|
1
|
Yazdi SNM, Moradi SA, Rasoulighasemlouei SS, Parouei F, Hashemi MG. Quantitative Dynamic Contrast-Enhanced Magnetic Resonance Imaging and Positron Emission Tomography (PET) for Distinguishing Metastatic Lymph Nodes from Nonmetastatic Among Patients with Rectal Cancer: A Systematic Review and Meta-Analysis. World J Nucl Med 2025; 24:3-12. [PMID: 39959143 PMCID: PMC11828646 DOI: 10.1055/s-0044-1788794] [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] [Indexed: 02/18/2025] Open
Abstract
Objective The objective of this research was to assess the proficiency of quantitative dynamic contrast-enhanced magnetic resonance imaging (QDCE-MRI) and positron emission tomography (PET) imaging in distinguishing between metastatic and nonmetastatic lymph nodes in cases of rectal carcinoma. Method This meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards. Two independent reviewers systematically searched databases including PubMed, Embase, Web of Science, and the Cochrane Library. The research took place in July 2022, with no restriction on the initial date of publication. For the analysis, we utilized Stata software (version 16.0), Review Manager (version 5.3), and the Open Meta-Analyst computational tool. Results A total of 19 studies consisting of 1,451 patients were included in the current meta-analysis. The differences between metastatic and nonmetastatic lymph node parameters were significant by using short axis and Ktrans (6.9 ± 4 vs. 5.4 ± 0.5, 0.22 ± 0.1 vs. 0.14 ± 0.1, respectively). Contrast-enhanced MRI (CE-MRI) showed 73% sensitivity, 71% specificity, and 79% accuracy in detecting metastatic lymph nodes among rectal cancer patients based on six included studies ( n = 530). The overall sensitivity, specificity, and accuracy of QDCE-MRI using Ktrans was calculated to be 80, 79, and 80%, respectively. Furthermore, PET-computed tomography (CT) showed a sensitivity of 80%, specificity of 91%, and accuracy of 86% in distinguishing metastatic lymph nodes. Quality utility analysis showed that using CE-MRI, QDCE-MRI, and PET-CT would increase the posttest probability to 69, 73, and 85%, respectively. Conclusion QDCE-MRI demonstrates a commendable sensitivity and specificity, but slightly overshadowed by the higher specificity of PET-CT at 91%, despite comparable sensitivities. However, the heterogeneity in PET-CT sensitivity across studies and its high specificity indicate variability that can influence clinical decision-making. Thus, combining these imaging techniques and perhaps newer methods like PET/MRI could enhance diagnostic accuracy, reduce variability, and improve patient management strategies in rectal cancer.
Collapse
Affiliation(s)
| | - Sahand Adib Moradi
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | | | - Fatemeh Parouei
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | |
Collapse
|
|
2
|
Geubels BM, Maas M, Beets GL, Grotenhuis BA. What To Do With Suspected Nodal Regrowth on MRI During Follow-Up in an Organ Preservation Approach for Rectal Cancer? Dis Colon Rectum 2024; 67:1528-1535. [PMID: 39250317 DOI: 10.1097/dcr.0000000000003385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
BACKGROUND For nodal regrowth in patients with rectal cancer following watch-and-wait, standardized protocols on diagnostic procedures and subsequent treatment are lacking. OBJECTIVE To evaluate the diagnosis and treatment of suspected nodal regrowth following an organ preservation approach. SETTINGS Patients were included from national and institutional watch-and-wait databases. DESIGN Thirty-five rectal cancer patients with suspected nodal regrowth on MRI were retrospectively identified during watch-and-wait follow-up. PATIENTS Twenty-seven of 35 patients followed the watch-and-wait schedule after neoadjuvant (chemo)radiotherapy and 8 of 35 patients followed the watch-and-wait schedule after local excision for early rectal cancer. MAIN OUTCOME MEASURES Diagnostic procedures, treatment, and histopathological outcome. RESULTS The median follow-up was 34 months. The median time from the end of (chemo)radiotherapy or local excision to the first detection of suspected nodal regrowth on MRI following watch-and-wait was 9 and 10 months. After the first detection, 17 of 35 patients underwent immediate treatment without further diagnostics, of whom 7 also had luminal regrowth. In 18 of 35 patients, additional diagnostic procedures were performed. In 4 of 18 patients, PET-CT or endorectal ultrasound-guided biopsy was