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Kobayashi R, Uehara K, Ebata T, Yatsuya H, Li Y, Hida K, Hashiguchi Y, Ishihara S, Ogawa S, Shiomi A, Kawai K, Ajioka Y. A comparison of the diagnostic ability of 1-mm computed tomography and 3-mm magnetic resonance imaging for detecting lateral pelvic lymph node metastases from rectal cancer. Surg Today 2025:10.1007/s00595-025-03018-w. [PMID: 40011277 DOI: 10.1007/s00595-025-03018-w] [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: 12/09/2024] [Accepted: 02/02/2025] [Indexed: 02/28/2025]
Abstract
AIM The best modality for evaluating lateral pelvic lymph node (LPLN) metastases from rectal cancer remains unclear. This study compared the diagnostic ability of 1-mm computed tomography (CT) and 3-mm magnetic resonance imaging (MRI) in identifying LPLN metastases based on size. METHODS This observational study analyzed not individual patients but 191 sides from 100 rectal cancer patients without preoperative treatment for whom preoperative CT and MRI and corresponding pathological results for LPLNs were available. A swollen LPLN was defined as an LN with a short-axis size of ≥5 mm on 1-mm CT. RESULTS LPLNs were detected significantly more frequently with 1-mm CT than with 3-mm MRI (p < 0.001). Among the 117 sides without swollen LPLNs, metastasis was observed in 1.7% of patients. In contrast, LPLN metastasis was confirmed in 28.4% of 74 sides with swollen LPLNs. In the evaluation of swollen LPLNs, 3-mm MRI yielded a 34% improvement in the diagnostic performance of LPLN metastasis over 1-mm CT (categorical net reclassification improvement: 0.341, p = 0.045). CONCLUSIONS In conclusion, 1-mm CT should be performed preoperatively to evaluate LPLNs. Further evaluations can be omitted in the absence of swollen LPLNs. In patients with swollen LPLNs, a careful assessment of LPLN metastasis should be conducted via additional MRI, even in early T-stage tumors.
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Affiliation(s)
- Ryutaro Kobayashi
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kay Uehara
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
- Department of Gastroenterological Surgery, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
| | - Tomoki Ebata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Yatsuya
- Department of Public Health, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuanying Li
- Department of Public Health, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Koya Hida
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yojiro Hashiguchi
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Shimpei Ogawa
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Akio Shiomi
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Kazushige Kawai
- Department of Colorectal Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Yoichi Ajioka
- Division of Molecular and Diagnostic Pathology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
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2
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Nagainallur Ravichandran S, Das D, Dayananda EK, Dey A, Banerjee A, Sun-Zhang A, Zhang H, Sun XF, Pathak S. A Review on Emerging Techniques for Diagnosis of Colorectal Cancer. Cancer Invest 2024; 42:119-140. [PMID: 38404236 DOI: 10.1080/07357907.2024.2315443] [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: 06/11/2023] [Accepted: 02/02/2024] [Indexed: 02/27/2024]
Abstract
Common detection methods in practice for diagnosing colorectal cancer (CRC) are painful and invasive leading to less participation of individuals for CRC diagnosis. Whereas, improved or enhanced imaging systems and other minimally invasive techniques with shorter detection times deliver greater detail and less discomfort in individuals. Thus, this review is a summary of the diagnostic tests, ranging from the simple potential use in developing a flexible CRC treatment to the patient's potential benefits in receiving less invasive procedures and the advanced treatments that might provide a better assessment for the diagnosis of CRC and reduce the mortality related to CRC.
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Affiliation(s)
- Shruthi Nagainallur Ravichandran
- Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute (CHRI), Chettinad Academy of Research and Education (CARE), Kelambakkam, Chennai, India
| | - Diptimayee Das
- Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute (CHRI), Chettinad Academy of Research and Education (CARE), Kelambakkam, Chennai, India
| | - Erica Katriel Dayananda
- Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute (CHRI), Chettinad Academy of Research and Education (CARE), Kelambakkam, Chennai, India
| | - Amit Dey
- Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute (CHRI), Chettinad Academy of Research and Education (CARE), Kelambakkam, Chennai, India
| | - Antara Banerjee
- Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute (CHRI), Chettinad Academy of Research and Education (CARE), Kelambakkam, Chennai, India
| | - Alexander Sun-Zhang
- Department of Oncology-Pathology, BioClinicum, Karolinska Institutet, Stockholm, Sweden
| | - Hong Zhang
- Faculty of Medicine and Health, School of Medical Sciences, Orebro University, Örebro, Sweden
| | - Xiao-Feng Sun
- Division of Oncology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Surajit Pathak
- Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute (CHRI), Chettinad Academy of Research and Education (CARE), Kelambakkam, Chennai, India
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3
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Ou X, van der Reijd DJ, Lambregts DMJ, Grotenhuis BA, van Triest B, Beets GL, Beets-Tan RGH, Maas M. Sense and non-sense of imaging in the era of organ preservation for rectal cancer. Br J Radiol 2023; 96:20230318. [PMID: 37750870 PMCID: PMC10607404 DOI: 10.1259/bjr.20230318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/17/2023] [Accepted: 08/01/2023] [Indexed: 09/27/2023] Open
Abstract
This review summarizes the current applications and benefits of imaging modalities for organ preservation in the treatment of rectal cancer. The concept of organ preservation in the treatment of rectal cancer has revolutionized the way rectal cancer is managed. Initially, organ preservation was limited to patients with locally advanced rectal cancer who needed neoadjuvant therapy to reduce tumor size before surgery and achieved complete response. However, neoadjuvant therapy is now increasingly utilized for smaller and less aggressive tumors to achieve primary organ preservation. Additionally, more intensive neoadjuvant strategies are employed to improve complete response rates and increase the chances of successful organ preservation. The selection of patients for organ preservation is a critical component of treatment, and imaging techniques such as digital rectal exam, endoscopy, and MRI are commonly used for this purpose. In this review, we provide an overview of what imaging modalities should be chosen and how they can aid in the selection and follow-up of patients undergoing organ-preserving strategies.
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Affiliation(s)
| | | | | | | | - Baukelien van Triest
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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4
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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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Fernandes MC, Gollub MJ, Brown G. The importance of MRI for rectal cancer evaluation. Surg Oncol 2022; 43:101739. [PMID: 35339339 PMCID: PMC9464708 DOI: 10.1016/j.suronc.2022.101739] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 02/20/2022] [Indexed: 12/19/2022]
Abstract
Magnetic resonance imaging (MRI) has gained increasing importance in the management of rectal cancer over the last two decades. The role of MRI in patients with rectal cancer has expanded beyond the tumor-node-metastasis (TNM) system in both staging and restaging scenarios and has contributed to identifying "high" and "low" risk features that can be used to tailor and personalize patient treatment; for instance, selecting the patients for neoadjuvant chemoradiation (NCRT) before the total mesorectal excision (TME) surgery based on risk of recurrence. Among those features, the status of the circumferential resection margin (CRM), extramural vascular invasion (EMVI), and tumor deposits (TD) have stood out. Moreover, MRI also has played a role in surgical planning, especially when the tumor is located in the low rectum, when the relationship between tumor and the anal canal is important to choose the best surgical approach, and in cases of locally advanced or recurrent tumors invading adjacent pelvic organs that may require more complex surgeries such as pelvic exenteration. As approaches using organ preservation emerge, including transanal local excision and "watch-and-wait", MRI may help in the patient selection for those treatments, follow up, and detection of tumor regrowth. Additionally, potential MRI-based prognostic and predictive biomarkers, such as quantitative and semi-quantitative metrics derived from functional sequences like diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE), and radiomics, are under investigation. This review provides an overview of the current role of MRI in rectal cancer in staging and restaging and highlights the main areas under investigation and future perspectives.
