Martín Hervás C, Travaglio Morales D, Monachello Araujo D, Rodado Marina S, Domínguez Gadea L. Controversy in the initial nodal staging of rectal cancer (MRI or PET/CT?). Rev Esp Med Nucl Imagen Mol 2024; 43:500004. [PMID: 38527730 DOI: 10.1016/j.remnie.2024.500004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/06/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVE To compare the usefulness of MRI and PET/CT in nodal staging (N) of patients with locally advanced rectal cancer (LARC). MATERIAL AND METHODS Retrospective study of patients with LARC, who completed their initial staging with PET/CT, between January-20 and March-23. Regional nodes were assessed, and N was determined using both techniques according to TNM criteria. Concordance between MRI and PET/CT was analyzed. The accuracy of both techniques was calculated for those patients who underwent direct surgery. Non-regional pelvic lymph nodes were evaluated by both modalities. RESULTS Among the 73 patients, 48 were ultimately diagnosed with a locally advanced stage. Of these, 39 underwent neoadjuvant treatment (chemoradiotherapy) followed by surgery, and 9 direct surgery. In 25, the PET/CT extension study revealed distant disease, leading to systemic treatment. Weak concordance was observed between MRI and PET/CT in determining N (k=0.286; p<0.005). Out of 73 patients, 31(42%) exhibited concordance, and 42(58%) showed discordance. In 83% of the discordant cases, MRI overstaged compared to PET/CT, with 17 cases indicating nodal involvement (N+) by MRI and N0 by PET/CT. Diagnostic accuracy was 78% for both techniques. Sensitivity, specificity, positive predictive value, and negative predictive value were 80%, 75%, 80%, and 75% for MRI, and 60%, 100%, 100%, and 67%, for PET/CT. PET/CT identified pelvic metastatic adenopathies in 8 patients that were not visible/doubtful by MRI. CONCLUSIONS In the initial nodal staging of rectal cancer MRI overstages relative to PET/CT. Both modalities are complementary, PET/CT offers higher specificity and MRI higher sensitivity.
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Mayaud A, Grange R, Leroy B, Phelip JM, Sotton S, Boutet C, Magné N. MRI in rectal cancer: An institutional real life analysis of technical parameters. Bull Cancer 2023; 110:1244-1250. [PMID: 37858424 DOI: 10.1016/j.bulcan.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 07/19/2023] [Accepted: 08/13/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION MRI plays a key role in the preoperative staging of rectal cancers and choice of neoadjuvant radiochemotherapy. Yet, the acquisition and interpretation of rectum magnetic resonance imaging (MRI) turn out to be unequal, impacting patients'care. The present study aims at evaluating the quality of the acquisition of technical parameters of the rectal MRI performed by comparing them according to the various guidelines. METHODS The medical MRI reports of all consecutive patients with locally advanced rectal cancer treated in a curative intent, by preoperative RCT and completion surgery were retrospectively reviewed over two periods (January 2010-December 2014 and January 2018 and December 2020) according to international 2012 and 2016 ESGAR and 2017 SAR MRI recommendation reports. RESULTS During the first period (69 MRI performed), 58% of these MRI abided by the recommendations and 75% of essential criteria could be found in 25.5% of MRI reportings. During the second period (73 MRI performed), the protocol used by 6.8% of MR images abided by the 2016 Society of Gastrointestinal and Abdominal Radiology (ESGAR) recommendations and 39.7% abided by the Society of Abdominal Radiology (SAR) recommendations. 75% of essential criteria could be found in 52.3% of MRI reportings and 90% of essential criteria could be found in 6.2% of MRI reportings. DISCUSSION In an era of increasing individualized patient care and conservative treatment focused on tumour response and prognostic factors, the present study showed that compliance to MRI protocols and reporting guidelines needs improving to upgrade patient care.
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Affiliation(s)
- Alexandre Mayaud
- Saint-Étienne Teaching Hospital (CHU), Radiology Department, Saint-Étienne, France
| | - Rémi Grange
- Saint-Étienne Teaching Hospital (CHU), Radiology Department, Saint-Étienne, France
| | - Bertrand Leroy
- Saint-Étienne Teaching Hospital (CHU), Digestive Surgery Department, Saint-Étienne, France
| | - Jean-Marc Phelip
- Saint-Étienne Teaching Hospital (CHU), Gastroenterology Department, Saint-Étienne, France
| | - Sandrine Sotton
- Lucien Neuwirth Cancer Centre (ICLN), Teaching and Research Department, Saint-Priest-en Jarez, France
| | - Claire Boutet
- Saint-Étienne Teaching Hospital (CHU), Radiology Department, Saint-Étienne, France
| | - Nicolas Magné
- Bergonié Institut, Radiotherapy Department, Bordeaux, France.
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Ke J, Jin C, Tang J, Cao H, He S, Ding P, Jiang X, Zhao H, Cao W, Meng X, Gao F, Lan P, Li R, Wu X. A Longitudinal MRI-Based Artificial Intelligence System to Predict Pathological Complete Response After Neoadjuvant Therapy in Rectal Cancer: A Multicenter Validation Study. Dis Colon Rectum 2023; 66:e1195-e1206. [PMID: 37682775 DOI: 10.1097/dcr.0000000000002931] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
BACKGROUND Accurate prediction of response to neoadjuvant chemoradiotherapy is critical for subsequent treatment decisions for patients with locally advanced rectal cancer. OBJECTIVE To develop and validate a deep learning model based on the comparison of paired MRI before and after neoadjuvant chemoradiotherapy to predict pathological complete response. DESIGN By capturing the changes from MRI before and after neoadjuvant chemoradiotherapy in 638 patients, we trained a multitask deep learning model for response prediction (DeepRP-RC) that also allowed simultaneous segmentation. Its performance was independently tested in an internal and 3 external validation sets, and its prognostic value was also evaluated. SETTINGS Multicenter study. PATIENTS We retrospectively enrolled 1201 patients diagnosed with locally advanced rectal cancer who underwent neoadjuvant chemoradiotherapy before total mesorectal excision. Patients had been treated at 1 of 4 hospitals in China between January 2013 and December 2020. MAIN OUTCOME MEASURES The main outcome was the accuracy of predicting pathological complete response, measured as the area under receiver operating curve for the training and validation data sets. RESULTS DeepRP-RC achieved high performance in predicting pathological complete response after neoadjuvant chemoradiotherapy, with area under the curve values of 0.969 (0.942-0.996), 0.946 (0.915-0.977), 0.943 (0.888-0.998), and 0.919 (0.840-0.997) for the internal and 3 external validation sets, respectively. DeepRP-RC performed similarly well in the subgroups defined by receipt of radiotherapy, tumor location, T/N stages before and after neoadjuvant chemoradiotherapy, and age. Compared with experienced radiologists, the model showed substantially higher performance in pathological complete response prediction. The model was also highly accurate in identifying the patients with poor response. Furthermore, the model was significantly associated with disease-free survival independent of clinicopathological variables. LIMITATIONS This study was limited by its retrospective design and absence of multiethnic data. CONCLUSIONS DeepRP-RC could be an accurate preoperative tool for pathological complete response prediction in rectal cancer after neoadjuvant chemoradiotherapy. UN SISTEMA DE IA BASADO EN RESONANCIA MAGNTICA LONGITUDINAL PARA PREDECIR LA RESPUESTA PATOLGICA COMPLETA DESPUS DE LA TERAPIA NEOADYUVANTE EN EL CNCER DE RECTO UN ESTUDIO DE VALIDACIN MULTICNTRICO ANTECEDENTES:La predicción precisa de la respuesta a la quimiorradioterapia neoadyuvante es fundamental para las decisiones de tratamiento posteriores para los pacientes con cáncer de recto localmente avanzado.OBJETIVO:Desarrollar y validar un modelo de aprendizaje profundo basado en la comparación de resonancias magnéticas pareadas antes y después de la quimiorradioterapia neoadyuvante para predecir la respuesta patológica completa.DISEÑO:Al capturar los cambios de las imágenes de resonancia magnética antes y después de la quimiorradioterapia neoadyuvante en 638 pacientes, entrenamos un modelo de aprendizaje profundo multitarea para la predicción de respuesta (DeepRP-RC) que también permitió la segmentación simultánea. Su rendimiento se probó de forma independiente en un conjunto de validación interna y tres externas, y también se evaluó su valor pronóstico.ESCENARIO:Estudio multicéntrico.PACIENTES:Volvimos a incluir retrospectivamente a 1201 pacientes diagnosticados con cáncer de recto localmente avanzado y sometidos a quimiorradioterapia neoadyuvante antes de la escisión total del mesorrecto. Eran de cuatro hospitales en China en el período entre enero de 2013 y diciembre de 2020.PRINCIPALES MEDIDAS DE RESULTADO:Los principales resultados fueron la precisión de la predicción de la respuesta patológica completa, medida como el área bajo la curva operativa del receptor para los conjuntos de datos de entrenamiento y validación.RESULTADOS:DeepRP-RC logró un alto rendimiento en la predicción de la respuesta patológica completa después de la quimiorradioterapia neoadyuvante, con valores de área bajo la curva de 0,969 (0,942-0,996), 0,946 (0,915-0,977), 0,943 (0,888-0,998), y 0,919 (0,840-0,997) para los conjuntos de validación interna y las tres externas, respectivamente. DeepRP-RC se desempeñó de manera similar en los subgrupos definidos por la recepción de radioterapia, la ubicación del tumor, los estadios T/N antes y después de la quimiorradioterapia neoadyuvante y la edad. En comparación con los radiólogos experimentados, el modelo mostró un rendimiento sustancialmente mayor en la predicción de la respuesta patológica completa. El modelo también fue muy preciso en la identificación de los pacientes con mala respuesta. Además, el modelo se asoció significativamente con la supervivencia libre de enfermedad independientemente de las variables clinicopatológicas.LIMITACIONES:Este estudio estuvo limitado por el diseño retrospectivo y la ausencia de datos multiétnicos.CONCLUSIONES:DeepRP-RC podría servir como una herramienta preoperatoria precisa para la predicción de la respuesta patológica completa en el cáncer de recto después de la quimiorradioterapia neoadyuvante. (Traducción-Dr. Felipe Bellolio ).
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Affiliation(s)
- Jia Ke
- Department of General Surgery, Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
| | - Cheng Jin
- Department of Radiation Oncology, School of Medicine, Stanford University, California
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai City, China
| | - Jinghua Tang
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou City, China
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou City, China
| | - Haimei Cao
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou City, China
| | - Songbing He
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou City, China
| | - Peirong Ding
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou City, China
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou City, China
| | - Xiaofeng Jiang
- Department of General Surgery, Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
| | - Hengyu Zhao
- Department of General Surgery, Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
| | - Wuteng Cao
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
| | - Xiaochun Meng
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
| | - Feng Gao
- Department of General Surgery, Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
| | - Ping Lan
- Department of General Surgery, Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
| | - Ruijiang Li
- Department of Radiation Oncology, School of Medicine, Stanford University, California
| | - Xiaojian Wu
- Department of General Surgery, Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
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Prata I, Eriksson M, Krdzalic J, Kranenbarg EMK, Roodvoets AGH, Beets-Tan R, van de Velde CJH, van Etten B, Hospers GAP, Glimelius B, Nilsson PJ, Marijnen CAM, Peeters KCMJ, Blomqvist LK. Results of a diagnostic imaging audit in a randomised clinical trial in rectal cancer highlight the importance of careful planning and quality control. Insights Imaging 2023; 14:206. [PMID: 38001376 PMCID: PMC10673763 DOI: 10.1186/s13244-023-01552-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Magnetic resonance (MR) imaging is the modality used for baseline assessment of locally advanced rectal cancer (LARC) and restaging after neoadjuvant treatment. The overall audited quality of MR imaging in large multicentre trials on rectal cancer is so far not routinely reported. MATERIALS AND METHODS We collected MR images obtained within the Rectal Cancer And Pre-operative Induction Therapy Followed by Dedicated Operation (RAPIDO) trial and performed an audit of the technical features of image acquisition. The required MR sequences and slice thickness stated in the RAPIDO protocol were used as a reference. RESULTS Out of 920 participants of the RAPIDO study, MR investigations of 668 and 623 patients in the baseline and restaging setting, respectively, were collected. Of these, 304/668 (45.5%) and 328/623 (52.6%) MR images, respectively, fulfilled the technical quality criteria. The main reason for non-compliance was exceeding slice thickness 238/668, 35.6% in the baseline setting and 162/623, 26.0% in the restaging setting. In 166/668, 24.9% and 168/623, 27.0% MR images in the baseline and restaging setting, respectively, one or more of the required pulse sequences were missing. CONCLUSION Altogether, 49.0% of the MR images obtained within the RAPIDO trial fulfilled the image acquisition criteria required in the study protocol. High-quality MR imaging should be expected for the appropriate initial treatment and response evaluation of patients with LARC, and efforts should be made to maximise the quality of imaging in clinical trials and in clinical practice. CRITICAL RELEVANCE STATEMENT This audit highlights the importance of adherence to MR image acquisition criteria for rectal cancer, both in multicentre trials and in daily clinical practice. High-resolution images allow correct staging, treatment stratification and evaluation of response to neoadjuvant treatment. KEY POINTS - Complying to MR acquisition guidelines in multicentre trials is challenging. - Neglection on MR acquisition criteria leads to poor staging and treatment. - MR acquisition guidelines should be followed in trials and clinical practice. - Researchers should consider mandatory audits prior to study initiation.