performed, and treatment was initiated on the basis of increased nodal regrowth suspicion. In 14 of 18 patients, MRI was repeated after 8 to 12 weeks: growth of suspected lymph nodes was the most decisive factor to proceed to treatment. In 8 patients, repeated MRI was combined with PET-CT and/or endorectal ultrasound-guided biopsy: in half of them, it contributed to treatment initiation. In total, 34 of 35 patients were treated: 9 received (re-)irradiation and 33 underwent total mesorectal excision. In 27 of 33 patients, nodal regrowth was pathologically confirmed in the total mesorectal excision-resection specimen; 5 of 6 patients without nodal involvement had pathologically confirmed luminal regrowth. LIMITATIONS Highly selected study population. CONCLUSIONS During watch-and-wait follow-up of patients with rectal cancer in an organ preservation strategy, MRI plays an important role in the diagnosis of nodal regrowth. Repeated MRI after an interval can be helpful in making treatment decisions, and the role of PET-CT and endorectal ultrasound-guided biopsy appears limited. See Video Abstract . QU HACER ANTE LA SOSPECHA DE UN NUEVO CRECIMIENTO GANGLIONAR EN LA RESONANCIA MAGNTICA DURANTE EL SEGUIMIENTO EN UN ENFOQUE DE PRESERVACIN DE RGANOS PARA EL CNCER DE RECTO ANTECEDENTES:Para el recrecimiento ganglionar en pacientes con cáncer de recto posterior a watch-and-wait (W&W), faltan protocolos estandarizados de sobre procedimientos de diagnóstico y tratamiento subsecuente.OBJETIVO:Evaluar el diagnóstico y tratamiento de sospecha de recrecimiento ganglionar posterior a tratamiento de preservación del órgano.ENTORNO CLINICO:Se incluyeron pacientes de la base de datos W&W nacionales e institucionales.DISEÑO:Se identificaron retrospectivamente 35 pacientes con cáncer de recto con sospecha de recrecimiento ganglionar en la resonancia magnética durante el seguimiento de W&W.PACIENTES:27 de 35 pacientes siguieron el programa W&W después de (quimio)radioterapia neoadyuvante y 8 de 35 siguieron el programa W&W después de la escisión local en cáncer rectal temprano.PRINCIPALES MEDIDAS DE RESULTADO:Procedimientos de diagnóstico, tratamiento y resultado histopatológico.RESULTADOS:La mediana de seguimiento fue de 34 meses. La mediana de tiempo desde el final de la (quimio)radioterapia o la escisión local hasta la primera detección de un presunto recrecimiento ganglionar en la resonancia magnética después de W&W fue de 9 y 10 meses. Después de la primera detección, 17 de 35 pacientes fueron sometidos a tratamiento inmediato sin diagnóstico adicional, de los cuales 7 también tuvieron un nuevo crecimiento luminal. En 18 de 35 pacientes se realizaron procedimientos de diagnóstico adicionales. En 4 de 18 pacientes se realizó PET-CT o biopsia guiada por ecografía endorrectal (ERUS) y se inició tratamiento en base a una mayor sospecha de recrecimiento ganglionar. En 14 de 18 pacientes, la resonancia magnética se repitió después de 8 a 12 semanas: el crecimiento de los ganglios linfáticos sospechosos fue el factor más decisivo para proceder al tratamiento. En 8 pacientes, la resonancia magnética repetida se combinó con PET-CT y/o biopsia guiada por ERUS: en la mitad de ellos contribuyó al inicio del tratamiento. En total, se trataron 34 de 35 pacientes: 9 recibieron (re)irradiación y 33 se sometieron a escisión total de mesorrecto. En 27 de 33 pacientes se confirmó patológicamente el recrecimiento ganglionar en la muestra de escisión total de mesorrecto; 5 de 6 pacientes sin afectación ganglionar tuvieron un recrecimiento luminal patológicamente confirmado.LIMITACIONES:Población de estudio altamente seleccionada.CONCLUSIONES:Durante el seguimiento de W&W de pacientes con cáncer de recto en estrategia de preservación de órganos, la resonancia magnética juega un papel importante en el diagnóstico del recrecimiento ganglionar. La repetición de la resonancia magnética después de un intervalo puede ser útil para tomar decisiones de tratamiento, y el papel de la PET-CT y la biopsia guiada por ERUS parece limitado. (Traducción- Dr. Francisco M. Abarca-Rendon ).
Collapse
Affiliation(s)
- Barbara M Geubels
- Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Monique Maas
- Department of Radiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Geerard L Beets
- Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Brechtje A Grotenhuis
- Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| |
Collapse
|
|
3
|
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.