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Ramanan RV, Munikrishnan V, Venkataramanan A, Swain SK, Sunilkumar KS, Venu V, Hariharan M, Saipillai MZ, Ahamed A. Accuracy of High Resolution Multidetector Computed Tomography in the Local Staging of Rectal Cancer. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2021. [DOI: 10.1055/s-0041-1726662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Abstract
Background Magnetic resonance imaging (MRI) is the gold standard for local staging of rectal cancer. Advanced computed tomography (CT) machines are now capable of high-resolution images of rectal cancer and utilized for CT perfusion. The possibility of local staging of rectal cancer by CT needs to be explored.
Purpose The aim of the study is to evaluate accuracy of high-resolution CT for local rectal cancer staging.
Methods A high-resolution CT was performed for local staging of rectal cancer in our study group of 93 patients, where 64 underwent primary surgery and 29 underwent surgery post neoadjuvant chemoradiotherapy (NACRT).
Results In differentiating stages T2-and-less than T2 from T3–T4 rectal cancer, accuracy, sensitivity, specificity, and kappa score in overall patients were 91%, 87%, 94%, and 0.8; in primary surgery group were 89%, 76%, 94%, and 0.7; in NACRT group were 97%, 100%, 94%, and 0.9; in low rectal group were 94%, 89%, 97%, and 0.82, respectively.
Conclusion High resolution CT is an accurate tool for local staging of rectal cancer.
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Affiliation(s)
| | | | | | | | | | - Vadanika Venu
- Department of Radiology, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Muthuswamy Hariharan
- Department of Medical Gastroenterology, Apollo Hospitals, Chennai, Tamil Nadu, India
| | | | - Asfar Ahamed
- Department of Colorectal Surgery, Apollo Hospitals, Chennai, Tamil Nadu, India
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7
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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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8
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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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9
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Gal O, Feldman D, Mari A, Baker FA, Hebron D, Kopelman Y. Computerized Tomography Criteria as a Tool for Simplifying the Assessment of Locally Advanced Rectal Cancer. J Gastrointest Cancer 2020; 51:130-134. [PMID: 30854604 DOI: 10.1007/s12029-019-00220-1] [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] [Indexed: 12/24/2022]
Abstract
BACKGROUND Rectal cancer represents a leading cause of mortality worldwide. Staging defines the local and distant extent of the disease, guides management, and predicts prognosis. Different modalities are available for staging including TRUS (transrectal ultrasound), CT (computed tomography), and MRI (magnetic resonance imaging). OBJECTIVE The objective of this study was to screen and isolate CT imaging parameters suggestive of advanced rectal cancer and its utility as a tool in simplifying the staging protocol making further imaging studies unnecessary. DESIGN Retrospective, single center study. PATIENTS AND SETTINGS Seventy-five patients with rectal carcinoma were included and were divided into two groups according to their T score and nodal involvement status, as diagnosed by TRUS. Group 1 (n = 15) "local disease" (T1/T2 N0) and group 2 (n = 60) "locally advanced disease" are both eligible for neoadjuvant treatment (N/any T or T3/any N). For each patient, three CT imaging parameters that represent locally advanced disease, i.e., perirectal fat infiltration, local lymphadenopathy, and rectal wall thickening, were evaluated and compared between the two groups. MAIN OUTCOME MEASURE The capability of CT imaging to accurately predict locally advanced rectal carcinoma. RESULTS Rectal wall thickening on CT was found to have 92% PPV and perirectal lymphadenopathy 96% PPV for predicting a locally advanced stage. A combination of those two parameters results in a predictive PPV of 98%. LIMITATIONS This was a single center retrospective study, with a relatively small cohort. CONCLUSIONS CT is a valuable tool in the assessment and management of rectal carcinoma as it can identify locally advanced rectal cancer. This enables treatment without any further unnecessary evaluation.
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Affiliation(s)
- Oren Gal
- Gastroenterology Department, Hillel Yaffe Medical Center, Hashalom Street, Hadera, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Dan Feldman
- Gastroenterology Department, Hillel Yaffe Medical Center, Hashalom Street, Hadera, Israel.
- Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel.
| | - Amir Mari
- Gastroenterology Department, Hillel Yaffe Medical Center, Hashalom Street, Hadera, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
- Gastroenterology Department, Nazareth Hospital EMMS, Nazareth, Israel
| | - Fadi Abu Baker
- Gastroenterology Department, Hillel Yaffe Medical Center, Hashalom Street, Hadera, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Dan Hebron
- Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
- Radiology Department, Hillel Yaffe Medical Center, Hadera, Israel
| | - Yael Kopelman
- Gastroenterology Department, Hillel Yaffe Medical Center, Hashalom Street, Hadera, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
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Zhou XC, Chen QL, Huang CQ, Liao HL, Ren CY, He QS. The clinical application value of multi-slice spiral CT enhanced scans combined with multiplanar reformations images in preoperative T staging of rectal cancer. Medicine (Baltimore) 2019; 98:e16374. [PMID: 31305437 PMCID: PMC6641797 DOI: 10.1097/md.0000000000016374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
This study aims to evaluate the diagnostic accuracy and clinical application value of multi-slice spiral CT (MSCT) enhanced scans combined with multiplanar reformations (MPRs) images compared with postoperative pathological results in preoperative T staging of rectal cancer.One hundred sixty-eight consecutive patients with rectal cancer were admitted in our hospital between January 2013 and October 2018. Conventional MSCT plain scans, multi-phase dynamic contrast-enhanced scans, and MPRs were performed in all patients before surgical operation. The preoperative T staging of the rectal cancer lesions was evaluated using MSCT enhanced scans combined with MPRs, which was verified by postoperative pathological results. The diagnostic accuracy of MSCT enhanced scans combined with MPRs in evaluating T staging of the rectal cancer lesions were analyzed by χ test and Kappa test.Compared with postoperative pathology, T staging using MSCT enhanced scans combined with MPRs had overall accuracy of 85.7%. Consistency between MSCT enhanced scans combined with MPRs and postoperative pathological staging was effective for T staging (Kappa = 0.658, χ = 4.200, P = .122).Conventional MSCT enhanced scans combined with MPRs are simple and feasible. It is consistent with the pathological diagnosis of evaluating T staging in the rectal cancer lesions. It can provide reliable imaging evidence for the preoperative evaluation of primary rectal cancer, especially in patients with magnetic resonance imaging (MRI) contraindications, or in grass-roots hospitals due to lack of MRI equipment.