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Affiliation(s)
- Ilaria Prata
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands.
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands.
| | - Martina Eriksson
- Department of Radiology, Capio S:T Göran Hospital, Stockholm, Sweden
| | - Jasenko Krdzalic
- Department of Radiology, Zuyderland Medical Center, Geleen, the Netherlands
| | | | - Annet G H Roodvoets
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Regina Beets-Tan
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Boudewijn van Etten
- Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Geke A P Hospers
- Department of Medical Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Per J Nilsson
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Corrie A M Marijnen
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Koen C M J Peeters
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Lennart K Blomqvist
- Department of Radiation Physics/Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
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14
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Fraum TJ, Ma J, Jhaveri K, Nepal P, Lall C, Costello J, Harisinghani M. The optimized rectal cancer MRI protocol: choosing the right sequences, sequence parameters, and preparatory strategies. Abdom Radiol (NY) 2023; 48:2771-2791. [PMID: 36899281 DOI: 10.1007/s00261-023-03850-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 03/12/2023]
Abstract
Pelvic MRI plays a critical role in rectal cancer staging and treatment response assessment. Despite a consensus regarding the essential protocol components of a rectal cancer MRI, substantial differences in image quality persist across institutions and vendor software/hardware platforms. In this review, we present image optimization strategies for rectal cancer MRI examinations, including but not limited to preparation strategies, high-resolution T2-weighted imaging, and diffusion-weighted imaging. Our specific recommendations are supported by case studies from multiple institutions. Finally, we describe an ongoing initiative by the Society of Abdominal Radiology's Disease-Focused Panel (DFP) on Rectal and Anal Cancer to create standardized rectal cancer MRI protocols across scanner platforms.
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Affiliation(s)
- Tyler J Fraum
- Department of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus, Box 8131, St. Louis, MO, 63110, USA.
| | - Jingfei Ma
- Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kartik Jhaveri
- Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Pankaj Nepal
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Chandana Lall
- Department of Radiology, College of Medicine, University of Florida, Jacksonville, FL, USA
| | - James Costello
- Department of Radiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Mukesh Harisinghani
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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15
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Zhang Z, Chen Y, Wen Z, Wu X, Que Y, Ma Y, Wu Y, Liu Q, Fan W, Yu S. MRI for nodal restaging after neoadjuvant therapy in rectal cancer with histopathologic comparison. Cancer Imaging 2023; 23:67. [PMID: 37443085 DOI: 10.1186/s40644-023-00589-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 07/02/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND After neoadjuvant therapy, most of the lymph nodes (LNs) will shrink and disappear in patients with rectal cancer. However, LNs that are still detectable on MRI carry a risk of metastasis. This study aimed to evaluate the performance of the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) criterion (short-axis diameter ≥ 5 mm) in diagnosing malignant LNs in patients with rectal cancer after neoadjuvant therapy, and whether nodal morphological characteristics (including shape, border, signal homogeneity, and enhancement homogeneity) could improve the diagnostic efficiency for LNs ≥ 5 mm. METHODS This retrospective study included 90 patients with locally advanced rectal cancer who underwent surgery after neoadjuvant therapy and performed preoperative MRI. Two radiologists independently measured the short-axis diameter of LNs and evaluated the morphological characteristics of LNs ≥ 5 mm in consensus. With a per node comparison with histopathology as the reference standard, a ROC curve was performed to evaluate the diagnostic performance of the size criterion. For categorical variables, either a χ2 test or Fisher's exact test was used. RESULTS A total of 298 LNs were evaluated. The AUC for nodal size in determining nodal status was 0.81. With a size cutoff value of 5 mm, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 65.9%, 87.0%, 46.8%, 93.6% and 83.9%, respectively. No significant differences were observed in any of the morphological characteristics between benign and malignant LNs ≥ 5 mm (all P > 0.05). CONCLUSIONS The ESGAR criterion demonstrated moderate diagnostic performance in identifying malignant LNs in patients with rectal cancer after neoadjuvant therapy. It was effective in determining the status of LNs < 5 mm but not for LNs ≥ 5 mm, and the diagnostic efficiency could not be improved by considering nodal morphological characteristics.
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Affiliation(s)
- Zhiwen Zhang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 510080, Guangzhou, China
| | - Yan Chen
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 510080, Guangzhou, China
| | - Ziqiang Wen
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 510080, Guangzhou, China
| | - Xuehan Wu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 510080, Guangzhou, China
- Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-sen University, 518036, Shenzhen, China
| | - Yutao Que
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 510080, Guangzhou, China
- Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-sen University, 518036, Shenzhen, China
| | - Yuru Ma
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 510080, Guangzhou, China
| | - Yunzhu Wu
- MR Scientific Marketing, SIEMENS Healthineers Ltd, 200124, Shanghai, China
| | - Quanmeng Liu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 510080, Guangzhou, China
| | - Wenjie Fan
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 510080, Guangzhou, China
- Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-sen University, 518036, Shenzhen, China
| | - Shenping Yu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 510080, Guangzhou, China.
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16
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Horvat N, El Homsi M, Miranda J, Mazaheri Y, Gollub MJ, Paroder V. Rectal MRI Interpretation After Neoadjuvant Therapy. J Magn Reson Imaging 2023; 57:353-369. [PMID: 36073323 PMCID: PMC9851947 DOI: 10.1002/jmri.28426] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 02/01/2023] Open
Abstract
In recent years, several key advances in the management of locally advanced rectal cancer have been made, including the implementation of total mesorectal excision as the standard surgical approach; use of neoadjuvant chemoradiotherapy in selected patients with a high risk of local recurrence, and finally, adoption of organ preservation strategies, through either local excision or nonoperative management in selected patients with clinical complete response following neoadjuvant chemoradiotherapy. This review aims to shed light on the role of rectal MRI in the assessment of treatment response after neoadjuvant therapy, which is especially important given the growing feasibility of nonoperative management. First, an overview of current neoadjuvant therapies and response assessment based on digital rectal examination, endoscopy, and MRI will be provided. Second, the use of a high-quality restaging rectal MRI protocol will be presented. Third, a step-by-step approach to assessing treatment response on restaging rectal MRI following neoadjuvant treatment will be outlined, acknowledging challenges faced by radiologists during MRI interpretation. Finally, research related to response assessment will be discussed. LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Natally Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria El Homsi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joao Miranda
- Department of Radiology, University of Sao Paulo, Sao Paulo, Brazil
| | - Yousef Mazaheri
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marc J. Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Viktoriya Paroder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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17
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Mayaud A, Bousarsar A, Soltani S, Sotton S, Grange R, Le Roy B, Phelip JM, Boutet C, Magne N. Prognostic factors of pelvic MRI at the initial workflow in locally advanced rectal cancer: Focus on extra mural venous invasion and tumour deposits. Bull Cancer 2022; 109:1269-1276. [DOI: 10.1016/j.bulcan.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 02/25/2022] [Accepted: 03/05/2022] [Indexed: 11/11/2022]
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18
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The awareness of radiologists for the presence of lateral lymph nodes in patients with locally advanced rectal cancer: a single-centre, retrospective cohort study. Eur Radiol 2022; 32:6637-6645. [PMID: 35581479 PMCID: PMC9474434 DOI: 10.1007/s00330-022-08840-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/14/2022] [Accepted: 04/25/2022] [Indexed: 11/30/2022]
Abstract
Objectives Enlarged lateral lymph nodes (LLNs) are associated with increased (lateral) local recurrence rates. Size and anatomical location should therefore always be reported by radiologists and discussed during multidisciplinary meetings. The objective was to investigate how often LLNs are mentioned in MRI reports in a tertiary referral centre. Methods A single - centre, retrospective study of 202 patients treated for primary rectal cancer between 2012 and 2020, with at least a T2 tumour located within 12cm of the anorectal junction. The radiology reports were written by 30–40 consultant radiologists. MRI scans were independently re-assessed by an expert radiologist. The primary outcome was how often the presence or absence of LLNs was mentioned in the initial report. Results Primary MRI reports explicitly mentioned the presence or absence of LLNs in 89 (44%) cases. Of the 43 reports with present LLNs, only one (1%) reported on all features such as size, location or malignant features. Expert review revealed 17 LLNs which were ≥ 7 mm (short-axis); two of these were not mentioned in the original reports. In 14/43 (33%) cases, LLNs were discussed during the primary multidisciplinary meeting, while 17/43 (40%) restaging MRI reports failed to report on the previously visible LLN. Reporting LLNs increased significantly with higher N-stage (p = .010) and over time (p = .042). Conclusions Though improving with time, there is still limited consistency in reporting LLNs. Only 44% of primary MRI reports mentioned LLNs and relevant features of those LLNs were seldomly reported. Given the importance of this information for subsequent treatment; increased awareness, proper training and the use of templates are needed. Key Points • Comprehensive reporting of lateral lymph nodes in primary MRI reports was limited to less than 50%. • Lateral lymph nodes are not always discussed during primary multidisciplinary meetings or mentioned in restaging reports. • Improvements in the awareness and knowledge of lateral lymph nodes are needed to ensure adequate multidisciplinary treatment decisions.
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Borgheresi A, De Muzio F, Agostini A, Ottaviani L, Bruno A, Granata V, Fusco R, Danti G, Flammia F, Grassi R, Grassi F, Bruno F, Palumbo P, Barile A, Miele V, Giovagnoni A. Lymph Nodes Evaluation in Rectal Cancer: Where Do We Stand and Future Perspective. J Clin Med 2022; 11:2599. [PMID: 35566723 PMCID: PMC9104021 DOI: 10.3390/jcm11092599] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/25/2022] [Accepted: 05/03/2022] [Indexed: 12/12/2022] Open
Abstract
The assessment of nodal involvement in patients with rectal cancer (RC) is fundamental in disease management. Magnetic Resonance Imaging (MRI) is routinely used for local and nodal staging of RC by using morphological criteria. The actual dimensional and morphological criteria for nodal assessment present several limitations in terms of sensitivity and specificity. For these reasons, several different techniques, such as Diffusion Weighted Imaging (DWI), Intravoxel Incoherent Motion (IVIM), Diffusion Kurtosis Imaging (DKI), and Dynamic Contrast Enhancement (DCE) in MRI have been introduced but still not fully validated. Positron Emission Tomography (PET)/CT plays a pivotal role in the assessment of LNs; more recently PET/MRI has been introduced. The advantages and limitations of these imaging modalities will be provided in this narrative review. The second part of the review includes experimental techniques, such as iron-oxide particles (SPIO), and dual-energy CT (DECT). Radiomics analysis is an active field of research, and the evidence about LNs in RC will be discussed. The review also discusses the different recommendations between the European and North American guidelines for the evaluation of LNs in RC, from anatomical considerations to structured reporting.
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Affiliation(s)
- Alessandra Borgheresi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60121 Ancona, Italy; (A.B.); (A.A.); (A.B.); (A.G.)
| | - Federica De Muzio
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy;
| | - Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60121 Ancona, Italy; (A.B.); (A.A.); (A.B.); (A.G.)
- Department of Radiological Sciences, University Hospital Ospedali Riuniti, 60126 Ancona, Italy;
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (G.D.); (R.G.); (F.G.); (F.B.); (P.P.); (V.M.)
| | - Letizia Ottaviani
- Department of Radiological Sciences, University Hospital Ospedali Riuniti, 60126 Ancona, Italy;
| | - Alessandra Bruno
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60121 Ancona, Italy; (A.B.); (A.A.); (A.B.); (A.G.)
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale IRCCS di Napoli, 80131 Naples, Italy;
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Napoli, Italy
| | - Ginevra Danti
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (G.D.); (R.G.); (F.G.); (F.B.); (P.P.); (V.M.)
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy;
| | - Federica Flammia
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy;
| | - Roberta Grassi
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (G.D.); (R.G.); (F.G.); (F.B.); (P.P.); (V.M.)