Collapse
|
|
4
|
Binda C, Secco M, Tuccillo L, Coluccio C, Liverani E, Jung CFM, Fabbri C, Gibiino G. Early Rectal Cancer and Local Excision: A Narrative Review. J Clin Med 2024; 13:2292. [PMID: 38673565 PMCID: PMC11051053 DOI: 10.3390/jcm13082292] [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: 03/20/2024] [Revised: 04/03/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
A rise in the incidence of early rectal cancer consequent to bowel-screening programs around the world and an increase in the incidence in young adults has led to a growing interest in organ-sparing treatment options. The rectum, being the most distal portion of the large intestine, is a fertile ground for local excision techniques performed with endoscopic or surgical techniques. Moreover, the advancement in endoscopic optical evaluation and the better definition of imaging techniques allow for a more precise local staging of early rectal cancer. Although the local treatment of early rectal cancer seems promising, in clinical practice, a significant number of patients who could benefit from local excision techniques undergo total mesorectal excision (TME) as the first approach. All relevant prospective clinical trials were identified through a computer-assisted search of the PubMed, EMBASE, and Medline databases until January 2024. This review is dedicated to endoscopic and surgical local excision in the treatment of early rectal cancer and highlights its possible role in current and future clinical practice, taking into account surgical completion techniques and chemoradiotherapy.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, 47121 Forlì, Italy; (C.B.); (M.S.); (L.T.); (C.C.); (E.L.); (C.F.M.J.); (G.G.)
| | | |
Collapse
|
|
5
|
Jayaprakasam VS, Ince S, Suman G, Nepal P, Hope TA, Paspulati RM, Fraum TJ. PET/MRI in colorectal and anal cancers: an update. Abdom Radiol (NY) 2023; 48:3558-3583. [PMID: 37062021 DOI: 10.1007/s00261-023-03897-y] [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: 02/06/2023] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 04/17/2023]
Abstract
Positron emission tomography (PET) in the era of personalized medicine has a unique role in the management of oncological patients and offers several advantages over standard anatomical imaging. However, the role of molecular imaging in lower GI malignancies has historically been limited due to suboptimal anatomical evaluation on the accompanying CT, as well as significant physiological 18F-flurodeoxyglucose (FDG) uptake in the bowel. In the last decade, technological advancements have made whole-body FDG-PET/MRI a feasible alternative to PET/CT and MRI for lower GI malignancies. PET/MRI combines the advantages of molecular imaging with excellent soft tissue contrast resolution. Hence, it constitutes a unique opportunity to improve the imaging of these cancers. FDG-PET/MRI has a potential role in initial diagnosis, assessment of local treatment response, and evaluation for metastatic disease. In this article, we review the recent literature on FDG-PET/MRI for colorectal and anal cancers; provide an example whole-body FDG-PET/MRI protocol; highlight potential interpretive pitfalls; and provide recommendations on particular clinical scenarios in which FDG-PET/MRI is likely to be most beneficial for these cancer types.
Collapse
Affiliation(s)
- Vetri Sudar Jayaprakasam
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| | - Semra Ince
- Department of Radiology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Garima Suman
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Pankaj Nepal
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Thomas A Hope
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, CA, USA
| | | | - Tyler J Fraum
- Department of Radiology, Washington University School of Medicine, Saint Louis, MO, USA
| |
Collapse
|
|
6
|
Peng W, Qiao H, Mo L, Guo Y. Progress in the diagnosis of lymph node metastasis in rectal cancer: a review. Front Oncol 2023; 13:1167289. [PMID: 37519802 PMCID: PMC10374255 DOI: 10.3389/fonc.2023.1167289] [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: 03/15/2023] [Accepted: 06/28/2023] [Indexed: 08/01/2023] Open
Abstract
Historically, the chief focus of lymph node metastasis research has been molecular and clinical studies of a few essential pathways and genes. Recent years have seen a rapid accumulation of massive omics and imaging data catalyzed by the rapid development of advanced technologies. This rapid increase in data has driven improvements in the accuracy of diagnosis of lymph node metastasis, and its analysis further demands new methods and the opportunity to provide novel insights for basic research. In fact, the combination of omics data, imaging data, clinical medicine, and diagnostic methods has led to notable advances in our basic understanding and transformation of lymph node metastases in rectal cancer. Higher levels of integration will require a concerted effort among data scientists and clinicians. Herein, we review the current state and future challenges to advance the diagnosis of lymph node metastases in rectal cancer.