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Affiliation(s)
- Xiao-Cong Zhou
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong
- Deparment of Colorectal Surgery
| | | | | | - Hong-Li Liao
- Deparment of Pathology, The Dingli Clinical Institute of Wenzhou Medical University (Wenzhou Central Hospital), Wenzhou, Zhejiang
| | - Chun-Yi Ren
- Deparment of Pathology, The Dingli Clinical Institute of Wenzhou Medical University (Wenzhou Central Hospital), Wenzhou, Zhejiang
| | - Qing-Si He
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, PR China
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CT Staging to Triage Selection of Patients With Poor-Prognosis Rectal Cancer for Neoadjuvant Treatment. AJR Am J Roentgenol 2019; 213:358-364. [PMID: 30995084 DOI: 10.2214/ajr.18.20929] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE. The purpose of this study was to evaluate CT as a screening tool for determining high risk of local recurrence of rectal tumors in a scenario of limited MRI availability. MATERIALS AND METHODS. Data were retrospectively analyzed for 180 consecutively registered patients with rectal adenocarcinoma and no previous treatment who underwent baseline CT and MRI staging within 30 days of each other. Two radiologists independently reviewed CT and MR images. CT scans were interpreted in multiplanar reformation. High risk of local recurrence was based on the MRI reference standard: T3cd (more than 5 mm of mesorectal fat infiltration) or T4 disease, N2 nodal status, mesorectal fascia involvement, extramural venous invasion, or positive pelvic sidewall nodes. The performance of CT for determination of high risk of local tumor recurrence was evaluated. RESULTS. Among the 180 patients 128 (71%) met MRI criteria for high risk of local recurrence. CT sensitivity was 84.4% (108/128) and specificity was 78.8% (41/52). The positive predictive value (PPV) of any high-risk CT feature was 90.7% (108/119). When T status was considered, the sensitivity of CT was 75.2% (79/105), specificity was 90.7% (68/75), and PPV was 91.9% (79/86). When tumors within 5.0 cm of the anal verge were excluded, sensitivity was 89.5% (51/57), specificity was 85.7% (24/28), and PPV was 92.7% (51/55). Using CT for disease staging could reduce MRI use by 66%. CONCLUSION. Tumors at high risk of local recurrence can be identified with CT without baseline MRI. Use of CT rather than MRI could markedly reduce costs of baseline staging and shorten time to initiation of neoadjuvant treatment.
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12
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Tamandl D, Mang T, Ba-Ssalamah A. Imaging of colorectal cancer - the clue to individualized treatment. Innov Surg Sci 2018; 3:3-15. [PMID: 31579761 PMCID: PMC6754048 DOI: 10.1515/iss-2017-0049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 02/20/2018] [Indexed: 12/18/2022] Open
Abstract
Colorectal cancer (CRC) is the most common gastrointestinal neoplasm and the second most common cause for cancer-related death in Europe. Imaging plays an important role both in the primary diagnosis, treatment evaluation, follow-up, and, to some extent, also in prevention. Like in the clinical setting, colon and rectal cancer have to be distinguished as two quite separate entities with different goals of imaging and, consequently, also different technical requirements. Over the past decade, there have been improvements in both more robust imaging techniques and new data and guidelines that help to use the optimal imaging modality for each scenario. For colon cancer, the continued research on computed tomography (CT) colonography (CTC) has led to high-level evidence that puts this technique on eye height to optical colonoscopy in terms of detection of cancer and polyps ≥10 mm. However, also for smaller polyps and thus for screening purposes, CTC seems to be an optimal tool. In rectal cancer, the technical requirements to perform state-of-the art imaging have recently been defined. Evaluation of T-stage, mesorectal fascia infiltration and extramural vascular invasion are the most important prognostic factors that can be identified on MRI. With this information, risk stratification both for local and distal failure is possible, enabling the clinician to tailor the optimal therapeutic approach in non-metastatic rectal cancer. Imaging of metastatic CRC is also covered, although the complex ramifications of treatment options in the metastatic setting are beyond the scope of this article. In this review, the most important recent developments in the imaging of colon and rectal cancer will be highlighted. If used in an interdisciplinary setting, this can lead to an individualized treatment concept for each patient.
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Affiliation(s)
- Dietmar Tamandl
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Thomas Mang
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Ahmed Ba-Ssalamah
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
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13
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Lee CC, Chen PC, Chen HH, Huang CC, Lin LH, Ng SH, Chen MC, Ko SF. Effectiveness of a Tailored Anterior Saturation Band in the Improvement of the Image Quality of Pelvic Magnetic Resonance for Assessing Rectal Cancer. Clin Colorectal Cancer 2017; 16:187-194. [PMID: 28209482 DOI: 10.1016/j.clcc.2017.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 01/13/2017] [Indexed: 01/04/2023]
Abstract
PURPOSE We sought to test the effectiveness of the application of a tailored anterior saturation band (ASB) to improve the image quality of pelvic magnetic resonance imaging (MRI) for assessing rectal cancer. METHODS A total of 165 patients with MRI assessment of rectal cancer between 2013 and 2015 were included. The image quality scores (4-point scale: 1, nondiagnostic through 4, excellent) of MRI without and with tailored ASBs were compared. Sensitivity, specificity, positive and negative predictive values, and accuracy of pelvic MRIs with and without a tailored ASB for T-staging in 65 patients with direct surgery and 67 patients with chemoradiotherapy before surgery were evaluated. RESULTS Two independent raters exhibited moderate-to-excellent interobserver agreements (κ = 0.529-0.879) in the grading of MRI image quality. Overall, the quality scores of sagittal and axial T2-weighted images with tailored ASBs were significantly improved compared with MRIs without ASBs (3.5 ± 0.3 vs. 2.7 ± 0.8 [mean ± SD]; P < .001, and 3.6 ± 0.3 vs. 2.8 ± 0.8; P < .001, respectively). The application of tailored ASBs in MRIs improved the averaged accuracies for staging of ≤ T2, T3, and T4 tumors from 87.7%, 78.5%, and 90.8% to 93.1%, 86.9%, and 97.7%, respectively. In post-chemoradiotherapy MRI follow-ups, the use of tailored ASBs also improved the average accuracies for staging of yT0, yT1-2, yT3, and yT4 tumors from 80.6%, 73.1%, 73.9%, and 91.0%, to 85.8%, 82.9%, 85.1%, and 94.0%, respectively. CONCLUSIONS Application of a tailored ASB in pelvic MRI is effective in substantially reducing motion artifacts, significantly upgrading image quality, and improving accuracies of rectal tumor staging.
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Affiliation(s)
- Chen-Chang Lee
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Biomedical Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Po-Chou Chen
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hong-Hwa Chen
- Department of Colorectal Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chung-Cheng Huang
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Li-Han Lin
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shu-Hang Ng
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Min-Chi Chen
- Biostatistics Consulting Center and Department of Public Health, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheung-Fat Ko
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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14
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Ippolito D, Drago SG, Franzesi CT, Fior D, Sironi S. Rectal cancer staging: Multidetector-row computed tomography diagnostic accuracy in assessment of mesorectal fascia invasion. World J Gastroenterol 2016; 22:4891-4900. [PMID: 27239115 PMCID: PMC4873881 DOI: 10.3748/wjg.v22.i20.4891] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 03/24/2016] [Accepted: 04/07/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the diagnostic accuracy of multidetector-row computed tomography (MDCT) as compared with conventional magnetic resonance imaging (MRI), in identifying mesorectal fascia (MRF) invasion in rectal cancer patients. METHODS Ninety-one patients with biopsy proven rectal adenocarcinoma referred for thoracic and abdominal CT staging were enrolled in this study. The contrast-enhanced MDCT scans were performed on a 256 row scanner (ICT, Philips) with the following acquisition parameters: tube voltage 120 KV, tube current 150-300 mAs. Imaging data were reviewed as axial and as multiplanar reconstructions (MPRs) images along the rectal tumor axis. MRI study, performed on 1.5 T with dedicated phased array multicoil, included multiplanar T2 and axial T1 sequences and diffusion weighted images (DWI). Axial and MPR CT images independently were compared to MRI and MRF involvement was determined. Diagnostic accuracy of both modalities was compared and statistically analyzed. RESULTS According to MRI, the MRF was involved in 51 patients and not involved in 40 patients. DWI allowed to recognize the tumor as a focal mass with high signal intensity on high b-value images, compared with the signal of the normal adjacent rectal wall or with the lower tissue signal intensity background. The number of patients correctly staged by the native axial CT images was 71 out of 91 (41 with involved MRF; 30 with not involved MRF), while by using the MPR 80 patients were correctly staged (45 with involved MRF; 35 with not involved MRF). Local tumor staging suggested by MDCT agreed with those of MRI, obtaining for CT axial images sensitivity and specificity of 80.4% and 75%, positive predictive value (PPV) 80.4%, negative predictive value (NPV) 75% and accuracy 78%; while performing MPR the sensitivity and specificity increased to 88% and 87.5%, PPV was 90%, NPV 85.36% and accuracy 88%. MPR images showed higher diagnostic accuracy, in terms of MRF involvement, than native axial images, as compared to the reference magnetic resonance images. The difference in accuracy was statistically significant (P = 0.02). CONCLUSION New generation CT scanner, using high resolution MPR images, represents a reliable diagnostic tool in assessment of loco-regional and whole body staging of advanced rectal cancer, especially in patients with MRI contraindications.