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 80128 Naples, Italy
| | - Francesca Grassi
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (G.D.); (R.G.); (F.G.); (F.B.); (P.P.); (V.M.)
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 80128 Naples, Italy
| | - Federico Bruno
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (G.D.); (R.G.); (F.G.); (F.B.); (P.P.); (V.M.)
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Pierpaolo Palumbo
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (G.D.); (R.G.); (F.G.); (F.B.); (P.P.); (V.M.)
- Abruzzo Health Unit 1, Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, 67100 L’Aquila, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Vittorio Miele
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (G.D.); (R.G.); (F.G.); (F.B.); (P.P.); (V.M.)
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy;
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60121 Ancona, Italy; (A.B.); (A.A.); (A.B.); (A.G.)
- Department of Radiological Sciences, University Hospital Ospedali Riuniti, 60126 Ancona, Italy;
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20
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A new magnetic resonance imaging tumour response grading scheme for locally advanced rectal cancer. Br J Cancer 2022; 127:268-277. [PMID: 35388140 PMCID: PMC9296509 DOI: 10.1038/s41416-022-01801-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/14/2022] [Accepted: 03/21/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The potential of using magnetic resonance image tumour-regression grading (MRI-TRG) system to predict pathological TRG is debatable for locally advanced rectal cancer treated by neoadjuvant radiochemotherapy. METHODS Referring to the American Joint Committee on Cancer/College of American Pathologists (AJCC/CAP) TRG classification scheme, a new four-category MRI-TRG system based on the volumetric analysis of the residual tumour and radiochemotherapy induced anorectal fibrosis was established. The agreement between them was evaluated by Kendall's tau-b test, while Kaplan-Meier analysis was used to calculate survival outcomes. RESULTS In total, 1033 patients were included. Good agreement between MRI-TRG and AJCC/CAP TRG classifications was observed (k = 0.671). Particularly, as compared with other pairs, MRI-TRG 0 displayed the highest sensitivity [90.1% (95% CI: 84.3-93.9)] and specificity [92.8% (95% CI: 90.4-94.7)] in identifying AJCC/CAP TRG 0 category patients. Except for the survival ratios that were comparable between the MRI-TRG 0 and MRI-TRG 1 categories, any two of the four categories had distinguished 3-year prognosis (all P < 0.05). Cox regression analysis further proved that the MRI-TRG system was an independent prognostic factor (all P < 0.05). CONCLUSION The new MRI-TRG system might be a surrogate for AJCC/CAP TRG classification scheme. Importantly, the system is a reliable and non-invasive way to identify patients with complete pathological responses.
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21
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Pedersen MR, Otto PO, Precht H, Rafaelsen SR. MRI interobserver reliability in rectal tumor angulation. Acta Radiol Open 2022; 11:20584601221081292. [PMID: 35223087 PMCID: PMC8874163 DOI: 10.1177/20584601221081292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 01/31/2022] [Indexed: 11/30/2022] Open
Abstract
Background When rectal tumors are examined using magnetic resonance imaging (MRI) the perpendicular angulation of the axial T2-weighted image to the tumor axis is essential for a correct measure of the shortest distance between tumor and mesorectal facia. Purpose The purpose of this study was to determine the interobserver variability in rectal tumor angulation between a radiologist and a radiographer. Material and Methods Two observers performed the angulation independently. All MRI examinations were performed using an MRI 1.5 Tesla unit. A Bland–Altman plot was used to assess the interobserver variance and Intraclass correlation coefficient (ICC) statistic was used to assess the interobserver reliability. Results MRI was performed in 55 patients with rectal cancer during a one-year period (25 (45.5%) women and 30 (54.5%) men). The median age was 71 years (range 46–87 years). The rectal tumor mean length was 3.9 cm. The interobserver reliability was good (ICC = 0.83, 95% confidence interval 0.72–0.90). Conclusion Radiographers receiving training will be able to perform MRI rectal tumor angulation.
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Affiliation(s)
- Malene Rv Pedersen
- Department of Radiology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark.,Department of Regional Health, University of Southern Denmark, Odense, Denmark.,Danish Colorectal Center South, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark.,Department of Radiology, Kolding hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | - Peter O Otto
- Department of Radiology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Helle Precht
- Department of Regional Health, University of Southern Denmark, Odense, Denmark.,Department of Radiology, Kolding hospital, University Hospital of Southern Denmark, Kolding, Denmark.,Health Sciences Research Centre, University College Lillebælt, Svendborg, Denmark
| | - Søren R Rafaelsen
- Department of Radiology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark.,Department of Regional Health, University of Southern Denmark, Odense, Denmark.,Danish Colorectal Center South, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
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22
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Nougaret S, Rousset P, Gormly K, Lucidarme O, Brunelle S, Milot L, Salut C, Pilleul F, Arrivé L, Hordonneau C, Baudin G, Soyer P, Brun V, Laurent V, Savoye-Collet C, Petkovska I, Gerard JP, Rullier E, Cotte E, Rouanet P, Beets-Tan RGH, Frulio N, Hoeffel C. Structured and shared MRI staging lexicon and report of rectal cancer: A consensus proposal by the French Radiology Group (GRERCAR) and Surgical Group (GRECCAR) for rectal cancer. Diagn Interv Imaging 2022; 103:127-141. [PMID: 34794932 DOI: 10.1016/j.diii.2021.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE To develop French guidelines by experts to standardize data acquisition, image interpretation, and reporting in rectal cancer staging with magnetic resonance imaging (MRI). MATERIALS AND METHODS Evidence-based data and opinions of experts of GRERCAR (Groupe de REcherche en Radiologie sur le CAncer du Rectum [i.e., Rectal Cancer Imaging Research Group]) and GRECCAR (Groupe de REcherche en Chirurgie sur le CAncer du Rectum [i.e., Rectal Cancer Surgery Research Group]) were combined using the RAND-UCLA Appropriateness Method to attain consensus guidelines. Experts scoring of reporting template and protocol for data acquisition were collected; responses were analyzed and classified as "Recommended" versus "Not recommended" (when ≥ 80% consensus among experts) or uncertain (when < 80% consensus among experts). RESULTS Consensus regarding patient preparation, MRI sequences, staging and reporting was attained using the RAND-UCLA Appropriateness Method. A consensus was reached for each reporting template item among the experts. Tailored MRI protocol and standardized report were proposed. CONCLUSION These consensus recommendations should be used as a guide for rectal cancer staging with MRI.
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Affiliation(s)
- Stephanie Nougaret
- Department of Radiology, Institut Régional du Cancer de Montpellier, Montpellier Cancer Research Institute, INSERM U1194, University of Montpellier, 34295, Montpellier, France.
| | - Pascal Rousset
- Department of Radiology, Lyon 1 Claude-Bernard University, 69495 Pierre-Benite, France
| | - Kirsten Gormly
- Dr Jones & Partners Medical Imaging, Kurralta Park, 5037, Australia; University of Adelaide, North Terrace, Adelaide, South Australia 5000, Australia
| | - Oliver Lucidarme
- Department of Radiology, Pitié-Salpêtrière Hospital, Sorbonne Université, 75013 Paris, France; LIB, INSERM, CNRS, UMR7371-U1146, 75013 Paris, France
| | - Serge Brunelle
- Department of Radiology, Institut Paoli-Calmettes, 13009 Marseille, France
| | - Laurent Milot
- Radiology Department, Hospices Civils de Lyon, Lyon Sud University Hospital, 69495 Pierre Bénite, France; Lyon 1 Claude Bernard University, 69100 Villeurbanne, France
| | - Cécile Salut
- Department of Radiology, CHU de Bordeaux, Université de Bordeaux, 33000 Bordeaux, France
| | - Franck Pilleul
- Department of Radiology, Centre Léon Bérard, Lyon, France Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621, Lyon, France
| | - Lionel Arrivé
- Department of Radiology, Hopital St Antoine, Paris, France
| | - Constance Hordonneau
- Department of Radiology, CHU Estaing, Université Clermont-Auvergne, 63000 Clermont-Ferrand, France
| | - Guillaume Baudin
- Department of Radiology, Centre Antoine Lacassagne, 06100 Nice, France
| | - Philippe Soyer
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université de Paris, 75006 Paris, France
| | - Vanessa Brun
- Department of Radiology, CHU Hôpital Pontchaillou, 35000 Rennes Cedex, France
| | - Valérie Laurent
- Department of Radiology, Brabois-Nancy University Hospital, Université de Lorraine, 54500 Vandoeuvre-lès-Nancy, France
| | | | - Iva Petkovska
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Jean Pierre Gerard
- Department of Radiotherapy, Centre Antoine Lacassagne, 06100 Nice, France
| | - Eric Rullier
- Department of Digestive Surgery, Hôpital Haut-Lévèque, Université de Bordeaux, 33600 Pessac, France
| | - Eddy Cotte
- Department of Digestive Surgery, Hospices Civils de Lyon, Lyon Sud University Hospital, 69310 Pierre Bénite, France; Lyon 1 Claude Bernard University, 69100 Villeurbanne, France
| | - Philippe Rouanet
- Department of surgery, Institut Régional du Cancer de Montpellier, Montpellier Cancer Research Institute, INSERM U1194, University of Montpellier, 34295, Montpellier, France
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, 1066 CX, Amsterdam, the Netherlands
| | - Nora Frulio
- Department of Radiology, CHU de Bordeaux, Université de Bordeaux, 33000 Bordeaux, France
| | - Christine Hoeffel
- Department of Radiology, Hôpital Robert Debré & CRESTIC, URCA, 51092 Reims, France
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23
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Bates DD, Homsi ME, Chang K, Lalwani N, Horvat N, Sheedy S. MRI for Rectal Cancer: Staging, mrCRM, EMVI, Lymph Node Staging and Post-Treatment Response. Clin Colorectal Cancer 2022; 21:10-18. [PMID: 34895835 PMCID: PMC8966586 DOI: 10.1016/j.clcc.2021.10.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 10/26/2021] [Accepted: 10/31/2021] [Indexed: 12/16/2022]
Abstract
Rectal cancer is a relatively common malignancy in the United States. Magnetic resonance imaging (MRI) of rectal cancer has evolved tremendously in recent years, and has become a key component of baseline staging and treatment planning. In addition to assessing the primary tumor and locoregional lymph nodes, rectal MRI can be used to help with risk stratification by identifying high-risk features such as extramural vascular invasion and can assess treatment response for patients receiving neoadjuvant therapy. As the practice of rectal MRI continues to expand further into academic centers and private practices, standard MRI protocols, and reporting are critical. In addition, it is imperative that the radiologists reading these cases work closely with surgeons, medical oncologists, radiation oncologists, and pathologists to ensure we are providing the best possible care to patients. This review aims to provide a broad overview of the role of MRI for rectal cancer.
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Affiliation(s)
- David D.B. Bates
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria El Homsi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kevin Chang
- Department of Radiology, Boston University Medical Center, Boston, MA, USA
| | - Neeraj Lalwani
- Department of Radiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Natally Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shannon Sheedy
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Sim KC, Park BJ, Kim MJ, Sung DJ, Han NY, Han YE, Kwak JM, An H. Accuracy of MRI for predicting anterior peritoneal reflection involvement in locally advanced rectal cancer: a comparison with operative findings. Abdom Radiol (NY) 2022; 47:508-516. [PMID: 34842978 DOI: 10.1007/s00261-021-03356-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 01/17/2023]
Abstract
PURPOSE To assess the diagnostic accuracy of preoperative rectal MRI for anterior peritoneal reflection (APR) involvement in rectal cancer through comparison with the surgeon's operative findings. METHODS This retrospective study was approved by the institutional review board; informed consent was waived. We enrolled 55 consecutive patients with suspected locally advanced mid-to-upper rectal cancer. All patients underwent rectal MRI using a 3T system. APR involvement in rectal cancer was assessed radiologically using a 5-point scale by two independent board-certified abdominal radiologists. The surgeon's evaluation during surgery was regarded as the gold standard for APR involvement. The accuracy of rectal MRI in predicting APR involvement was obtained. RESULTS Rectal MRI showed good APR identification (rater 1, 92.7%; rater 2, 94.7%). On preoperative rectal MRI, rater 1 diagnosed 19 (34.5%) patients as having APR involvement and rater 2 diagnosed 28 (50.9%) as having APR involvement. There was moderate agreement (κ = 0.602, p < 0.001) between the two raters with regard to the evaluation of APR involvement. During surgery, the surgeon confirmed APR involvement in 13 (23.6%) patients. The sensitivity, specificity, PPV, and NPV of preoperative MRI for APR involvement were 69.2%, 76.2%, 47.4%, and 88.9%, respectively. The diagnostic accuracy of MRI for predicting APR involvement was 74.6%. CONCLUSION Preoperative rectal MRI provides accurate anatomical information regarding APR involvement with high conspicuity. However, MRI has relatively low sensitivity (< 70%) and a low PPV (< 50%) with regard to the assessment of APR involvement in rectal tumors. Both rater 1 and rater 2 evaluated these images as positive involvement of APR. The patient underwent laparoscopic low anterior resection after preoperative evaluation. However, during surgery, the surgeon evaluated APR involvement as negative, and the final pathologic staging was confirmed as T3.