Collapse
Affiliation(s)
- Wei Peng
- Medical Big Data and Bioinformatics Research Centre, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
- School of Public Health and Health Management, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Huimin Qiao
- Medical Big Data and Bioinformatics Research Centre, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
- School of Public Health and Health Management, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Linfeng Mo
- School of Health and Medicine, Guangzhou Huashang Vocational College, Guangzhou, Guangdong, China
| | - You Guo
- Medical Big Data and Bioinformatics Research Centre, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| |
Collapse
|
|
7
|
Chen MZ, Zhang X, Mui M, Kong JCH, Heriot AG, Ellis-Clark J. Retrospective audit: Utility of PET scan in routine preoperative rectal cancer staging. ANZ J Surg 2023; 93:617-621. [PMID: 36117452 DOI: 10.1111/ans.18058] [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: 08/06/2022] [Revised: 08/30/2022] [Accepted: 09/02/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Accurate staging for rectal cancer is pertinent with recent introduction of rectum-sparing approaches for patients showing complete clinical response on restaging. Positron emission tomography(PET) is used in detection of recurrence or metastasis, but its value in routine preoperative rectal cancer staging remains unclear. Studies report that preoperative PET altered the stage in 39% and changed the management in 17-27% of patients. Our study aims to look at the utility of PET in routine preoperative staging of rectal cancer within 2 two colorectal units, and to determine if PET did result in a change in management. METHODS Patients in Nepean Hospital (NSW) and Peter MacCallum Cancer Centre (VIC) who were diagnosed with rectal cancer between 1 January 2017 and 31 December 2021 were included in this retrospective study. All patients who did not have a PET scan were excluded. PET scan results were then compared with MRI and CT results. RESULTS Three hundred and fifty-seven patients were included in the study. 30.3% of the patients had Stage 3 rectal cancer. 71.7% received neoadjuvant therapy. PET scan provided additional information in 55.5% of patients when compared with CT and MRI alone; 18.2% of the PET findings resulted in an altered management for the patient. CONCLUSION PET scan can be a valuable tool in accurate staging, especially for ambiguous or equivocal lesions on CT. Our study demonstrated that additional information from PET scan resulted in an altered management plan in 18.2% of the patients. PET/MRI as a newer modality may be more accurate with reduced radiation exposure.
Collapse
Affiliation(s)
- Michelle Zhiyun Chen
- Department of Colorectal Surgery, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Xinyi Zhang
- Department of Colorectal Surgery, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Milton Mui
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Joseph C H Kong
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
- Department of Surgery, Central Clinical School, Monash University, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Alexander G Heriot
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Jodie Ellis-Clark
- Department of Colorectal Surgery, Nepean Hospital, Kingswood, New South Wales, Australia
| |
Collapse
|
|
8
|
Rooney S, Meyer J, Afzal Z, Ashcroft J, Cheow H, De Paepe KN, Powar M, Simillis C, Wheeler J, Davies J, Joshi H. The Role of Preoperative Imaging in the Detection of Lateral Lymph Node Metastases in Rectal Cancer: A Systematic Review and Diagnostic Test Meta-analysis. Dis Colon Rectum 2022; 65:1436-1446. [PMID: 36102825 DOI: 10.1097/dcr.0000000000002537] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Different techniques exist for the imaging of lateral lymph nodes in rectal cancer. OBJECTIVE This study aimed to compare the diagnostic accuracy of pelvic MRI, 18 F-FDG-PET/CT, and 18 F-FDG-PET/MRI for the identification of lateral lymph node metastases in rectal cancer. DATA SOURCES Data sources include PubMed, Embase, Cochrane Library, and Google Scholar. STUDY SELECTION All studies evaluating the diagnostic accuracy of pelvic MRI, 18 F-FDG-PET/CT, and 18 F-FDG-PET/MRI for the preoperative detection of lateral lymph node metastasis in patients with rectal cancer were selected. INTERVENTIONS The interventions were pelvic MRI, 18 F-FDG-PET/CT, and/or 18 F-FDG-PET/MRI. MAIN OUTCOME MEASURES Definitive histopathology was used as a criterion standard. RESULTS A total of 20 studies (1,827 patients) were included out of an initial search yielding 7,360 studies. The pooled sensitivity of pelvic MRI was 0.88 (95% CI, 0.85-0.91), of 18 F-FDG-PET/CT was 0.83 (95% CI, 0.80-0.86), and of 18 F-FDG-PET/MRI was 0.72 (95% CI, 0.51-0.87) for the detection of lateral lymph node metastasis. The pooled specificity of pelvic MRI was 0.85 (95% CI, 0.78-0.90), of 18 F-FDG-PET/CT was 0.95 (95% CI, 0.86-0.98), and of 18 F-FDG-PET/MRI was 0.90 (95% CI, 0.78-0.96). The area under the curve was 0.88 (95% CI, 0.85-0.91) for pelvic MRI and was 0.83 (95% CI, 0.80-0.86) for 18 F-FDG-PET/CT. LIMITATIONS Heterogeneity in terms of patients' populations, definitions of suspect lateral lymph nodes, and administration of neoadjuvant treatment. CONCLUSIONS For the preoperative identification of lateral lymph node metastasis in rectal cancer, this review found compelling evidence that pelvic MRI should constitute the imaging modality of choice. In contrast, to confirm the presence of lateral lymph node metastasis, 18 F-FDG-PET/MRI modalities allow discarding false positive cases because of increased specificity. PROSPERO REGISTRATION NUMBER CRD42020200319.