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15
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Milinis K, Thornton M, Montazeri A, Rooney PS. Adjuvant chemotherapy for rectal cancer: Is it needed? World J Clin Oncol 2015; 6:225-236. [PMID: 26677436 PMCID: PMC4675908 DOI: 10.5306/wjco.v6.i6.225] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 08/01/2015] [Accepted: 09/08/2015] [Indexed: 02/06/2023] Open
Abstract
Adjuvant chemotherapy has become a standard treatment of advanced rectal cancer in the West. The benefits of adjuvant chemotherapy after surgery alone have been well established. However, controversy surrounds the use adjuvant chemotherapy in patients who received preoperative chemoradiotherapy, despite it being recommended by a number of international guidelines. Results of recent multicentre randomised control trials showed no benefit of adjuvant chemotherapy in terms of survival and rates of distant metastases. However, concerns exist regarding the quality of the studies including inadequate staging modalities, out-dated chemotherapeutic regimens and surgical approaches and small sample sizes. It has become evident that not all the patients respond to adjuvant chemotherapy and more personalised approach should be employed when considering the benefits of adjuvant chemotherapy. The present review discusses the strengths and weaknesses of the current evidence-base and suggests improvements for future studies.
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16
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Orsini RG, Wiggers T, DeRuiter MC, Quirke P, Beets-Tan RG, van de Velde CJ, Rutten HJT. The modern anatomical surgical approach to localised rectal cancer. EJC Suppl 2015. [PMID: 26217114 PMCID: PMC4041398 DOI: 10.1016/j.ejcsup.2013.07.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- R G Orsini
- Catharina Hospital, Eindhoven, The Netherlands
| | - T Wiggers
- University Medical Centre Groningen, Groningen, The Netherlands
| | - M C DeRuiter
- Leiden University Medical Centre, Leiden, The Netherlands
| | - P Quirke
- Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK
| | - R G Beets-Tan
- GROW School for Oncology & Developmental Biology, Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - H J T Rutten
- Catharina Hospital, Eindhoven, The Netherlands ; GROW School for Oncology & Developmental Biology, Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
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17
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Raman SP, Chen Y, Fishman EK. Evolution of imaging in rectal cancer: multimodality imaging with MDCT, MRI, and PET. J Gastrointest Oncol 2015; 6:172-84. [PMID: 25830037 DOI: 10.3978/j.issn.2078-6891.2014.108] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 12/13/2014] [Indexed: 12/13/2022] Open
Abstract
Magnetic resonance imaging (MRI), multidetector computed tomography (MDCT), and positron emission tomography (PET) are complementary imaging modalities in the preoperative staging of patients with rectal cancer, and each offers their own individual strengths and weaknesses. MRI is the best available radiologic modality for the local staging of rectal cancers, and can play an important role in accurately distinguishing which patients should receive preoperative chemoradiation prior to total mesorectal excision. Alternatively, both MDCT and PET are considered primary modalities when performing preoperative distant staging, but are limited in their ability to locally stage rectal malignancies. This review details the role of each of these three modalities in rectal cancer staging, and how the three imaging modalities can be used in conjunction.
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Affiliation(s)
- Siva P Raman
- Department of Radiology, Johns Hopkins University, JHOC 3251, 601 N. Caroline Street, Baltimore, MD 21287, USA
| | - Yifei Chen
- Department of Radiology, Johns Hopkins University, JHOC 3251, 601 N. Caroline Street, Baltimore, MD 21287, USA
| | - Elliot K Fishman
- Department of Radiology, Johns Hopkins University, JHOC 3251, 601 N. Caroline Street, Baltimore, MD 21287, USA
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Arya S, Das D, Engineer R, Saklani A. Imaging in rectal cancer with emphasis on local staging with MRI. Indian J Radiol Imaging 2015; 25:148-161. [PMID: 25969638 PMCID: PMC4419424 DOI: 10.4103/0971-3026.155865] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Imaging in rectal cancer has a vital role in staging disease, and in selecting and optimizing treatment planning. High-resolution MRI (HR-MRI) is the recommended method of first choice for local staging of rectal cancer for both primary staging and for restaging after preoperative chemoradiation (CT-RT). HR-MRI helps decide between upfront surgery and preoperative CT-RT. It provides high accuracy for prediction of circumferential resection margin at surgery, T category, and nodal status in that order. MRI also helps assess resectability after preoperative CT-RT and decide between sphincter saving or more radical surgery. Accurate technique is crucial for obtaining high-resolution images in the appropriate planes for correct staging. The phased array external coil has replaced the endorectal coil that is no longer recommended. Non-fat suppressed 2D T2-weighted (T2W) sequences in orthogonal planes to the tumor are sufficient for primary staging. Contrast-enhanced MRI is considered inappropriate for both primary staging and restaging. Diffusion-weighted sequence may be of value in restaging. Multidetector CT cannot replace MRI in local staging, but has an important role for evaluating distant metastases. Positron emission tomography-computed tomography (PET/CT) has a limited role in the initial staging of rectal cancer and is reserved for cases with resectable metastatic disease before contemplating surgery. This article briefly reviews the comprehensive role of imaging in rectal cancer, describes the role of MRI in local staging in detail, discusses the optimal MRI technique, and provides a synoptic report for both primary staging and restaging after CT-RT in routine practice.
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Affiliation(s)
- Supreeta Arya
- Department of Radio-Diagnosis, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Deepak Das
- Department of Radio-Diagnosis, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Reena Engineer
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Avanish Saklani
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
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Burdan F, Sudol-Szopinska I, Staroslawska E, Kolodziejczak M, Klepacz R, Mocarska A, Caban M, Zelazowska-Cieslinska I, Szumilo J. Magnetic resonance imaging and endorectal ultrasound for diagnosis of rectal lesions. Eur J Med Res 2015; 20:4. [PMID: 25586770 PMCID: PMC4304171 DOI: 10.1186/s40001-014-0078-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 12/16/2014] [Indexed: 12/13/2022] Open
Abstract
Endorectal ultrasonography (ERUS) and magnetic resonance imaging (MRI) allow exploring the morphology of the rectum in detail. Use of such data, especially assessment of the rectal wall, is an important tool for ascertaining the perianal fistula localization as well as stage of the cancer and planning it appropriate treatment, as stage T3 tumors are usually treated with neoadjuvant therapy, whereas T2 tumors are initially managed surgically. The only advantage of ERUS over MRI is the possibility of assessing T1 tumors that could be treated by transanal endoscopic microsurgery. However, MRI is better for visualizing most radiological prognostic features in rectal or anal cancer such as a circumferential resection margin less than 1 mm, T stage at T1-T2 or T3 tumors with extramural extension less than 5 mm, absence of extramural vascular invasion, N stage at N0/N1, and tumors located in the middle or upper third of the rectum. It can also evaluate the intersphincteric space or levator ani muscle involvement. Increased signal on diffusion weighted imaging (DWI) and low apparent diffusion coefficient (ADC) values as well as an irregular contour and heterogeneous internal signal intensity seem to predict the involvement of pelvic lymphatic nodes better than their size alone. Computed tomography as well as other examination techniques, including digital rectal examination, contrast edema, recto- and colonoscopy, are less useful in staging of rectal cancer but still are very important screening tools.