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Affiliation(s)
- Ki Choon Sim
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Beom Jin Park
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.
| | - Min Ju Kim
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Deuk Jae Sung
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Na Yeon Han
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Yeo Eun Han
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Jung-Myun Kwak
- Department of Surgery, Korea University Anam Hospital, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Hyonggin An
- Department of Biostatistics, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
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Comparison of compressed sensing-sensitivity encoding (CS-SENSE) accelerated 3D T2W TSE sequence versus conventional 3D and 2D T2W TSE sequences in rectal cancer: a prospective study. Abdom Radiol (NY) 2022; 47:3660-3670. [PMID: 35997800 PMCID: PMC9560929 DOI: 10.1007/s00261-022-03636-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE This study aimed to evaluate the image quality and diagnostic value of compressed sensing-sensitivity encoding (CS-SENSE) accelerated 3-dimensional (3D) T2-weighted turbo spin-echo (T2W TSE) sequence in patients with rectal cancer compared with conventional 3D and 2-dimensional (2D) sequences. METHODS A total of 54 patients who underwent the above three sequences were enrolled. Two radiologists independently reviewed the image quality using an ordinal 5-point Likert scale. The quantitative measurement was performed to calculate the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). The diagnostic value was assessed using TN staging, extramural vascular invasion and mesorectal fascia status. Friedman and McNemar's tests were applied for comparative analysis. RESULTS Forty-two patients were successfully included. Compared with 3D and 2D sequences, the CS-SENSE 3D sequence speeded up by 39% and 23%, respectively. The edge sharpness of CS-SENSE 3D images was similar to that of 3D and 2D images. The noise of CS-SENSE 3D images was comparable to that of 3D images but higher than that of 2D images. The SNRtumor and SNRrectal wall of CS-SENSE 3D images were considerably lower than those of 3D and 2D images. The CNR of CS-SENSE 3D images was similar to that of 3D images but lower than that of 2D images. However, no considerable differences were noted in diagnostic value among the three sequences. CONCLUSIONS CS-SENSE 3D T2 sequence provided comparable diagnostic performance, with substantially reduced imaging time and no significant sacrifices in image quality. This technique may serve as a reliable tool for evaluating rectal cancer.
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26
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Park IJ. Watch and wait strategies for rectal cancer A systematic review. PRECISION AND FUTURE MEDICINE 2021. [DOI: 10.23838/pfm.2021.00177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Alvfeldt G, Aspelin P, Blomqvist L, Sellberg N. Radiology reporting in rectal cancer using MRI: adherence to national template for structured reporting. Acta Radiol 2021; 63:1603-1612. [PMID: 34866405 DOI: 10.1177/02841851211057276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In 2014, a national workshop program was initiated and a reporting template and manual for rectal cancer primary staging using magnetic resonance imaging (MRI) was introduced and made available by the national Swedish Colorectal Cancer Registry. PURPOSE To evaluate the effect of the national template program by identify if there was a gap between the content in Swedish MRI reports from 2016 and the national reporting template from 2014. The aim was to explore and compare differences in content in reporting practice in different hospitals in relation to the national reporting template, with focus on: (i) identifying any implementational differences in reporting styles; and (ii) evaluating if reporting completeness vary based on such implementational differences. MATERIAL AND METHODS A total of 250 MRI reports from 10 hospitals in four healthcare regions in Sweden were collected. Reports were analyzed using qualitative content analysis with a deductive thematic coding scheme based on the national reporting template. RESULTS Three different implemented reporting styles were identified with variations of content coverage in relation to the template: (i) standardized and structured protocol (reporting style A); (ii) standardized semi-structured free-text (reporting style B); and (iii) regular free-text (reporting style C). The relative completeness of reporting practice of rectal cancer staging in relation to the national reporting template were 92.9% for reporting style A, 77.5% for reporting style B, and 63.9% for reporting style C. CONCLUSION The implementation of template-based reporting according to reporting style A is a key factor to conform to evidence-based practice for rectal cancer reporting using MRI.
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Affiliation(s)
- Gustav Alvfeldt
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Peter Aspelin
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Lennart Blomqvist
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. Department of Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Nina Sellberg
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
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Grimm P, Loft MK, Dam C, Pedersen MRV, Timm S, Rafaelsen SR. Intra- and Interobserver Variability in Magnetic Resonance Imaging Measurements in Rectal Cancer Patients. Cancers (Basel) 2021; 13:cancers13205120. [PMID: 34680269 PMCID: PMC8534180 DOI: 10.3390/cancers13205120] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/04/2021] [Accepted: 10/07/2021] [Indexed: 12/14/2022] Open
Abstract
Colorectal cancer is the second most common cancer in Europe, and accurate lymph node staging in rectal cancer patients is essential for the selection of their treatment. MRI lymph node staging is complex, and few studies have been published regarding its reproducibility. This study assesses the inter- and intraobserver variability in lymph node size, apparent diffusion coefficient (ADC) measurements, and morphological characterization among inexperienced and experienced radiologists. Four radiologists with different levels of experience in MRI rectal cancer staging analyzed 36 MRI scans of 36 patients with rectal adenocarcinoma. Inter- and intraobserver variation was calculated using interclass correlation coefficients and Cohens-kappa statistics, respectively. Inter- and intraobserver agreement for the length and width measurements was good to excellent, and for that of ADC it was fair to good. Interobserver agreement for the assessment of irregular border was moderate, heterogeneous signal was fair, round shape was fair to moderate, and extramesorectal lymph node location was moderate to almost perfect. Intraobserver agreement for the assessment of irregular border was fair to substantial, heterogeneous signal was fair to moderate, round shape was fair to moderate, and extramesorectal lymph node location was substantial to almost perfect. Our data indicate that subjective variables such as morphological characteristics are less reproducible than numerical variables, regardless of the level of experience of the observers.
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Affiliation(s)
- Peter Grimm
- Department of Radiology, Vejle Hospital, University Hospital of Southern Denmark, 7100 Vejle, Denmark; (M.K.L.); (C.D.); (M.R.V.P.); (S.R.R.)
- Correspondence:
| | - Martina Kastrup Loft
- Department of Radiology, Vejle Hospital, University Hospital of Southern Denmark, 7100 Vejle, Denmark; (M.K.L.); (C.D.); (M.R.V.P.); (S.R.R.)
- Department of Regional Health Research, University of Southern Denmark, 5230 Odense, Denmark;
| | - Claus Dam
- Department of Radiology, Vejle Hospital, University Hospital of Southern Denmark, 7100 Vejle, Denmark; (M.K.L.); (C.D.); (M.R.V.P.); (S.R.R.)
| | - Malene Roland Vils Pedersen
- Department of Radiology, Vejle Hospital, University Hospital of Southern Denmark, 7100 Vejle, Denmark; (M.K.L.); (C.D.); (M.R.V.P.); (S.R.R.)
- Department of Regional Health Research, University of Southern Denmark, 5230 Odense, Denmark;
| | - Signe Timm
- Department of Regional Health Research, University of Southern Denmark, 5230 Odense, Denmark;
- Research Unit, Kolding Hospital, University Hospital of Southern Denmark, 6000 Kolding, Denmark
| | - Søren Rafael Rafaelsen
- Department of Radiology, Vejle Hospital, University Hospital of Southern Denmark, 7100 Vejle, Denmark; (M.K.L.); (C.D.); (M.R.V.P.); (S.R.R.)
- Department of Regional Health Research, University of Southern Denmark, 5230 Odense, Denmark;
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Li C, Yin J. Radiomics Based on T2-Weighted Imaging and Apparent Diffusion Coefficient Images for Preoperative Evaluation of Lymph Node Metastasis in Rectal Cancer Patients. Front Oncol 2021; 11:671354. [PMID: 34041033 PMCID: PMC8141802 DOI: 10.3389/fonc.2021.671354] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/12/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose To develop and validate a radiomics nomogram based on T2-weighted imaging (T2WI) and apparent diffusion coefficient (ADC) features for the preoperative prediction of lymph node (LN) metastasis in rectal cancer patients. Materials and Methods One hundred and sixty-two patients with rectal cancer confirmed by pathology were retrospectively analyzed, who underwent T2WI and DWI sequences. The data sets were divided into training (n = 97) and validation (n = 65) cohorts. For each case, a total of 2,752 radiomic features were extracted from T2WI, and ADC images derived from diffusion-weighted imaging. A two-sample t-test was used for prefiltering. The least absolute shrinkage selection operator method was used for feature selection. Three radiomics scores (rad-scores) (rad-score 1 for T2WI, rad-score 2 for ADC, and rad-score 3 for the combination of both) were calculated using the support vector machine classifier. Multivariable logistic regression analysis was then used to construct a radiomics nomogram combining rad-score 3 and independent risk factors. The performances of three rad-scores and the nomogram were evaluated using the area under the receiver operating characteristic curve (AUC). Decision curve analysis (DCA) was used to assess the clinical usefulness of the radiomics nomogram. Results The AUCs of the rad-score 1 and rad-score 2 were 0.805, 0.749 and 0.828, 0.770 in the training and validation cohorts, respectively. The rad-score 3 achieved an AUC of 0.879 in the training cohort and an AUC of 0.822 in the validation cohort. The radiomics nomogram, incorporating the rad-score 3, age, and LN size, showed good discrimination with the AUC of 0.937 for the training cohort and 0.884 for the validation cohort. DCA confirmed that the radiomics nomogram had clinical utility. Conclusions The radiomics nomogram, incorporating rad-score based on features from the T2WI and ADC images, and clinical factors, has favorable predictive performance for preoperative prediction of LN metastasis in patients with rectal cancer.
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Affiliation(s)
- Chunli Li
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China.,Department of Biomedical Engineering, School of Fundamental Sciences, China Medical University, Shenyang, China
| | - Jiandong Yin
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
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Zhou S, Jiang Y, Pei W, Zhou H, Liang J, Zhou Z. Neoadjuvant chemoradiotherapy followed by lateral pelvic lymph node dissection for rectal cancer patients: A retrospective study of its safety and indications. J Surg Oncol 2021; 124:354-360. [PMID: 33882149 DOI: 10.1002/jso.26509] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/18/2021] [Accepted: 04/11/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES There is no consensus on the safety and indications of lateral pelvic lymph node dissection (LPND) for patients with clinical lateral pelvic node metastasis (LPNM) after neoadjuvant chemoradiotherapy (nCRT). METHODS We retrospectively analyzed 151 patients who underwent total mesorectal excision (TME) + LPND and divided them into two groups: nCRT group (n = 73) and non-nCRT group (n = 78). RESULTS Thirty-one (20.5%) patients had LPNM by pathology. The operative time was significantly longer in the nCRT group (291.9 vs. 237.0 min, p < 0.001); however, the two groups had comparable intraoperative blood loss (87.3 vs. 78.9 ml, p = 0.607) and morbidity (19.2% vs. 15.7%, p = 0.537). Additionally, in the nCRT group, multivariate logistic regression analysis showed that poor/mucinous/signet adenocarcinoma (odds ratio [OR] = 6.65, 95% confidence interval [CI] = 1.03-43.03, p = 0.047) and post-nCRT LPN size ≥7 mm (OR = 26.67, 95% CI = 2.87-247.91, p = 0.004) were independent risk factors for pathological LPNM. CONCLUSION nCRT before TME + LPND is safe and feasible with a comparably low mortality and acceptable morbidity. Poor/mucinous/signet adenocarcinoma and post-nCRT LPN size ≥7 mm were independent predictive factors of pathological LPNM after nCRT for rectal cancer patients with clinical LPNM, and patients with these characteristics should consider LPND after nCRT.