Collapse
Affiliation(s)
- Siobhan Rooney
- Department of Surgery, Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Jeremy Meyer
- Department of Surgery, Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland
- Medical School, University of Geneva, Geneva, Switzerland
| | - Zeeshan Afzal
- Department of Surgery, Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - James Ashcroft
- Department of Surgery, Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Heok Cheow
- Department of Nuclear Medicine/Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Katja N De Paepe
- Department of Nuclear Medicine/Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Michael Powar
- Department of Surgery, Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Constantinos Simillis
- Department of Surgery, Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - James Wheeler
- Department of Surgery, Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Justin Davies
- Department of Surgery, Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Medical School, University of Cambridge, United Kingdom
| | - Heman Joshi
- Department of Surgery, Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| |
Collapse
|
|
9
|
Korngold EK, Moreno C, Kim DH, Fowler KJ, Cash BD, Chang KJ, Gage KL, Gajjar AH, Garcia EM, Kambadakone AR, Liu PS, Macomber M, Marin D, Pietryga JA, Santillan CS, Weinstein S, Zreloff J, Carucci LR. ACR Appropriateness Criteria® Staging of Colorectal Cancer: 2021 Update. J Am Coll Radiol 2022; 19:S208-S222. [PMID: 35550803 DOI: 10.1016/j.jacr.2022.02.012] [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: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 12/19/2022]
Abstract
Preoperative imaging of rectal carcinoma involves accurate assessment of the primary tumor as well as distant metastatic disease. Preoperative imaging of nonrectal colon cancer is most beneficial in identifying distant metastases, regardless of primary T or N stage. Surgical treatment remains the definitive treatment for colon cancer, while organ-sparing approach may be considered in some rectal cancer patients based on imaging obtained before and after neoadjuvant treatment. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Collapse
Affiliation(s)
- Elena K Korngold
- Oregon Health and Science University, Portland, Oregon; Section Chief, Body Imaging; Chair, P&T Committee; Modality Chief, CT.
| | - Courtney Moreno
- Emory University, Atlanta, Georgia; Chair America College of Radiology CT Colonography Registry Committee
| | - David H Kim
- Panel Chair, University of Wisconsin Hospital & Clinics, Madison, Wisconsin; Vice Chair of Education (University of Wisconsin Dept of Radiology)
| | - Kathryn J Fowler
- Panel Vice-Chair, University of California San Diego, San Diego, California; ACR LI-RADS Working Group Chair
| | - Brooks D Cash
- University of Texas Health Science Center at Houston and McGovern Medical School, Houston, Texas; American Gastroenterological Association; Chief of GI, UTHealth
| | - Kevin J Chang
- Boston University Medical Center, Boston, Massachusetts; Director of MRI, Associate Chief of Abdominal Imaging; ACR Chair of Committee on C-RADS
| | - Kenneth L Gage
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Aakash H Gajjar
- PRiSMA Proctology Surgical Medicine & Associates, Houston, Texas; American College of Surgeons
| | - Evelyn M Garcia
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Avinash R Kambadakone
- Massachusetts General Hospital, Boston, Massachusetts; Division Chief, Abdominal Imaging, Massachusetts General Hospital; Medical Director, Martha's Vineyard Hospital Imaging
| | - Peter S Liu
- Cleveland Clinic, Cleveland, Ohio; Section Head, Abdominal Imaging, Cleveland Clinic, Cleveland OH
| | | | - Daniele Marin
- Duke University Medical Center, Durham, North Carolina
| | | | - Cynthia S Santillan
- University of California San Diego, San Diego, California; Vice Chair of Clinical Operations for Department of Radiology
| | - Stefanie Weinstein
- University of California San Francisco, San Francisco, California; Associate Chief of Radiology, San Francisco VA Health Systems
| | | | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia; Director MR and CT at VCUHS; Section Chief Abdominal Imaging VCUHS
| |
Collapse
|
|
10
|
Zhuang Z, Zhang Y, Wei M, Yang X, Wang Z. Magnetic Resonance Imaging Evaluation of the Accuracy of Various Lymph Node Staging Criteria in Rectal Cancer: A Systematic Review and Meta-Analysis. Front Oncol 2021; 11:709070. [PMID: 34327144 PMCID: PMC8315047 DOI: 10.3389/fonc.2021.709070] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 06/22/2021] [Indexed: 02/05/2023] Open