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Affiliation(s)
- Franciszek Burdan
- St. John's Cancer Centre, 7 Jaczewskiego Str., 20-090, Lublin, Poland. .,Department of Human Anatomy, Medical University of Lublin, 4 Jaczewskiego Str., 20-090, Lublin, Poland.
| | - Iwona Sudol-Szopinska
- Department of Radiology, Institute of Rheumatology, 1 Spartanska Str., 02-637, Warsaw, Poland. .,Department of Diagnostic Imaging, Second Faculty of Medicine, Medical University of Warsaw, 8 Kondratowicza Str., 03-242, Warsaw, Poland.
| | | | | | - Robert Klepacz
- Department of Clinical Pathomorphology, Medical University of Lublin, 1 Ceramiczna Str., 20-059, Lublin, Poland.
| | | | - Marek Caban
- St. John's Cancer Centre, 7 Jaczewskiego Str., 20-090, Lublin, Poland.
| | | | - Justyna Szumilo
- Department of Clinical Pathomorphology, Medical University of Lublin, 1 Ceramiczna Str., 20-059, Lublin, Poland.
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20
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Evaluation of mesorectal fascia in mid and low anterior rectal cancer using endorectal ultrasound is feasible and reliable: a comparison with MRI findings. Dis Colon Rectum 2014; 57:709-14. [PMID: 24807595 DOI: 10.1097/dcr.0000000000000096] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Accuracy of MRI in assessing mesorectal fascia and predicting circumferential resection margin decreases in low anterior rectal tumors. OBJECTIVE The purpose of this work was to evaluate the accuracy of endorectal ultrasound in predicting the pathologic circumferential resection margin in low rectal anterior tumors and to compare it with MRI findings. DESIGN This was a prospective series comparing the preoperative circumferential resection margin assessed by endorectal ultrasound and MRI with pathologic examination. SETTINGS The study was conducted by a specialized colorectal multidisciplinary team at a tertiary teaching hospital. PATIENTS Between 2002 and 2008, 76 patients with mid to low rectal cancer were preoperatively evaluated by endorectal ultrasound and MRI and underwent total mesorectal excision without neoadjuvant radiochemotherapy. Twenty-seven patients with posterior or postero-lateral tumors were excluded, leaving 49 patients with anterior or antero-lateral tumors for the present subanalysis. We compared preoperative circumferential resection margin status using endorectal ultrasound and MRI with pathologic examination. INTERVENTIONS We conducted a comparison between preoperative circumferential resection margin status and pathologic examination after total mesorectal excision surgery. MAIN OUTCOME MEASURES Accuracy in predicting pathologic circumferential resection margin status was measured. RESULTS Overall accuracy of endorectal ultrasound and MRI in assessing circumferential resection margin status was 83.7% and 91.8%, with negative predictive values of 97.2% and 97.5%. When focusing on low rectal tumors, the overall accuracy of endorectal ultrasound increased to 87.5%, whereas the accuracy of MRI decreased to 87.5%, with a negative predictive value of 95.6% for both diagnostic tests. LIMITATIONS The sample size is small, and interobserver variability in radiologic assessment was not evaluated. CONCLUSIONS Endorectal ultrasound can help MRI in predicting circumferential resection margin involvement in mid to low anterior rectal cancer, especially at the low third of the rectum, with a high negative predictive value.
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21
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Heo SH, Kim JW, Shin SS, Jeong YY, Kang HK. Multimodal imaging evaluation in staging of rectal cancer. World J Gastroenterol 2014; 20:4244-4255. [PMID: 24764662 PMCID: PMC3989960 DOI: 10.3748/wjg.v20.i15.4244] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 12/20/2013] [Accepted: 02/20/2014] [Indexed: 02/06/2023] Open
Abstract
Rectal cancer is a common cancer and a major cause of mortality in Western countries. Accurate staging is essential for determining the optimal treatment strategies and planning appropriate surgical procedures to control rectal cancer. Endorectal ultrasonography (EUS) is suitable for assessing the extent of tumor invasion, particularly in early-stage or superficial rectal cancer cases. In advanced cases with distant metastases, computed tomography (CT) is the primary approach used to evaluate the disease. Magnetic resonance imaging (MRI) is often used to assess preoperative staging and the circumferential resection margin involvement, which assists in evaluating a patient’s risk of recurrence and their optimal therapeutic strategy. Positron emission tomography (PET)-CT may be useful in detecting occult synchronous tumors or metastases at the time of initial presentation. Restaging after neoadjuvant chemoradiotherapy (CRT) remains a challenge with all modalities because it is difficult to reliably differentiate between the tumor mass and other radiation-induced changes in the images. EUS does not appear to have a useful role in post-therapeutic response assessments. Although CT is most commonly used to evaluate treatment responses, its utility for identifying and following-up metastatic lesions is limited. Preoperative high-resolution MRI in combination with diffusion-weighted imaging, and/or PET-CT could provide valuable prognostic information for rectal cancer patients with locally advanced disease receiving preoperative CRT. Based on these results, we conclude that a combination of multimodal imaging methods should be used to precisely assess the restaging of rectal cancer following CRT.
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22
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EURECCA consensus conference highlights about colon & rectal cancer multidisciplinary management: The radiology experts review. Eur J Surg Oncol 2014; 40:469-75. [DOI: 10.1016/j.ejso.2013.10.029] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 10/23/2013] [Accepted: 10/23/2013] [Indexed: 12/17/2022] Open
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23
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EURECCA colorectal: Multidisciplinary management: European consensus conference colon & rectum. Eur J Cancer 2014; 50:1.e1-1.e34. [DOI: 10.1016/j.ejca.2013.06.048] [Citation(s) in RCA: 298] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 06/19/2013] [Indexed: 02/06/2023]
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Ptok H, Ruppert R, Stassburg J, Maurer CA, Oberholzer K, Junginger T, Merkel S, Hermanek P. Pretherapeutic MRI for decision-making regarding selective neoadjuvant radiochemotherapy for rectal carcinoma: Interim analysis of a multicentric prospective observational study. J Magn Reson Imaging 2013; 37:1122-8. [DOI: 10.1002/jmri.23917] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 09/27/2012] [Indexed: 12/29/2022] Open
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25
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Alsanea N. The shortcomings of radiologic staging for rectal cancer and the impact on the treatment plan. Saudi J Gastroenterol 2013; 19:99-100. [PMID: 23680705 PMCID: PMC3709378 DOI: 10.4103/1319-3767.111948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Nasser Alsanea
- Section of Colon and Rectal Surgery, King Faisal Specialist Hospital and Research Center-Riyadh, Riyadh, Saudi Arabia. E-mail:
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26
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Kosinski L, Habr-Gama A, Ludwig K, Perez R. Shifting concepts in rectal cancer management: a review of contemporary primary rectal cancer treatment strategies. CA Cancer J Clin 2012; 62:173-202. [PMID: 22488575 DOI: 10.3322/caac.21138] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The management of rectal cancer has transformed over the last 3 decades and continues to evolve. Some of these changes parallel progress made with other cancers: refinement of surgical technique to improve organ preservation, selective use of neoadjuvant (and adjuvant) therapy, and emergence of criteria suggesting a role for individually tailored therapy. Other changes are driven by fairly unique issues including functional considerations, rectal anatomic features, and surgical technical issues. Further complexity is due to the variety of staging modalities (each with its own limitations), neoadjuvant treatment alternatives, and competing strategies for sequencing multimodal treatment even for nonmetastatic disease. Importantly, observations of tumor response made in the era of neoadjuvant therapy are reshaping some traditionally held concepts about tumor behavior. Frameworks for prioritizing and integrating complex data can help to formulate treatment plans for patients.