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Affiliation(s)
- Sicheng Zhou
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yujuan Jiang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Pei
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haitao Zhou
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianwei Liang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhixiang Zhou
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Pangarkar S, Mistry K, Choudhari A, Smriti V, Ahuja A, Katdare A, Engineer R, Ostwal V, Ramadwar M, Saklani A, Baheti AD. Accuracy of MRI for nodal restaging in rectal cancer: a retrospective study of 166 cases. Abdom Radiol (NY) 2021; 46:498-505. [PMID: 32813028 DOI: 10.1007/s00261-020-02708-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/06/2020] [Accepted: 08/08/2020] [Indexed: 12/12/2022]
Abstract
AIM Assessing metastatic mesorectal nodal involvement is a challenge in rectal cancer, especially in the post chemoradiation setting. We aim to assess the accuracy of MRI for nodal restaging and the validity of SAR criteria (≥ 5 mm size being metastatic). MATERIALS AND METHODS This was an IRB-approved retrospective study of 166 patients with locally advanced rectal cancers, operated after neoadjuvant treatment. Two dedicated oncoradiologists reviewed the 166 post-chemoradiation presurgical MRIs in consensus. Nodal size and morphology (shape, margins, and signal intensity) were noted. The most accurate cut-off for size for predicting positive pN status was determined using the Youden index. RESULTS MRI understaged 30/166 (18%) and overstaged 40/166 (24%) patients using the SAR criteria. The most accurate cut-off for node size was 5.5 mm, with a sensitivity of 75%, specificity of 60.2%, PPV of 40.7%, NPV of 86.9% (95% CI:78-92.5%), accuracy of 64.2%, and area under the curve (AUC) 0.657 (95% CI-0.524-0.79). Morphological characteristics were not significant to determine involvement, with positive nodes including 42% of round and 31% of oval nodes, 40% of heterogeneous and 45% of homogeneous nodes, and 31% irregularly marginated and 46% nodes with regular margins being positive on pathology. MRI was accurate in predicting pathology for mucinous nodes in 9/29 (31%) cases. Seven cases which were yN2 on MRI and yN0 on pathology demonstrated mucinous changes on MRI and had acellular mucin on histopathology. CONCLUSIONS MRI has good negative predictive value, poor positive predictive value and moderate accuracy in nodal restaging. The cut-off of 5.5 mm demonstrated in our study is close to the SAR cut-off of 5 mm in the post-treatment setting. MRI accuracy is lower in patients with mucinous nodes.
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Affiliation(s)
- Sayali Pangarkar
- Department of Radio-Diagnosis, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Kunal Mistry
- Department of Radio-Diagnosis, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Amit Choudhari
- Department of Radio-Diagnosis, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Vasundhara Smriti
- Department of Radio-Diagnosis, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Ankita Ahuja
- Department of Radio-Diagnosis, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Aparna Katdare
- Department of Radio-Diagnosis, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Reena Engineer
- Homi Bhabha National Institute, Mumbai, India
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India
| | - Vikas Ostwal
- Homi Bhabha National Institute, Mumbai, India
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - Mukta Ramadwar
- Homi Bhabha National Institute, Mumbai, India
- Department of Pathology, Tata Memorial Centre, Mumbai, India
| | - Avanish Saklani
- Homi Bhabha National Institute, Mumbai, India
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India
| | - Akshay D Baheti
- Department of Radio-Diagnosis, Tata Memorial Centre, Mumbai, India.
- Homi Bhabha National Institute, Mumbai, India.
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Park SH, Cho SH, Choi SH, Jang JK, Kim MJ, Kim SH, Lim JS, Moon SK, Park JH, Seo N. MRI Assessment of Complete Response to Preoperative Chemoradiation Therapy for Rectal Cancer: 2020 Guide for Practice from the Korean Society of Abdominal Radiology. Korean J Radiol 2020; 21:812-828. [PMID: 32524782 PMCID: PMC7289703 DOI: 10.3348/kjr.2020.0483] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 04/18/2020] [Accepted: 04/19/2020] [Indexed: 12/23/2022] Open
Abstract
Objective To provide an evidence-based guide for the MRI interpretation of complete tumor response after neoadjuvant chemoradiation therapy (CRT) for rectal cancer using visual assessment on T2-weighted imaging (T2) and diffusion-weighted imaging (DWI). Materials and Methods PubMed MEDLINE, EMBASE, and Cochrane Library were searched on November 28, 2019 to identify articles on the following issues: 1) sensitivity and specificity of T2 or DWI for diagnosing pathologic complete response (pCR) and the criteria for MRI diagnosis; 2) MRI alone vs. MRI combined with other test(s) in sensitivity and specificity for pCR; and 3) tests to select patients for the watch-and-wait management. Eligible articles were selected according to meticulous criteria and were synthesized. Results Of 1615 article candidates, 55 eligible articles (for all three issues combined) were identified. Combined T2 and DWI performed better than T2 alone, with a meta-analytic summary sensitivity of 0.62 (95% confidence interval [CI], 0.43–0.77; I2 = 80.60) and summary specificity of 0.89 (95% CI, 0.80–0.94; I2 = 92.61) for diagnosing pCR. The criteria for the complete response on T2 in most studies had the commonality of remarkable tumor decrease to the absence of mass-like or nodular intermediate signal, although somewhat varied, as follows: (near) normalization of the wall; regular, thin, hypointense scar in the luminal side with (near) normal-appearance or homogeneous intermediate signal in the underlying wall; and hypointense thickening of the wall. The criteria on DWI were the absence of a hyperintense signal at high b-value (≥ 800 sec/mm2) in most studies. The specific algorithm to combine T2 and DWI was obscure in half of the studies. MRI combined with endoscopy was the most utilized means to select patients for the watch-and-wait management despite a lack of strong evidence to guide and support a multi-test approach. Conclusion This systematic review and meta-analysis provide an evidence-based practical guide for MRI assessment of complete tumor response after CRT for rectal cancer.
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Affiliation(s)
- Seong Ho Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Seung Hyun Cho
- Department of Radiology, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sang Hyun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jong Keon Jang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Min Ju Kim
- Department of Radiology, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Seung Ho Kim
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Korea
| | - Joon Seok Lim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Kyoung Moon
- Department of Radiology, Kyung Hee University Hospital, Seoul, Korea
| | - Ji Hoon Park
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Nieun Seo
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Alvfeldt G, Aspelin P, Blomqvist L, Sellberg N. Rectal cancer staging using MRI: adherence in reporting to evidence-based practice. Acta Radiol 2020; 61:1463-1472. [PMID: 32106682 PMCID: PMC7653401 DOI: 10.1177/0284185120906663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Magnetic resonance imaging (MRI) is the first-line imaging modality for local
staging of rectal cancer. The radiology report should deliver all relevant
available imaging information to guide treatment. Purpose To explore and describe if there was a gap between the contents in MRI
reports for primary staging of rectal cancer in Sweden in 2010 compared to
evidence-based practice. Material and Methods A total of 243 primary MRI staging reports from 2010, collected from 10
hospitals in four healthcare regions in Sweden, were analyzed using content
analysis with a deductive thematic coding scheme based on evidence-based
practice. Focus was on: (i) most frequently reported findings; (ii)
correlation to key prognostic findings; and (iii) identifying if any
findings being reported were beyond the information defined in
evidence-based practice. Results Most frequently reported findings were spread through the bowel wall or not,
local lymph node description, tumor length, and distance of tumor from anal
verge. These items accounted for 35% of the reporting content. Of all
reported content, 86% correlated with the evidence-based practice. However,
these included more information than was generally found in the reports.
When adjusting for omitted information, 48% of the reported content were
accounted for. Of the reported content, 20% correlated to key pathological
prognostic findings. Six types of findings were reported beyond the
evidence-based practice, representing 14% of the total reporting
content. Conclusion There was a gap between everyday practice and evidence-based practice in
2010. This indicates a need for national harmonization and implementation of
standardized structured reporting templates.
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Affiliation(s)
- Gustav Alvfeldt
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Peter Aspelin
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Lennart Blomqvist
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Nina Sellberg
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
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Pechlivanides G, Gourtsoyianni S, Gouvas N, Sougklakos J, Xynos E. Management of the adenocarcinoma of the upper rectum: a reappraisal. Updates Surg 2020; 73:513-526. [PMID: 33108641 DOI: 10.1007/s13304-020-00903-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 10/15/2020] [Indexed: 12/25/2022]
Abstract
The present review attempts to assess whether upper rectal cancer (URC) should be treated either as colon cancer or as rectal one, namely to be managed with upfront surgery without neo-adjuvant treatment and partial mesorectal excision (PME), or with neo-adjuvant short course radiotherapy (SCRT) or chemoradiotherapy (CRT) as indicated, followed by surgery with total mesorectal excision. Reports from current evidence including studies, reviews and various guidelines are conflicting. Main reasons for inability to reach safe conclusions are (i) the various anatomical definitions of the rectum and its upper part, (ii) the inadequate preoperative local staging,(iii) the heterogeneity of selection criteria for the neo-adjuvant treatment,(iv) the different neo-adjuvant treatment regimens, and(v) the variety in the extent of surgical resection, among the studies. Although not adequately supported, locally advanced URC can be treated with neo-adjuvant CRT provided the lesion is within the radiation field of safety, and a PME if the lower border of the tumour is located above the anterior peritoneal reflection. There is evidence that adjuvant chemotherapy is of benefit in high-risk stage II and stage III lesions.
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Affiliation(s)
| | - Sophia Gourtsoyianni
- Department of Radiology, Medical School, Aretaieion Hospital, University of Athens, Athens, Greece
| | - Nikolaos Gouvas
- General Surgery, Medical School, University of Cyprus, Nicosia General Hospital, Nicosia, Cyprus.
| | - John Sougklakos
- Department of Medical Oncology, Laboratory of Translational Oncology, Medical School, University of Crete, Heraklion, Greece
| | - Evangelos Xynos
- Department of General Surgery, Creta Interclinic Hospital, Heraklion, Crete, Greece
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Cao W, Zou Q, Zhao Y, Zhou J, Li W, Ren D, Meng X, Hu B, Zhou Z. Application of liver acquisition with volume acceleration enhanced sequence in improving the accuracy of reassessing organ-invasive rectal mucinous adenocarcinoma after chemoradiation. Eur J Radiol 2020; 133:109368. [PMID: 33207287 DOI: 10.1016/j.ejrad.2020.109368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/08/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To explore the ability of liver acquisition with volume acceleration contrast-enhanced sequence (LAVA-ce) to improve the accuracy of reassessing adjacent organ involvement by rectal mucinous adenocarcinoma (MC) after neoadjuvant therapy (NAT). METHODS This study retrospectively enrolled twenty-five patients with MC who underwent pre- and post-NAT MRI, were staged as T4b using pre-NAT T2 weighted imaging, received NAT and underwent radical resection. All MR images were divided into two schemes, T2 weighted plus diffusion weighted imaging (T2Dw protocol) and plus LAVA-ce (T2DwLce protocol). All patients were scored on a 0-4 scale to reassess organ-invasive mucus components. Postoperative pathology was used to identify the involvement of surrounding organs (ypT4b). The receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the consistency of the results with pathology after adding fs-CE sequence. RESULTS Among 25 MC patients (15 males and 10 females, aged 21-89 years), 21 were restaged as yT4b after NAT by using T2Dw, with an accuracy of 44.0 % (11/25), which was lower than the accuracy of staging patients with non-mucinous rectal adenocarcinoma (94.1 %, 96/102). The accuracy of MC restaging was improved by using T2DwLce (23/25). The AUC of T2DwLce was 0.857 (95 % CI, 0.660∼0.964), which was higher than that of T2Dw (AUC, 0.611 [95 % CI, 0.397∼0.798]) (P = 0.019). CONCLUSION The LAVA-ce sequence can improve the accuracy of reevaluation and should be included in the MRI protocol for MC patients.
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Affiliation(s)
- Wuteng Cao
- Department of Radiology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, 510655, China
| | - Qi Zou
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, 510655, China; Department of Gastrointestinal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China
| | - Yandong Zhao
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, 510655, China; Department of Pathology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China
| | - Jie Zhou
- Department of Radiology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China
| | - Wenli Li
- Department of Radiology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, 510655, China
| | - Donglin Ren
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, 510655, China; Department of Gastrointestinal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China
| | - Xiaochun Meng
- Department of Radiology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, 510655, China.
| | - Bang Hu
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, 510655, China; Department of Gastrointestinal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China.
| | - Zhiyang Zhou
- Department of Radiology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, 510655, China.