Abstract
Background Magnetic resonance imaging (MRI)-based lymph node staging remains a significant challenge in the treatment of rectal cancer. Pretreatment evaluation of lymph node metastasis guides the formulation of treatment plans. This systematic review aimed to evaluate the diagnostic performance of MRI in lymph node staging using various morphological criteria. Methods A systematic search of the EMBASE, Medline, and Cochrane databases was performed. Original articles published between 2000 and January 2021 that used MRI for lymph node staging in rectal cancer were eligible. The included studies were assessed using the QUADAS-2 tool. A bivariate random-effects model was used to conduct a meta-analysis of diagnostic test accuracy. Results Thirty-seven studies were eligible for this meta-analysis. The pooled sensitivity, specificity, and diagnostic odds ratio of preoperative MRI for the lymph node stage were 0.73 (95% confidence interval [CI], 0.68–0.77), 0.74 (95% CI, 0.68–0.80), and 7.85 (95% CI, 5.78–10.66), respectively. Criteria for positive mesorectal lymph node metastasis included (A) a short-axis diameter of 5 mm, (B) morphological standard, including an irregular border and mixed-signal intensity within the lymph node, (C) a short-axis diameter of 5 mm with the morphological standard, (D) a short-axis diameter of 8 mm with the morphological standard, and (E) a short-axis diameter of 10 mm with the morphological standard. The pooled sensitivity/specificity for these criteria were 75%/64%, 81%/67%, 74%/79%, 72%/66%, and 62%/91%, respectively. There was no significant difference among the criteria in sensitivity/specificity. The area under the receiver operating characteristic (ROC) curve values of the fitted summary ROC indicated a diagnostic accuracy rate of 0.75–0.81. Conclusion MRI scans have minimal accuracy as a reference index for pretreatment staging of various lymph node staging criteria in rectal cancer. Multiple types of evidence should be used in clinical decision-making.
Collapse
Affiliation(s)
- Zixuan Zhuang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yang Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Mingtian Wei
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xuyang Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ziqiang Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
|
11
|
Haak HE, Žmuc J, Lambregts DMJ, Beets-Tan RGH, Melenhorst J, Beets GL, Maas M. The evaluation of follow-up strategies of watch-and-wait patients with a complete response after neoadjuvant therapy in rectal cancer. Colorectal Dis 2021; 23:1785-1792. [PMID: 33725387 DOI: 10.1111/codi.15636] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/19/2021] [Accepted: 03/05/2021] [Indexed: 12/25/2022]
Abstract
AIM Many of the current follow-up schedules in a watch-and-wait approach include very frequent MRI and endoscopy examinations to ensure early detection of local regrowth (LR). The aim of this study was to analyse the occurrence and detection of LR in a watch-and-wait cohort and to suggest a more efficient follow-up schedule. METHOD Rectal cancer patients with a clinical complete response after neoadjuvant therapy were prospectively and retrospectively included in a multicentre watch-and-wait registry between 2004 and 2018, with the current follow-up schedule with 3-monthly endoscopy and MRI in the first year and 6 monthly thereafter. A theoretical comparison was constructed for the detection of LR in the current follow-up schedule against four other hypothetical schedules. RESULTS In all, 50/304 (16%) of patients developed a LR. The majority (98%) were detected at ≤2 years, located in the lumen (94%) and were visible on endoscopy (88%). The theoretical comparison of the different hypothetical schedules suggests that the optimal follow-up schedule should focus on the first 2 years with 3-monthly endoscopy and 3-6 monthly MRI. Longer intervals in the first 2 years will cause delays in diagnosis of LR ranging from 0 to 5 months. After 2 years, increasing the interval from 6 to 12 months did not cause important delays. CONCLUSION The optimal follow-up schedule for a watch-and-wait policy in patients with a clinical complete response after chemoradiation for rectal cancer should include frequent endoscopy and to a lesser degree MRI in the first 2 years. Longer intervals, up to 12 months, can be considered after 2 years.