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Affiliation(s)
- Lauren Kosinski
- Division of Colorectal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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Popek S, Tsikitis VL, Hazard L, Cohen AM. Preoperative radiation therapy for upper rectal cancer T3,T4/Nx: selectivity essential. Clin Colorectal Cancer 2011; 11:88-92. [PMID: 22154165 DOI: 10.1016/j.clcc.2011.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 06/14/2011] [Indexed: 01/14/2023]
Abstract
This review explores the current available literature regarding the role of neoadjuvant therapy for upper locally advanced rectal cancers (≥10 cm-15 cm). Although there is a paucity of data evaluating the outcomes of preoperative chemoradiation for upper rectal cancers the authors suggest that T3N0 tumors will not likely benefit from radiation and that treatment of T4N0 should be individualized.
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Affiliation(s)
- Sarah Popek
- Department of Surgery, Section of Surgical Oncology, University Medical Center, University of Arizona, Tucson, AZ, USA
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28
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Beets-Tan RGH, Beets GL. Local staging of rectal cancer: a review of imaging. J Magn Reson Imaging 2011; 33:1012-9. [PMID: 21509856 DOI: 10.1002/jmri.22475] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
During the past decades the management of patients with rectal cancer has substantially changed, with a significant reduction in local recurrence rates following the introduction of better imaging, better surgery, and more efficient neoadjuvant therapy. This review discusses the clinically relevant information radiologists should know on staging of rectal cancer patients. The crucial role of the radiologist in patient management is explained. Furthermore, the evidence for the use of magnetic resonance imaging (MRI) in staging and restaging of rectal cancer patients as well as the main features that need to be evaluated when interpreting rectal cancer MRI are given. New diagnostic challenges as a result of new treatment options are also discussed.
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Affiliation(s)
- Regina G H Beets-Tan
- GROW School for Oncology & Developmental Biology, Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands.
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29
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Bertolini G, Prokop M. Multidetector-row computed tomography: Technical basics and preliminary clinical applications in small animals. Vet J 2011; 189:15-26. [DOI: 10.1016/j.tvjl.2010.06.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Revised: 06/03/2010] [Accepted: 06/04/2010] [Indexed: 11/27/2022]
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Ahmetoğlu A, Cansu A, Baki D, Kul S, Cobanoğlu U, Alhan E, Ozdemir F. MDCT with multiplanar reconstruction in the preoperative local staging of rectal tumor. ACTA ACUST UNITED AC 2011; 36:31-7. [PMID: 19949791 DOI: 10.1007/s00261-009-9591-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To evaluate the accuracy of MDCT with multiplanar reconstruction in the preoperative local staging of rectal tumor. MATERIALS AND METHODS Thirty-seven patients with rectal tumor underwent preoperative MDCT. Two radiologists evaluated the depth of tumor invasion (T staging), regional lymph node involvement (N staging) and mesorectal fascia involvement on axial, sagittal, and coronal multiplanar reconstruction images in consensus. MDCT findings were compared with pathologic results, which served as the reference standard. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were assessed. RESULTS Overall accuracy was 86% in T staging, 84% in N staging, 89% in International Union Against Cancer (UICC) Staging, and 94.5% in the prediction of mesorectal fascia involvement. CONCLUSION MDCT with multiplanar reconstruction is an accurate technique in the preoperative local staging of rectal tumor.
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Affiliation(s)
- Ali Ahmetoğlu
- Department of Radiology, Karadeniz Technical University, Farabi Hospital, Trabzon, Turkey.
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31
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Sani F, Foresti M, Parmiggiani A, D'Andrea V, Manenti A, Amorotti C, Scotti R, Gallo E, Torricelli P. 3-T MRI with phased-array surface coil in the local staging of rectal cancer. Radiol Med 2011; 116:375-88. [PMID: 21225363 DOI: 10.1007/s11547-011-0621-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Accepted: 06/02/2010] [Indexed: 02/07/2023]
Abstract
PURPOSE This study sought to evaluate the diagnostic accuracy of surface-coil 3T magnetic resonance (MR) imaging in the preoperative study of patients with rectal cancer. MATERIALS AND METHODS Thirty patients with histologically proven rectal cancer underwent surface-coil 3T MR imaging with sagittal, paracoronal and para-axial T2-weighted turbo spin echo (TSE) sequences. Slice thickness was 3 mm without gap, field of view 24 cm, matrix 400 × 512. Images were assessed for infiltration of the rectal wall, perirectal fat and pelvic structures. Tumours were staged according to the TNM system, and the MR imaging results were correlated with histopathology. RESULTS In the patients who underwent MR imaging before and after radiotherapy (group 1), the diagnostic accuracy of 3T MR imaging was 88% for T2, 94% for T3 and 88% for T4 cancers. In those who underwent surgical treatment without preoperative radiotherapy (group 2), the diagnostic accuracy was 90% for T2, 87% for T3 and 87% for T4 cancers. CONCLUSIONS The high signal-to-noise ratio coupled with a large field of view enables surface-coil 3T MR imaging to achieve high levels of diagnostic accuracy in the local staging of rectal cancer, and in particular in assessing infiltration of mesorectum and mesorectal fascia.
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Affiliation(s)
- F Sani
- Department of Radiology, Azienda Ospedaliera Universitaria, Policlinico, Modena, Italy.
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Abstract
BACKGROUND AND PURPOSE During the first decade of the 21st century several important European randomized studies in rectal cancer have been published. In order to help shape clinical practice based on best scientific evidence, the International Conference on 'Multidisciplinary Rectal Cancer Treatment: Looking for an European Consensus' (EURECA-CC2) was organized. This article summarizes the consensus about imaging and radiotherapy of rectal cancer and gives an update until May 2010. METHODS Consensus was achieved using the Delphi method. Eight chapters were identified: epidemiology, diagnostics, pathology, surgery, radiotherapy and chemotherapy, treatment toxicity and quality of life, follow-up, and research questions. Each chapter was subdivided by topic, and a series of statements were developed. Each committee member commented and voted, sentence by sentence three times. Sentences which did not reach agreement after voting round # 2 were openly debated during the Conference in Perugia (Italy) December 2008. The Executive Committee scored percentage consensus based on three categories: "large consensus", "moderate consensus", "minimum consensus". RESULTS The total number of the voted sentences was 207. Of the 207, 86% achieved large consensus, 13% achieved moderate consensus, and only three (1%) resulted in minimum consensus. No statement was disagreed by more than 50% of members. All chapters were voted on by at least 75% of the members, and the majority was voted on by >85%. Considerable progress has been made in staging and treatment, including radiation treatment of rectal cancer. CONCLUSIONS This Consensus Conference represents an expertise opinion process that may help shape future programs, investigational protocols, and guidelines for staging and treatment of rectal cancer throughout Europe. In spite of substantial progress, many research challenges remain.