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Li Y, Mueller LI, Neuhaus JP, Bertram S, Schaarschmidt BM, Demircioglu A, Ludwig JM, Kirchner J, Rischpler C, Herrmann K, Catalano OA, Umutlu L. 18F-FDG PET/MR versus MR Alone in Whole-Body Primary Staging and Restaging of Patients with Rectal Cancer: What Is the Benefit of PET? J Clin Med 2020; 9:E3163. [PMID: 33003615 PMCID: PMC7599654 DOI: 10.3390/jcm9103163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 09/24/2020] [Accepted: 09/28/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND To investigate and compare the diagnostic performance of 18F-Fluorodeoxyglucose (18F-FDG) PET/MR and MR alone in whole-body primary staging and restaging of patients with rectal cancer. METHODS A retrospective analysis was performed to evaluate diagnostic accuracies of combined reading of PET/MR and MR alone in T, N and M staging against the reference standard. Inter-observer agreement regarding TNM staging was calculated separately for PET/MR and MR alone. RESULTS A total of 39 studies of 34 patients could be evaluated. Diagnostic accuracies of PET/MR and MR alone were the same in locoregional T staging. For predicting N+ stage, the specificity of combined reading of PET and MR (0.917 and 0.833 for reader 1 and 2, respectively) was slightly higher than MR alone (0.833 and 0.75) without significantly increasing the overall accuracy (0.783 vs. 0.783 and 0.783 vs. 0.739). For detecting distant metastasis, the sensitivities of PET/MR and MR alone were shown equal (1.0 vs. 1.0 and 0.938 vs. 0.938), while the specificity of PET/MR was marginally lower (0.87 vs. 0.913 and 0.826 vs. 0.87). The inter-observer agreements were good to excellent in M (κ = 0.64 and 0.637 for PET/MR and MR alone, p < 0.001) and N staging (0.819 and 0.738, p < 0.001). CONCLUSION PET did not yield a significant improvement in diagnostic accuracy of PET/MR in TNM staging of rectal cancer, since MR alone facilitated accurate classification of disease stage with good to excellent inter-observer agreement.
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Affiliation(s)
- Yan Li
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (L.I.M.); (B.M.S.); (A.D.); (J.M.L.); (L.U.)
| | - Laura Isabel Mueller
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (L.I.M.); (B.M.S.); (A.D.); (J.M.L.); (L.U.)
| | - Jan Peter Neuhaus
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany;
| | - Stefanie Bertram
- Institute of Pathology and Neuropathology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany;
| | - Benedikt Michael Schaarschmidt
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (L.I.M.); (B.M.S.); (A.D.); (J.M.L.); (L.U.)
| | - Aydin Demircioglu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (L.I.M.); (B.M.S.); (A.D.); (J.M.L.); (L.U.)
| | - Johannes Maximilian Ludwig
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (L.I.M.); (B.M.S.); (A.D.); (J.M.L.); (L.U.)
| | - Julian Kirchner
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, 40225 Dusseldorf, Germany;
| | - Christoph Rischpler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany; (C.R.); (K.H.)
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany; (C.R.); (K.H.)
| | - Onofrio Antonio Catalano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA 02114, USA;
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (L.I.M.); (B.M.S.); (A.D.); (J.M.L.); (L.U.)
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Attenberger UI, Tavakoli A, Stocker D, Stieb S, Riesterer O, Turina M, Schoenberg SO, Pilz L, Reiner CS. Reduced and standard field-of-view diffusion weighted imaging in patients with rectal cancer at 3 T-Comparison of image quality and apparent diffusion coefficient measurements. Eur J Radiol 2020; 131:109257. [PMID: 32947092 DOI: 10.1016/j.ejrad.2020.109257] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/30/2020] [Accepted: 08/24/2020] [Indexed: 01/03/2023]
Abstract
PURPOSE To compare a zoomed EPI-DWI (z-EPI) with a standard EPI-DWI (s-EPI) in the primary diagnostics of rectal cancer and assess its potential of reduced image artifacts. METHOD 22 therapy-naïve patients with rectal cancer underwent rectal MRI at a 3 T-system. The protocols consisted of a z-EPI DWI and s-EPI DWI sequence. Images were assessed by two independent and experienced readers regarding overall image quality and artifacts on a 5-point Likert scale, as well as overall sequence preference. In a lesion-based analysis, tumor and lymph node detection were rated on a 4-point Likert scale. Apparent diffusion coefficient (ADC) measurements were performed. RESULTS Overall Image quality score for z-EPI and s-EPI showed no statistically significant differences (p = 0.80/0.54, reader 1/2) with a median score of 4 ("good" image quality) for both sequences. The image quality preference rank for z-EPI and s-EPI was given the category 'no preference' in 64 % (reader 1) and 50 % (reader 2). Most artifact-related scores (susceptibility, motion and distortion) did not show reproducible significant differences between z-EPI and s-EPI. The two sequences exhibited comparable, mostly good and excellent quality scores for tumor and lymph node detection (p = 0.19-0.99). ADC values were significantly lower for z-EPI than for s-EPI (p = 0.001/0.002, reader 1/2) with good agreement of ADC measurements between both readers. CONCLUSION Our data showed comparable image quality and lesion detection for the z-EPI and the s-EPI sequence in MRI of rectal cancer, whereas the mean ADC of the tumor was significantly lower in z-EPI compared to s-EPI.
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Affiliation(s)
- U I Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany.
| | - A Tavakoli
- Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim, Germany; Department of Radiology, German Cancer Research Center (DKFZ), Germany.
| | - D Stocker
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
| | - S Stieb
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - O Riesterer
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland.
| | - M Turina
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland.
| | - S O Schoenberg
- Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim, Germany.
| | - L Pilz
- Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
| | - C S Reiner
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
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Guan Z, Sun RJ, Cao WT, Zhang HM, Yu T, Yu XP, Zhang JX, Zhang XY, Li XT, Zhou ZY, Zhao XM, Wen L, Sun YS. Magnetic resonance imaging tumor response score (mrTRS) predicts therapeutic effect and prognosis of locally advanced rectal cancer after neoadjuvant chemoradiotherapy: A prospective, multi-center study. Radiother Oncol 2020; 151:288-295. [PMID: 32890612 DOI: 10.1016/j.radonc.2020.08.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/25/2020] [Accepted: 08/30/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND PURPOSE The MRI-assessed tumor regression grade (mrTRG) is limited due to its subjectivity and poor consistency on pathological tumor regression grade (pTRG). A new MRI criterion was established to predict the prognosis of locally advanced rectal cancer (LARC). MATERIALS AND METHODS The new MRI criterion magnetic resonance imaging tumor response score (mrTRS) was based on the retrospective sample of 214 LARC patients (unpublished data). Subsequently, 878 LARC patients were enrolled for a prospective, multicenter study. Baseline and postoperative MRI were obtained, and imaging features were measured by collecting the pathological, clinical and follow-up data. Kaplan-Meier method with log-rank estimate and multivariate cox regression model was used to determine the prognosis of mrTRS in LARC patients with neoadjuvant chemoradiotherapy (NACRT). The predictive capability of 3-year prognosis between mrTRS and mrTRG was determined by time-dependent ROC curves. RESULTS The results demonstrated that mrTRS acted as an independent predictor of survival outcomes. mrTRS stratified by good and moderate responders showed significantly lower risk of death (HR = 0.04, 95%CI 0.01-0.31; HR = 0.35, 95%CI 0.23-0.52), distant metastasis (HR = 0.25, 95%CI 0.13-0.52; HR = 0.42, 95%CI 0.30-0.58), and local recurrence when compared with poor responders(HR = 0.01 95%CI 0.23-0.52;HR = 0.38, 95%CI 0.16-0.90). In contrast, no significant difference was observed among mrTRG stratified groups. Excellent and substantial interobserver agreement for mrTRS and mrTRG evaluation was observed (κ = 0.92 and 0.62), respectively. CONCLUSION mrTRS can serve as an effective predictor for assessing tumor regression grade in LARC patients with NACRT.
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Affiliation(s)
- Zhen Guan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Rui-Jia Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Wu-Teng Cao
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hong-Mei Zhang
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tao Yu
- Department of Medical Imaging, Cancer Hospital of China Medical University, Shenyang, China; Department of Medical Imaging, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Xiao-Ping Yu
- Department of Radiology, Hunan Cancer Hospital, Changsha, China
| | - Jian-Xin Zhang
- Department of MR and CT, Shanxi Province Tumor Hospital, The Third People Hospital of Shanxi Province, Taiyuan, China
| | - Xiao-Yan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiao-Ting Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhi-Yang Zhou
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xin-Ming Zhao
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lu Wen
- Department of Radiology, Hunan Cancer Hospital, Changsha, China
| | - Ying-Shi Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing, China.
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The Effect of Rectal Distention on the Intravoxel Incoherent Motion Parameters: Using Sonography Transmission Gel. J Comput Assist Tomogr 2020; 44:759-765. [DOI: 10.1097/rct.0000000000001083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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López-Campos F, Martín-Martín M, Fornell-Pérez R, García-Pérez JC, Die-Trill J, Fuentes-Mateos R, López-Durán S, Domínguez-Rullán J, Ferreiro R, Riquelme-Oliveira A, Hervás-Morón A, Couñago F. Watch and wait approach in rectal cancer: Current controversies and future directions. World J Gastroenterol 2020; 26:4218-4239. [PMID: 32848330 PMCID: PMC7422545 DOI: 10.3748/wjg.v26.i29.4218] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/25/2020] [Accepted: 07/22/2020] [Indexed: 02/06/2023] Open
Abstract
According to the main international clinical guidelines, the recommended treatment for locally-advanced rectal cancer is neoadjuvant chemoradiotherapy followed by surgery. However, doubts have been raised about the appropriate definition of clinical complete response (cCR) after neoadjuvant therapy and the role of surgery in patients who achieve a cCR. Surgical resection is associated with significant morbidity and decreased quality of life (QoL), which is especially relevant given the favourable prognosis in this patient subset. Accordingly, there has been a growing interest in alternative approaches with less morbidity, including the organ-preserving watch and wait strategy, in which surgery is omitted in patients who have achieved a cCR. These patients are managed with a specific follow-up protocol to ensure adequate cancer control, including the early identification of recurrent disease. However, there are several open questions about this strategy, including patient selection, the clinical and radiological criteria to accurately determine cCR, the duration of neoadjuvant treatment, the role of dose intensification (chemotherapy and/or radiotherapy), optimal follow-up protocols, and the future perspectives of this approach. In the present review, we summarize the available evidence on the watch and wait strategy in this clinical scenario, including ongoing clinical trials, QoL in these patients, and the controversies surrounding this treatment approach.