Collapse
Affiliation(s)
- Hester E Haak
- Department of Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Jan Žmuc
- Department of Surgical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Regina G H Beets-Tan
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.,Department of Radiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Jarno Melenhorst
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Geerard L Beets
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.,Department of Radiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Monique Maas
- Department of Radiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | | |
Collapse
|
|
12
|
Liu Y, Wan L, Peng W, Zou S, Zheng Z, Ye F, Jiang J, Ouyang H, Zhao X, Zhang H. A magnetic resonance imaging (MRI)-based nomogram for predicting lymph node metastasis in rectal cancer: a node-for-node comparative study of MRI and histopathology. Quant Imaging Med Surg 2021; 11:2586-2597. [PMID: 34079725 PMCID: PMC8107309 DOI: 10.21037/qims-20-1049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 02/05/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND The aim of the present study was to investigate the potential risk factors for lymph node metastasis (LNM) in rectal cancer using magnetic resonance imaging (MRI), and to construct and validate a nomogram to predict its occurrence with node-for-node histopathological validation. METHODS Our prediction model was developed between March 2015 and August 2016 using a prospective primary cohort (32 patients, mean age: 57.3 years) that included 324 lymph nodes (LNs) from MR images with node-for-node histopathological validation. We evaluated multiple MRI variables, and a multivariable logistic regression analysis was used to develop the predictive nomogram. The performance of the nomogram was assessed with respect to its calibration, discrimination, and clinical usefulness. The performance of the nomogram in predicting LNM was validated in an independent clinical validation cohort comprising 182 consecutive patients. RESULTS The predictors included in the individualized prediction nomogram were chemical shift effect (CSE), nodal border, short-axis diameter of nodes, and minimum distance to rectal cancer or rectal wall. The nomogram showed good discrimination (C-index: 0.947; 95% confidence interval: 0.920-0.974) and good calibration in the primary cohort. Decision curve analysis confirmed the clinical usefulness of the nomogram in predicting the status of each LN. For the prediction of LN status in the clinical validation cohort by readers 1 and 2, the areas under the curves using the nomogram were 0.890 and 0.841, and the areas under the curves of readers using their experience were 0.754 and 0.704, respectively. Diagnostic efficiency was significantly improved by using the nomogram (P<0.001). CONCLUSIONS The nomogram, which incorporates CSE, nodal location, short-axis diameter, and minimum distance to rectal cancer or rectal wall, can be conveniently applied in clinical practice to facilitate the prediction of LNM in patients with rectal cancer.
Collapse
Affiliation(s)
- Yuan Liu
- 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
| | - Lijuan Wan
- 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
| | - Wenjing Peng
- 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
| | - Shuangmei Zou
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhaoxu Zheng
- Department of Colorectal Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feng Ye
- 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
| | - Jun Jiang
- 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
| | - Han Ouyang
- 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
| | - Xinming 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
| | - Hongmei 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
| |
Collapse
|
|
13
|
Catalano OA, Lee SI, Parente C, Cauley C, Furtado FS, Striar R, Soricelli A, Salvatore M, Li Y, Umutlu L, Cañamaque LG, Groshar D, Mahmood U, Blaszkowsky LS, Ryan DP, Clark JW, Wo J, Hong TS, Kunitake H, Bordeianou L, Berger D, Ricciardi R, Rosen B. Improving staging of rectal cancer in the pelvis: the role of PET/MRI. Eur J Nucl Med Mol Imaging 2020; 48:1235-1245. [PMID: 33034673 DOI: 10.1007/s00259-020-05036-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/11/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The role of positron emission tomography/magnetic resonance (PET/MR) in evaluating the local extent of rectal cancer remains uncertain. This study aimed to investigate the possible role of PET/MR versus magnetic resonance (MR) in clinically staging rectal cancer. METHODS This retrospective two-center cohort study of 62 patients with untreated rectal cancer investigated the possible role of baseline staging PET/MR versus stand-alone MR in determination of clinical stage. Two readers reviewed T and N stage, mesorectal fascia involvement, tumor length, distance from the anal verge, sphincter involvement, and extramural vascular invasion (EMVI). Sigmoidoscopy, digital rectal examination, and follow-up imaging, along with surgery when available, served as the reference standard. RESULTS PET/MR outperformed MR in evaluating tumor size (42.5 ± 21.03 mm per the reference standard, 54 ± 20.45 mm by stand-alone MR, and 44 ± 20 mm by PET/MR, P = 0.004), and in identifying N status (correct by MR in 36/62 patients [58%] and by PET/MR in 49/62 cases [79%]; P = 0.02) and external sphincter infiltration (correct by MR in 6/10 and by PET/MR in 9/10; P = 0.003). No statistically significant differences were observed in relation to any other features. CONCLUSION PET/MR provides a more precise assessment of the local extent of rectal cancers in evaluating cancer length, N status, and external sphincter involvement. PET/MR offers the opportunity to improve clinical decision-making, especially when evaluating low rectal tumors with possible external sphincter involvement.