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Dresen RC, Kusters M, Daniels-Gooszen AW, Cappendijk VC, Nieuwenhuijzen GAP, Kessels AGH, de Bruïne AP, Beets GL, Rutten HJT, Beets-Tan RGH. Absence of tumor invasion into pelvic structures in locally recurrent rectal cancer: prediction with preoperative MR imaging. Radiology 2010; 256:143-50. [PMID: 20574091 DOI: 10.1148/radiol.10090725] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To retrospectively assess the accuracy of preoperative magnetic resonance (MR) imaging for identification of tumor invasion into pelvic structures in patients with locally recurrent rectal cancer scheduled to undergo curative resection. MATERIALS AND METHODS The institutional review board approved this study, and informed consent was waived because of the retrospective nature of the study. Preoperative MR images in 40 consecutive patients with locally recurrent rectal cancer scheduled to undergo curative treatment between October 2003 and November 2006 were analyzed retrospectively. Four observers with different levels of experience in reading pelvic MR images assessed tumor invasion into the following structures: bladder, uterus or seminal vesicles, vagina or prostate, left and right pelvic walls, and sacrum. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated, and a receiver operating characteristic curve was constructed. Surgical and/or histopathologic findings were used as the reference standard. Interobserver agreement was measured by using kappa statistics. RESULTS Preoperative MR imaging was accurate for the prediction of tumor invasion into structures with negative predictive values of 93%-100% and areas under receiver operating characteristic curves of 0.79-1.00 for all structures and observers. Positive predictive values were 53%-100%. Disease was overstaged in 11 (observer 1), 22 (observer 2), 10 (observer 3), and nine (observer 4) structures and was understaged in nine (observer 3) and two (observer 4) structures. Assessment failures were mainly because of misinterpretation of diffuse fibrosis, especially at the pelvic side walls. Interobserver agreement ranged between 0.64 and 0.99 for experienced observers. CONCLUSION Preoperative MR imaging is accurate for the prediction of absence of tumor invasion into pelvic structures. MR imaging may be useful as a preoperative road map for surgical procedure and may thus increase chances of complete resection. Interpretation of diffuse fibrosis remains difficult.
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Affiliation(s)
- Raphaëla C Dresen
- Department of Radiology, Maastricht University Medical Center, Postbus 5800, Maastricht, the Netherlands
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Herrmann KA, Paspulati RM, Lauenstein T, Reiser MF. Benefits and challenges in bowel MR imaging at 3.0 T. Top Magn Reson Imaging 2010; 21:165-175. [PMID: 21847036 DOI: 10.1097/rmr.0b013e31822a3294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Abdominal imaging at 3.0 T has shown to be challenging because of a number of artifacts and effects related to the physics at higher field strength. For bowel imaging at 3.0 T, artifacts due to magnetic field inhomogeneities, standing waves, increased susceptibility, and greater chemical shift effects are of particular concern because they are likely to affect the assessment of relevant structures and counterbalance the benefits of higher signal-to-noise ratio. Regarding small- and large-bowel magnetic resonance imaging, the benefits of higher field strengths translate mainly in better contrast-to-noise ratio of contrast-enhanced T1-weighted gradient echo and T2-weighted imaging, whereas steady-state free precession sequences seem to suffer from serious degradation of image quality. The present article summarizes the technical challenges in bowel imaging at 3.0 T, provides an overview of performance compared with 1.5 T in small- and large-bowel diseases including the rectum, and revises the current literature.
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Affiliation(s)
- Karin A Herrmann
- Institute of Clinical Radiology, Ludwig-Maximilians-University Munich, University Hospitals Munich, Munich, Germany.
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Punwani S, Taylor SA, Bainbridge A, Prakash V, Bandula S, De Vita E, Olsen OE, Hain SF, Stevens N, Daw S, Shankar A, Bomanji JB, Humphries PD. Pediatric and Adolescent Lymphoma:Comparison of Whole-Body STIR Half-Fourier RARE MR Imaging with an Enhanced PET/CT Reference for Initial Staging. Radiology 2010; 255:182-90. [DOI: 10.1148/radiol.09091105] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Valvo F, Mantello G, Coco C, Corvò R, Gambacorta MA, Genovesi D, Lupattelli M, Valentini V. Rectal Cancer Multidisciplinary Treatment: Evidences, Consensus and Perspectives. TUMORI JOURNAL 2010; 96:185-90. [DOI: 10.1177/030089161009600201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Francesca Valvo
- Radiotherapy Department, Fondazione
IRCCS Istituto Nazionale dei Tumori, Milan
| | | | - Claudio Coco
- Surgery Department, Policlinico A
Gemelli, Catholic University of Rome
| | | | | | | | | | - Vincenzo Valentini
- Radiotherapy Department, Policlinico A
Gemelli, Catholic University of Rome
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Can CT replace MRI in preoperative assessment of the circumferential resection margin in rectal cancer? Dis Colon Rectum 2010; 53:308-14. [PMID: 20173478 DOI: 10.1007/dcr.0b013e3181c5321e] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
UNLABELLED The surgical circumferential resection margin in total mesorectal excision surgery is defined by the relationship of the tumor to the mesorectal fascia. Patients with anticipated tumor invasion of the mesorectal fascia receive neoadjuvant therapy to downstage/downsize the tumor and to obtain tumor-free resection margins.Tumor relationship to the mesorectal fascia is accurately determined by MRI. Compared with MRI, multidetector-row computed tomography is more widely available, faster, less costly, and provides the ability to simultaneously assess the liver, peritoneum, and retroperitoneum for metastases. PURPOSE The objective of this study was to compare the accuracy of multidetector-row CT with conventional MRI in diagnosis of rectal cancer invasion of the mesorectal fascial envelope. MATERIALS AND METHODS During a 2-year period, all patients were enrolled in this study who had biopsy-proven rectal carcinoma and were referred, as a part of the routine preoperative staging workup, for a CT scan of the abdomen and pelvis and also an MRI of the pelvis.All examinations were reviewed independently by 2 radiologists who were blinded from one another, from the findings of the other modality, and from clinical information. Both observers were dedicated abdominal radiologists who are experienced in reading pelvic CT and MRI. Categorical agreement between MRI and multidetector-row CT for all the evaluated parameters of the tumor position, mesorectal fascia, and lymph nodes, as well as the interobserver agreement between CT and MRI, was determined by the intraclass correlation weighted kappa statistic to measure the data set's consistency. RESULTS Among the study's 92 patients, the tumor characteristics suggested by multidetector-row CT agreed with those of MRI, with a weighted kappa ranging from 0.488 to 0.748 for the first reader and 0.577 to 0.800 for the second reader. Interobserver agreement ranged from 0.506 to 0.746.Agreement regarding mesorectal fascia characteristics differed significantly between multidetector-row CT and MRI, depending on the level of assessment. In the distal rectum, agreement was 0.207 for the first reader and 0.385 for the second reader. In the mid rectum, agreement was 0.420 and 0.527, respectively, and in the proximal rectum agreement was 0.508 and 0.520. Interobserver agreement was 0.737 at the distal level and 0.700 at the mid and proximal levels. Agreement regarding measurement of the distance from the tumor to the mesorectal fascia was 0.425 for the first reader and 0.723 for the second reader, with interobserver agreement of 0.766. Agreement in assessment of the number of lymph nodes ranged from 0.743 to 0.787 for the first reader and 0.754 to 0.840 for the second reader. Interobserver agreement ranged from 0.779 to 0.841. Agreement in assessment of the size of the lymph nodes ranged from 0.540 to 0.830 for the first reader and 0.850 to 0.940 for the second reader. Interobserver agreement ranged from 0.900 to 0.920. Agreement in assessment of the distance from nodes to the mesorectal fascia was 0.320 for the first reader and 0.401 for the second reader, with interobserver agreement of 0.950. CONCLUSION The results of this study differ from previously published data by demonstrating substantial agreement between readers in multidetector-row CT assessment of the tumor, mesorectal fascia, and lymph nodes. With the exceptions of mesorectal fascia in the distal rectum and the distance from the nodes to mesorectal fascia, other evaluated parameters were assessed with moderate and substantial agreement between multidetector-row CT and MRI. However, our findings suggest that multidetector-row CT does not correlate well enough with MRI findings to replace it in rectal cancer staging.