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Affiliation(s)
- Fernando López-Campos
- Department of Radiation Oncology, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain
| | | | - Roberto Fornell-Pérez
- Department of Radiology, Hospital Universitario de Basurto, Bilbao 48013, Vizcaya, Spain
| | | | - Javier Die-Trill
- Department of Surgery, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain
| | - Raquel Fuentes-Mateos
- Department of Medical Oncology, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain
| | - Sergio López-Durán
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain
| | - José Domínguez-Rullán
- Department of Radiation Oncology, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain
| | - Reyes Ferreiro
- Department of Medical Oncology, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain
| | | | - Asunción Hervás-Morón
- Department of Radiation Oncology, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain
| | - Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario Quirónsalud, Madrid 28003, Spain
- Department of Radiation Oncology, Hospital La Luz, Madrid 28003, Spain
- Universidad Europea de Madrid (UEM), Madrid 28223, Spain
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Bielen D, Tomassetti C, Van Schoubroeck D, Vanbeckevoort D, De Wever L, Van den Bosch T, D'Hooghe T, Bourne T, D'Hoore A, Wolthuis A, Van Cleynenbreughel B, Meuleman C, Timmerman D. IDEAL study: magnetic resonance imaging for suspected deep endometriosis assessment prior to laparoscopy is as reliable as radiological imaging as a complement to transvaginal ultrasonography. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:255-266. [PMID: 31503381 DOI: 10.1002/uog.21868] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/18/2019] [Accepted: 08/27/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To compare the value of using one-stop magnetic resonance imaging (MRI) vs standard radiological imaging as a supplement to transvaginal ultrasonography (TVS) for the preoperative assessment of patients with endometriosis referred for surgery in a tertiary care academic center. METHODS This prospective observational study compared the diagnostic value of the standard preoperative imaging practice of our center, which involves expert TVS complemented by intravenous urography (IVU) for the evaluation of the ureters and double-contrast barium enema (DCBE) for the evaluation of the rectum, sigmoid and cecum, with that of expert TVS complemented by a 'one-stop' MRI examination evaluating the upper abdomen, pelvis, kidneys and ureters as well as rectum and sigmoid on the same day, for the preoperative triaging of 74 women with clinically suspected deep endometriosis. The findings at laparoscopy were considered the reference standard. Patients were stratified according to their need for monodisciplinary surgical approach, carried out by gynecologists only, or multidisciplinary surgical approach, involving abdominal surgeons and/or urologists, based on the extent to which endometriosis affected the reproductive organs, bowel, ureters, bladder or other abdominal organs. RESULTS Our standard preoperative imaging approach and the combined findings of TVS and MRI had similar diagnostic performance, resulting in correct stratification for a monodisciplinary or a multidisciplinary surgical approach of 67/74 (90.5%) patients. However, there were differences between the estimation of the severity of disease by DCBE and MRI. The severity of rectal involvement was underestimated in 2.7% of the patients by both TVS and DCBE, whereas it was overestimated in 6.8% of the patients by TVS and/or DCBE. CONCLUSIONS Complementary to expert TVS, 'one-stop' MRI can predict intraoperative findings equally well as standard radiological imaging (IVU and DCBE) in patients referred for endometriosis surgery in a tertiary care academic center. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- D Bielen
- Department of Radiology, KU Leuven University Hospitals, Leuven, Belgium
- Department of Imaging and Pathology, KU Leuven University Hospitals, Leuven, Belgium
| | - C Tomassetti
- Leuven University Fertility Center, KU Leuven University Hospitals, Leuven, Belgium
- Department of Obstetrics and Gynecology, KU Leuven University Hospitals, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven University Hospitals, Leuven, Belgium
| | - D Van Schoubroeck
- Department of Obstetrics and Gynecology, KU Leuven University Hospitals, Leuven, Belgium
| | - D Vanbeckevoort
- Department of Radiology, KU Leuven University Hospitals, Leuven, Belgium
| | - L De Wever
- Department of Radiology, KU Leuven University Hospitals, Leuven, Belgium
| | - T Van den Bosch
- Department of Obstetrics and Gynecology, KU Leuven University Hospitals, Leuven, Belgium
| | - T D'Hooghe
- Leuven University Fertility Center, KU Leuven University Hospitals, Leuven, Belgium
- Global Medical Affairs Fertility, Merck Healthcare KGaA, Darmstadt, Germany
| | - T Bourne
- Department of Obstetrics and Gynecology, KU Leuven University Hospitals, Leuven, Belgium
- Department of Gynecology and Obstetrics, Imperial College Healthcare NHS Trust, London, UK
| | - A D'Hoore
- Department of Abdominal Surgery, KU Leuven University Hospitals, Leuven, Belgium
- Department of Oncology, KU Leuven University Hospitals, Leuven, Belgium
| | - A Wolthuis
- Department of Abdominal Surgery, KU Leuven University Hospitals, Leuven, Belgium
- Department of Oncology, KU Leuven University Hospitals, Leuven, Belgium
| | | | - C Meuleman
- Department of Obstetrics and Gynecology, KU Leuven University Hospitals, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven University Hospitals, Leuven, Belgium
- Leuven University Endometriosis Center, KU Leuven University Hospitals, Leuven, Belgium
| | - D Timmerman
- Department of Obstetrics and Gynecology, KU Leuven University Hospitals, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven University Hospitals, Leuven, Belgium
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Ponnatapura J, Lalwani N. Imaging of Colorectal Cancer: Screening, Staging, and Surveillance. Semin Roentgenol 2020; 56:128-139. [PMID: 33858639 DOI: 10.1053/j.ro.2020.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Janardhana Ponnatapura
- Department of Radiology, Wake Forest University Baptist Hospital Sciences, Medical Center Bovlevard, Winston-Salem, NC.
| | - Neeraj Lalwani
- Department of Radiology, Virginia Commonwealth University School of Medicine, Richmond, VA
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Chen JN, Liu Z, Wang ZJ, Mei SW, Shen HY, Li J, Pei W, Wang Z, Wang XS, Yu J, Liu Q. Selective lateral lymph node dissection after neoadjuvant chemoradiotherapy in rectal cancer. World J Gastroenterol 2020; 26:2877-2888. [PMID: 32550762 PMCID: PMC7284184 DOI: 10.3748/wjg.v26.i21.2877] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/17/2020] [Accepted: 04/28/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Lateral lymph node metastasis is one of the leading causes of local recurrence in patients with advanced mid or low rectal cancer. Neoadjuvant chemoradiotherapy (NCRT) can effectively reduce the postoperative recurrence rate; thus, NCRT with total mesorectal excision (TME) is the most widely accepted standard of care for rectal cancer. The addition of lateral lymph node dissection (LLND) after NCRT remains a controversial topic. AIM To investigate the surgical outcomes of TME plus LLND, and the possible risk factors for lateral lymph node metastasis after NCRT. METHODS This retrospective study reviewed 89 consecutive patients with clinical stage II-III mid or low rectal cancer who underwent TME and LLND from June 2016 to October 2018. In the NCRT group, TME plus LLND was performed in patients with short axis (SA) of the lateral lymph node greater than 5 mm. In the non-NCRT group, TME plus LLND was performed in patients with SA of the lateral lymph node greater than 10 mm. Data regarding patient demographics, clinical workup, surgical procedure, complications, and outcomes were collected. Multivariate logistic regression analysis was performed to evaluate the possible risk factors for lateral lymph node metastasis in NCRT patients. RESULTS LLN metastasis was pathologically confirmed in 35 patients (39.3%): 26 (41.3%) in the NCRT group and 9 (34.6%) in the non-NCRT group. The most common site of metastasis was around the obturator nerve (21/35) followed by the internal iliac artery region (12/35). In the NCRT patients, 46% of patients with SA of LLN greater than 7 mm were positive. The postoperative 30-d mortality rate was 0%. Two (2.2%) patients suffered from lateral local recurrence in the 2-year follow up. Multivariate analysis showed that cT4 stage (odds ratio [OR] = 5.124, 95% confidence interval [CI]: 1.419-18.508; P = 0.013), poor differentiation type (OR = 4.014, 95%CI: 1.038-15.520; P = 0.044), and SA ≥ 7 mm (OR = 7.539, 95%CI: 1.487-38.214; P = 0.015) were statistically significant risk factors associated with LLN metastasis. CONCLUSION NCRT is not sufficient as a stand-alone therapy to eradicate LLN metastasis in lower rectal cancer patients and surgeons should consider performing selective LLND in patients with greater LLN SA diameter, poorer histological differentiation, or advanced T stage. Selective LLND for NCRT patients can have a favorable oncological outcome.
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Affiliation(s)
- Jia-Nan Chen
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union College, Beijing 100021, China
| | - Zheng Liu
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union College, Beijing 100021, China
| | - Zhi-Jie Wang
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union College, Beijing 100021, China
| | - Shi-Wen Mei
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union College, Beijing 100021, China
| | - Hai-Yu Shen
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union College, Beijing 100021, China
| | - Juan Li
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union College, Beijing 100021, China
| | - Wei Pei
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union College, Beijing 100021, China
| | - Zheng Wang
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union College, Beijing 100021, China
| | - Xi-Shan Wang
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union College, Beijing 100021, China
| | - Jun Yu
- Departments of Surgery, the Johns Hopkins University School of Medicine, Baltimore, MD 21218, United States
| | - Qian Liu
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union College, Beijing 100021, China
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Chen H, Shi L, Nguyen KNB, Monjazeb AM, Matsukuma KE, Loehfelm TW, Huang H, Qiu J, Rong Y. MRI Radiomics for Prediction of Tumor Response and Downstaging in Rectal Cancer Patients after Preoperative Chemoradiation. Adv Radiat Oncol 2020; 5:1286-1295. [PMID: 33305090 PMCID: PMC7718560 DOI: 10.1016/j.adro.2020.04.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/07/2020] [Accepted: 04/13/2020] [Indexed: 12/13/2022] Open
Abstract
Purpose This study aimed to investigate radiomic features extracted from magnetic resonance imaging (MRI) scans performed before and after neoadjuvant chemoradiotherapy (nCRT) in predicting response of locally advanced rectal cancer (LARC). Methods and Materials Thirty-nine patients who underwent nCRT for LARC were included, with 294 radiomic features extracted from MRI that was performed before (pre-CRT) and 6 to 8 weeks after completing nCRT (post-CRT). Based on tumor regression grade (TRG), 26 patients were classified as having a histopathologic good response (GR; TRG 0-1) and 13 as non-GR (TRG 2-3). Tumor downstaging (T-downstaging) occurred in 25 patients. Univariate analyses were performed to assess potential radiomic and delta-radiomic predictors for TRG in pathologic complete response (pCR) versus non-pCR, GR versus non-GR, and T-downstaging. The support vector machine-based multivariate model was used to select the best predictors for TRG and T-downstaging. Results We identified 13 predictive features for pCR versus non-pCR, 14 for GR versus non-GR, and 16 for T-downstaging. Pre-CRT gray-level run length matrix nonuniformity, pre-CRT neighborhood intensity difference matrix (NIDM) texture strength, and post-CRT NIDM busyness predicted all 3 treatment responses. The best predictor for GR versus non-GR was pre-CRT global minimum combined with clinical N stage in the multivariate analysis. The best predictor for T-downstaging was the combination of pre-CRT gray-level co-occurrence matrix correlation, NIDM-texture strength, and gray-level co-occurrence matrix variance. The pre-CRT, post-CRT, and delta radiomic-based models had no significant difference in predicting all 3 responses. Conclusions Pre-CRT MRI, post-CRT MRI, and delta radiomic-based models have the potential to predict tumor response after nCRT in LARC. These data, if validated in larger cohorts, can provide important predictive information to aid in clinical decision making.
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Affiliation(s)
- Haihui Chen
- Department of Medical Oncology, the Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China.,Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, California
| | - Liting Shi
- Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, California.,Medical Engineering and Technology Research Center, Imaging-X Joint Laboratory, Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Ky Nam Bao Nguyen
- Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, California
| | - Arta M Monjazeb
- Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, California
| | - Karen E Matsukuma
- Department of Pathology and Laboratory Medicine, University of California Davis School of Medicine, Sacramento, California
| | - Thomas W Loehfelm
- Department of Radiology, University of California Davis School of Medicine, Sacramento, California
| | - Haixin Huang
- Department of Medical Oncology, the Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Jianfeng Qiu
- Medical Engineering and Technology Research Center, Imaging-X Joint Laboratory, Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Yi Rong
- Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, California
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Žilinskas J, Jokubauskas M, Smailytė G, Gineikienė I, Tamelis A. Comparison of Changes in Disease-Free and Overall Survival of Resectable Rectal Adenocarcinoma between 2010 and 2015. Visc Med 2020; 36:144-149. [PMID: 32355671 DOI: 10.1159/000500730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 05/02/2019] [Indexed: 11/19/2022] Open
Abstract
Background Management of rectal cancer (RC) has undergone many changes in recent decades. A multidisciplinary approach to this complex disease is essential, ensuring high-quality diagnostic, treatment, and outcomes. We aimed to compare treatment results of RC in a single-centre setting between 2010 and 2015. Methods A retrospective comparative study included patients with newly diagnosed and operated resectable RC. Patients' diagnostic and treatment data were analysed. Postoperative morbidity was measured according to the Clavien-Dindo classification. Survival data were received from the Lithuanian Cancer Registry. Continuous variables were expressed as mean and SD. Student t test and one-way ANOVA were used for parametric data and the Mann-Whitney test for non-parametric. A multivariate logistic regression analysis was used to identify independent factors for increased survival. Association between categorical variables was verified using Pearson χ<sup>2</sup>. Results The study included 179 patients: 80 from 2010 and 99 from 2015. Mean sample age was 67.1 ± 10.7 years. There was no significant difference regarding age, gender, median ASA (3 in both groups), but mean hospital stay was 2 days shorter (8 vs. 10 days) in 2015 (p = 0.002). There were only 8 patients (4%) admitted to the hospital on an emergency basis. Pelvis MRI and abdominal CT were performed more often in 2015: from 37.5 to 77.8% (p < 0.001) and from 52.5 to 97% in 2015, respectively. Circumferential margin evaluation increased from 13.8 to 36.4% (p = 0.001). Neoadjuvant therapy increased from 20% in 2010 to 44.9% in 2015 (p = 0.01). The overall postoperative Clavien-Dindo complication rate was higher in 2015 (13.8 vs. 20.2%, p = 0.596), but in-hospital mortality was lower (1 vs. 0 patients). Comparison of radiological TNM and pathological TNM with one-way ANOVA showed a significant difference staging between 2010 (p = 0.002) and 2015 (p = 0.001). The 2-year overall survival (OS) increased from 76.3 to 86.9% (p = 0.046) and the median disease-free survival from 27 (range 0-35) months to 28 (range 0-35) months (72.5-83.5%, p = 0.077). Multivariate logistic regression analysis determined that availability and performance of MRI were associated with an increased OS (OR = 1.529, 95% CI 0.916-2.554, p = 0.020). Conclusions The expanded quantity of preoperative imaging, an improved radiological staging, and compulsory multidisciplinary team board discussions have led to selective neoadjuvant treatment decision followed by surgery which can positively affect the 2-year OS rate.
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Affiliation(s)
- Justas Žilinskas
- Department of Surgery, Medical Academy, Lithuanian University of Health Sciences (LUHS), Kaunas, Lithuania
| | - Mantas Jokubauskas
- Department of Surgery, Medical Academy, Lithuanian University of Health Sciences (LUHS), Kaunas, Lithuania
| | - Giedrė Smailytė
- Laboratory of Cancer Epidemiology, National Cancer Institute, Vilnius, Lithuania
| | - Irina Gineikienė
- Department of Radiology, Medical Academy, Lithuanian University of Health Sciences (LUHS), Kaunas, Lithuania
| | - Algimantas Tamelis
- Department of Surgery, Medical Academy, Lithuanian University of Health Sciences (LUHS), Kaunas, Lithuania
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Tang X, Jiang W, Li H, Xie F, Dong A, Liu L, Li L. Predicting poor response to neoadjuvant chemoradiotherapy for locally advanced rectal cancer: Model constructed using pre-treatment MRI features of structured report template. Radiother Oncol 2020; 148:97-106. [PMID: 32339781 DOI: 10.1016/j.radonc.2020.03.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 03/04/2020] [Accepted: 03/31/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE To develop a predictive model with pre-treatment magnetic resonance imaging (MRI) findings of the structured report template and clinical parameters for poor responses prediction after neoadjuvant chemoradiotherapy (neoCRT) in locally advanced rectal cancers (LARC) patients. METHOD Patients with clinicopathologically confirmed LARC (training and validation datasets, n = 100 and 71, respectively) were enrolled. Patients' clinical data were retrospectively collected. MRI findings of the structured report template were analysed. The tumour regression grade (TRG) system as proposed by Mandard et al was used. Poor response was defined as TRG 3-5. Univariate logistic regression analysis and a lasso regression model were performed to select the significant predictive features from the training set. A nomogram was constructed based on a multivariable logistic regression analysis. Calibration, discrimination, and clinical usefulness of the nomogram were assessed. The calibrative and discriminative ability of our model were compared with those of models including the tumour-node-metastasis (TNM) stage and clinical factors. RESULTS The MRI-reported T4b stage, MRI-reported extramural venous invasion (EMVI) positivity, MRI-detected number of positive mesorectal lymph nodes (LNs) > 0, and preoperative oxaliplatin and capecitabine (CAPOX) chemotherapy regimen were incorporated into our nomogram. The nomogram showed good discrimination, with areas under the receiver operating characteristic (ROC) curves of 0·823 and 0·820 in the training and test sets, respectively, and good calibration in both datasets. The decision curve analysis confirmed that the nomogram was clinically useful. The calibrative and discriminative ability of our model were better than those models including the TNM stage and clinical factors. CONCLUSION A nomogram based on pre-treatment MRI features of the structured report template and clinical risk factors has potential for use as a non-invasive tool to preoperatively predict poor responses in LARC patients after neoCRT.
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Affiliation(s)
- Xiaofeng Tang
- Department of Medical Imaging, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Wu Jiang
- Department of Colorectal Surgery, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Haojiang Li
- Department of Medical Imaging, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Fei Xie
- Department of Medical Imaging, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Annan Dong
- Department of Medical Imaging, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Lizhi Liu
- Department of Medical Imaging, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.
| | - Li Li
- Department of Medical Imaging, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.
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Arya S, Sen S, Engineer R, Saklani A, Pandey T. Imaging and Management of Rectal Cancer. Semin Ultrasound CT MR 2020; 41:183-206. [PMID: 32446431 DOI: 10.1053/j.sult.2020.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
High-resolution phased array external magnetic resonance imaging (MRI) is the first investigation of choice in rectal cancer for local staging, both in the primary and restaging situations. Use of MRI helps differentiate between those with good prognosis, which can be offered upfront surgery and the poor prognostic cases where treatment intensification is needed. MRI identified poor prognostic factors are threatened or involved mesorectal fascia, T3 tumors with >5 mm extramural spread, those with extramural vascular invasion, pelvic sidewall nodes and mucinous tumors. At restaging, use of MRI helps evaluate response and an MR tumor regression grading system is being evaluated. Complete response seen on clinical examination and endoscopy, needs confirmation on MRI using both T2-weighted and diffusion-weighted sequences to justify a "watch and wait" approach. In this subset of patients, MRI also plays a role in monitoring and detecting early regrowth. In those with partial response, MRI helps define surgical margins and can be used as a roadmap to decide between sphincter preserving surgeries and radical sphincter sacrificing surgeries; pelvic exenteration and pelvic sidewall lymph node dissection. Poor responders on MRI may benefit from adjuvant chemotherapy. Use of MRI thus helps in individualizing treatment in rectal cancer.
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Affiliation(s)
- Supreeta Arya
- Ex-Professor, Radiodiagnosis, Tata Memorial Centre, Mumbai, India; Member Expert Committee, National Cancer Grid, India.
| | - Saugata Sen
- Department of Radiology and Imaging Sciences, Tata Medical Center, Kolkata, India
| | - Reena Engineer
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | - Avanish Saklani
- Department of Surgical Oncology, Robotic & Colorectal Surgery, Tata Memorial Hospital, Mumbai, India
| | - Tarun Pandey
- Department of Radiology and Orthopedics, University of Arkansas for Medical Sciences, Little Rock, AR
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Kalisz KR, Enzerra MD, Paspulati RM. MRI Evaluation of the Response of Rectal Cancer to Neoadjuvant Chemoradiation Therapy. Radiographics 2020; 39:538-556. [PMID: 30844347 DOI: 10.1148/rg.2019180075] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
MRI plays a critical role in the staging and restaging of rectal cancer. Although newly diagnosed early-stage rectal cancers may immediately be amenable to surgical resection, patients with advanced disease first undergo neoadjuvant therapy that consists of a combination of chemotherapy and radiation therapy. Evaluation of rectal cancer after neoadjuvant therapy is best performed with MRI, given its superior soft-tissue contrast and its ability to allow multiplanar imaging and functional evaluation. In this setting, MRI allows accurate evaluation of primary tumor staging, which is determined on the basis of the depth of invasion within and through the rectal wall and the involvement of adjacent organs. MRI can also be used to evaluate posttreatment morphologic components within the tumors, including fibrosis and mucinous changes that have been shown to correlate with the response to treatment. Additional features such as the circumferential resection margin and extramural vascular invasion-factors shown to affect prognosis and local recurrence-are also assessed before and after therapy. Functional assessment with diffusion-weighted MRI and perfusion MRI plays a role in predicting tumor aggressiveness and the likelihood of response to treatment, as well as the extent of residual tumor after therapy. Lymph node staging is also performed at MRI, with assessment of not only lymph node size but also the internal architecture and signal intensity characteristics. ©RSNA, 2019 See discussion on this article by Wasnik and Al-Hawary .
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Affiliation(s)
- Kevin R Kalisz
- From the Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH 44106
| | - Michael D Enzerra
- From the Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH 44106
| | - Raj M Paspulati
- From the Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH 44106
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Terzi C, Bingul M, Arslan NC, Ozturk E, Canda AE, Isik O, Yilmazlar T, Obuz F, Birkay Gorken I, Kurt M, Unlu M, Ugras N, Kanat O, Oztop I. Randomized controlled trial of 8 weeks' vs 12 weeks' interval between neoadjuvant chemoradiotherapy and surgery for locally advanced rectal cancer. Colorectal Dis 2020; 22:279-288. [PMID: 31566843 DOI: 10.1111/codi.14867] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 08/14/2019] [Indexed: 12/12/2022]
Abstract
AIM The aim was to compare the pathological complete response (pCR) rate at 8 compared to 12 weeks' interval between completion of neoadjuvant chemoradiotherapy (CRT) and surgery in patients with locally advanced rectal cancer. METHOD This was a randomized trial which included a total of 330 patients from two institutions. Patients with locally advanced (T3-4N0M0, TxN+M0) rectal cancer were randomized into 8- and 12-week interval groups. All the patients received long-course CRT (45 Gy in 1.8 Gy fractions and concomitant oral capecitabine or 5-fluorouracil infusion). Surgery was performed at either 8 or 12 weeks after CRT. The primary end-point was pCR. Secondary end-points were sphincter preservation, postoperative morbidity and mortality. RESULTS Two-hundred and fifty-two patients (n = 125 in the 8-week group, n = 127 in the 12-week group) were included. Demographic and clinical characteristics were similar between groups. The overall pCR rate was 17.9% (n = 45): 12% (n = 15) in the 8-week group and 23.6% (n = 30) in the 12-week group (P = 0.021). Sphincter-preserving surgery was performed in 107 (85.6%) patients which was significantly higher than the 94 (74%) patients in the 12-week group (P = 0.016). Postoperative mortality was seen in three (1.2%) patients overall and was not different between groups (1.6% in 8 weeks vs 0.8% in 12 weeks, P = 0.494). Groups were similar in anastomotic leak (10.8% in 8 weeks vs 4.5% in 12 weeks, P = 0.088) and morbidity (30.4% in 8 weeks and 20.1% in 12 weeks, P = 0.083). CONCLUSION Extending the interval between CRT and surgery from 8 to 12 weeks resulted in a 2-fold increase in pCR rate without any difference in mortality and morbidity.
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Affiliation(s)
- C Terzi
- Department of General Surgery, Dokuz Eylul University, Izmir, Turkey
| | - M Bingul
- Department of General Surgery, Dokuz Eylul University, Izmir, Turkey
| | - N C Arslan
- Department of General Surgery, Medipol University, Istanbul, Turkey
| | - E Ozturk
- Department of General Surgery, Uludag University Hospital, Bursa, Turkey
| | - A E Canda
- Department of General Surgery, Dokuz Eylul University, Izmir, Turkey
| | - O Isik
- Department of General Surgery, Uludag University Hospital, Bursa, Turkey
| | - T Yilmazlar
- Department of General Surgery, Uludag University Hospital, Bursa, Turkey
| | - F Obuz
- Department of Radiology, Dokuz Eylul University, Izmir, Turkey
| | - I Birkay Gorken
- Department of Radiation Oncology, Dokuz Eylul University, Izmir, Turkey
| | - M Kurt
- Department of Radiation Oncology, Uludag University Hospital, Bursa, Turkey
| | - M Unlu
- Department of Pathology, Dokuz Eylul University, Izmir, Turkey
| | - N Ugras
- Department of Pathology, Uludag University Hospital, Bursa, Turkey
| | - O Kanat
- Department of Medical Oncology, Uludag University Hospital, Bursa, Turkey
| | - I Oztop
- Department of Medical Oncology, Dokuz Eylul University, Izmir, Turkey
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Wei MZ, Zhao ZH, Wang JY. The Diagnostic Accuracy of Magnetic Resonance Imaging in Restaging of Rectal Cancer After Preoperative Chemoradiotherapy: A Meta-Analysis and Systematic Review. J Comput Assist Tomogr 2020; 44:102-110. [PMID: 31939890 DOI: 10.1097/rct.0000000000000964] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the overall diagnostic value of magnetic resonance imaging (MRI) in restaging of rectal cancer after preoperative chemoradiotherapy based on qualified studies. METHODS PubMed, Cochrane, and EMBASE database were searched by the index words to identify the qualified studies, and relevant literature sources were also searched. The latest research was done in April 2019. Heterogeneity of the included studies was tested, which was used to select proper effect model to calculate pooled weighted sensitivity, specificity, and diagnostic odds ratio (DOR). Summary receiver operating characteristic (SROC) analyses were also performed. RESULT Nineteen studies with 1262 patients were involved in the meta-analysis exploring the diagnostic accuracy of MRI for rectal cancer. The diagnostic accuracy of MRI in T3-T4 rectal cancer was as follows: sensitivity, 81% (95% confidence interval [CI], 67%-90%); specificity, 67% (95% CI, 51%-80%); positive likelihood ratio, 2.48 (95% CI, 1.57-3.91); negative likelihood ratio, 0.28 (95% CI, 0.15-0.52); global DOR, 6.86 (95% CI, 3.07-15.30); the area under the SROC was high (0.81; 95% CI, 0.78-0.84). The diagnostic accuracy of MRI in lymphatic metastasis of rectal cancer was as follows: sensitivity, 77% (95% CI, 65%-86%); specificity, 77% (95% CI, 63%-87%); positive likelihood ratio, 3.40 (95% CI, 2.07-5.59); negative likelihood ratio, 0.30 (95% CI, 0.20-0.45); DOR, 10.81 (95% CI, 4.99-23.39); area under the SROC was high (0.84; 95% CI, 0.80-0.87). CONCLUSIONS This study provides a systematic review and meta-analysis of diagnostic accuracy studies of MRI for rectal cancer. The results indicate that MRI is a highly accurate diagnostic tool for rectal cancer T3-T4 staging and N staging but sensitivity and specificity are not high.
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Affiliation(s)
- Ming-Zhu Wei
- From the Department of Radiology, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, Zhejiang Province, China
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