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Valentini V, Aristei C, Glimelius B, Minsky BD, Beets-Tan R, Borras JM, Haustermans K, Maingon P, Overgaard J, Pahlman L, Quirke P, Schmoll HJ, Sebag-Montefiore D, Taylor I, Van Cutsem E, Van de Velde C, Cellini N, Latini P. Multidisciplinary Rectal Cancer Management: 2nd European Rectal Cancer Consensus Conference (EURECA-CC2). Radiother Oncol 2009; 92:148-63. [PMID: 19595467 DOI: 10.1016/j.radonc.2009.06.027] [Citation(s) in RCA: 223] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2009] [Revised: 06/11/2009] [Accepted: 06/27/2009] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE During the first decade of the 21st century a number of important European randomized studies were published. In order to help shape clinical practice based on best scientific evidence from the literature, the International Conference on 'Multidisciplinary Rectal Cancer Treatment: Looking for an European Consensus' (EURECA-CC2) was organized in Italy under the endorsement of European Society of Medical Oncology (ESMO), European Society of Surgical Oncology (ESSO), and European Society of Therapeutic Radiation Oncology (ESTRO). METHODS Consensus was achieved using the Delphi method. The document was available to all Committee members as a web-based document customized for the consensus process. Eight chapters were identified: epidemiology, diagnostics, pathology, surgery, radiotherapy and chemotherapy, treatment toxicity and quality of life, follow-up, and research questions. Each chapter was subdivided by a topic, and a series of statements were developed. Each member commented and voted, sentence by sentence thrice. Sentences upon which an agreement was not reached after voting round # 2 were openly debated during a Consensus Conference in Perugia (Italy) from 11 December to 13 December 2008. A hand-held televoting system collected the opinions of both the Committee members and the audience after each debate. The Executive Committee scored percentage consensus based on three categories: "large consensus", "moderate consensus", and "minimum consensus". RESULTS The total number of the voted sentences was 207. Of the 207, 86% achieved large consensus, 13% achieved moderate consensus, and only 3 (1%) resulted in minimum consensus. No statement was disagreed by more than 50% of the members. All chapters were voted on by at least 75% of the members, and the majority was voted on by >85%. CONCLUSIONS This Consensus Conference represents an expertise opinion process that may help shape future programs, investigational protocols, and guidelines for staging and treatment of rectal cancer throughout Europe.
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Affiliation(s)
- Vincenzo Valentini
- Cattedra di Radioterapia, Università Cattolica del Sacro Cuore, Policlinico Universitario A. Gemelli, largo Gemelli 8, Rome, Italy.
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Yeung JMC, Ferris NJ, Lynch AC, Heriot AG. Preoperative staging of rectal cancer. Future Oncol 2009; 5:1295-306. [DOI: 10.2217/fon.09.100] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Preoperative staging is now an essential factor in the multidisciplinary management of rectal cancer because tumor stage is the strongest predictive factor for recurrence. Preoperative staging of rectal cancer can be divided into either local or distant staging. Local staging incorporates the assessment of mural wall invasion, circumferential resection margin involvement, as well as the nodal status for metastasis. Distant staging assesses for evidence of metastatic disease. The aim of this review is to consider the indications and limitations of the current preoperative imaging modalities for rectal cancer staging including clinical examination, endorectal ultrasound, magnetic resonance imaging, computed tomography and positron emission tomography–computed tomography, with respect to local and distant disease.
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Affiliation(s)
- Justin MC Yeung
- Colorectal Fellow, Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Nicholas J Ferris
- Consultant Radiologist, Department of Diagnostic Radiology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - A Craig Lynch
- Consultant Surgeon, Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Alexander G Heriot
- Consultant Surgeon, Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
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Imaging for staging and response assessment in rectal cancer. CURRENT COLORECTAL CANCER REPORTS 2009. [DOI: 10.1007/s11888-009-0031-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Baatrup G, Endreseth BH, Isaksen V, Kjellmo Ä, Tveit KM, Nesbakken A. Preoperative staging and treatment options in T1 rectal adenocarcinoma. Acta Oncol 2009; 48:328-42. [PMID: 19180365 DOI: 10.1080/02841860802657243] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Major rectal resection for T1 rectal cancer offers more than 95% cancer specific five-year survival to patients surviving the first 30 days after surgery. A significant further improvement by development of the surgical technique may not be possible. Improvements in the total survival rate have to come from a more differentiated treatment modality, taking patient and procedure related risk factors into account. Subgroups of patients have operative mortality risks of 10% or more. Operative complications and long-term side effects after rectum resection are frequent and often severe. RESULTS Local treatment of T1 cancers combined with close follow-up, early salvage surgery or later radical resection of local recurrences or with chemo-radiation may lead to fewer severe complications and comparable, or even better, long-term survival. Accurate preoperative staging and careful selection of patients for local or non-operative treatment are mandatory. As preoperative staging, at present, is not sufficiently accurate, strategies for completion, salvage or rescue surgery is important, and must be accepted by the patient before local treatment for cure is initiated. RECOMMENDATIONS It is recommended that polyps with low-risk T1 cancers should be treated with endoscopic snare resection in case of Haggitt's stage 1 or 2. TEM is recommended if resection margins are uncertain after snare resection for Haggitt's stage 3 and 4, and for sessile and flat, low-risk T1 cancers. Average risk patients with high-risk T1 cancers should be offered rectum resection, but old and comorbid patients with high-risk T1 cancers should be treated individually according to objective criteria as age, physical performance as well as patient's preference. All patients treated for cure with local resection or non-surgical methods should be followed closely.
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Abstract
Among imaging techniques, magnetic resonance imaging (MRI) has evolved as the most robust technique for the detection, characterization, and staging of anorectal cancers. With its superior contrast resolution, multiplanar imaging capability, and nil radiation risk, it has become the standard preoperative imaging tool in rectal tumors. In this article we aim to outline the various types of anorectal cancers, highlight the complex anatomy of this region, and discuss the immensely useful role of MRI in the management of anorectal cancers. Existing limitations and future applications in this area will also be discussed. Because rectal adenocarcinomas constitute the majority of tumors in this region, we will be discussing the input of MRI in the management of this condition in greater detail. This will be followed by an overview of MRI in anal carcinoma and other less common anorectal neoplasms.
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Affiliation(s)
- Girish Raghunathan
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
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Abstract
Rectal cancer is one of the most common causes of death from cancer. Accurate staging is necessary for optimal treatment. The tumor node metastasis (TNM) system is used to describe numerically the anatomical extent of cancer. Various diagnostic methods provide accurate staging. Endorectal ultrasound (EUS) and magnetic resonance tomography (MR) are most adequate for determining tumor stage. Moreover, MR is highly accurate in predicting the circumferential resection margin. Accurate node staging remains however difficult with both EUS and MR. Modern multidetector row CT is predestined for detecting distant metastases as it is a widespread, fast, and reproducible method.
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