Collapse
Affiliation(s)
- Onofrio A Catalano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, White Building Rm 250, 55 Fruit St, Boston, MA, 02114, USA. .,Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA. .,Department of Radiology, University of Naples "Parthenope", Naples, Italy.
| | - Susanna I Lee
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, White Building Rm 250, 55 Fruit St, Boston, MA, 02114, USA
| | | | - Christy Cauley
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Felipe S Furtado
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, White Building Rm 250, 55 Fruit St, Boston, MA, 02114, USA.,Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Robin Striar
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, White Building Rm 250, 55 Fruit St, Boston, MA, 02114, USA.,Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Andrea Soricelli
- Department of Radiology, University of Naples "Parthenope", Naples, Italy.,SDN IRCCS, Naples, Italy
| | - Marco Salvatore
- SDN IRCCS, Naples, Italy.,University of Naples Suor Orsola Benincasa, Napoli, NA, Italy
| | - Yan Li
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | | | - David Groshar
- Department of Nuclear Medicine, Assuta Medical Centers, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Umar Mahmood
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, White Building Rm 250, 55 Fruit St, Boston, MA, 02114, USA.,Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Lawrence S Blaszkowsky
- Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Vernon Cancer Center, Newton-Wellesley Hospital, 2014 Washington Street, Newton, MA, 02462, USA
| | - David P Ryan
- Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeffrey W Clark
- Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jennifer Wo
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Theodore S Hong
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Hiroko Kunitake
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Liliana Bordeianou
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - David Berger
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Rocco Ricciardi
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Bruce Rosen
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, White Building Rm 250, 55 Fruit St, Boston, MA, 02114, USA.,Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| |
Collapse
|
|
14
|
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.
Collapse
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
| |
Collapse
|
|
15
|
Is 18F-FDG PET/CT an Accurate Way to Detect Lymph Node Metastasis in Colorectal Cancer: A Systematic Review and Meta-Analysis. CONTRAST MEDIA & MOLECULAR IMAGING 2020; 2020:5439378. [PMID: 32733174 PMCID: PMC7383332 DOI: 10.1155/2020/5439378] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 06/15/2020] [Indexed: 12/20/2022]
Abstract
Aims The purpose of this study was to assess the diagnostic value of 18F-fluorodeoxy-glucose positron emission tomography/computed tomography (FDG PET/CT) for detection of lymph node (LN) metastasis of colorectal cancer. Material and Methods. A computerized search was performed to determine the relevant articles, published before October 2019. Stata Statistical Software, version 15.0, and Meta-Disc (version 1.4) were used for the meta-analysis. Results the sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were 0.65, 0.75, 4.57, and 0.37 respectively. Studies that used SUVmax cut-off value (≤2.5) demonstrated the best accuracy. Conclusion 18F-FDG PET/CT shows a low sensitivity and high specificity for detecting the metastasis of LNs in patients with newly diagnosed colorectal cancer.
Collapse
|
|
16
|
Dekkers N, Boonstra JJ, Moons LMG, Hompes R, Bastiaansen BA, Tuynman JB, Koch AD, Weusten BLAM, Pronk A, Neijenhuis PA, Westerterp M, van den Hout WB, Langers AMJ, van der Kraan J, Alkhalaf A, Lai JYL, Ter Borg F, Fabry H, Halet E, Schwartz MP, Nagengast WB, Straathof JWA, Ten Hove RWR, Oterdoom LH, Hoff C, Belt EJT, Zimmerman DDE, Hadithi M, Morreau H, de Cuba EMV, Leijtens JWA, Vasen HFA, van Leerdam ME, de Graaf EJR, Doornebosch PG, Hardwick JCH. Transanal minimally invasive surgery (TAMIS) versus endoscopic submucosal dissection (ESD) for resection of non-pedunculated rectal lesions (TRIASSIC study): study protocol of a European multicenter randomised controlled trial. BMC Gastroenterol 2020; 20:225. [PMID: 32660488 PMCID: PMC7359465 DOI: 10.1186/s12876-020-01367-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/02/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND In the recent years two innovative approaches have become available for minimally invasive en bloc resections of large non-pedunculated rectal lesions (polyps and early cancers). One is Transanal Minimally Invasive Surgery (TAMIS), the other is Endoscopic Submucosal Dissection (ESD). Both techniques are standard of care, but a direct randomised comparison is lacking. The choice between either of these procedures is dependent on local expertise or availability rather than evidence-based. The European Society for Endoscopy has recommended that a comparison between ESD and local surgical resection is needed to guide decision making for the optimal approach for the removal of large rectal lesions in Western countries. The aim of this study is to directly compare both procedures in a randomised setting with regard to effectiveness, safety and perceived patient burden. METHODS Multicenter randomised trial in 15 hospitals in the Netherlands. Patients with non-pedunculated lesions > 2 cm, where the bulk of the lesion is below 15 cm from the anal verge, will be randomised between either a TAMIS or an ESD procedure. Lesions judged to be deeply invasive by an expert panel will be excluded. The primary endpoint is the cumulative local recurrence rate at follow-up rectoscopy at 12 months. Secondary endpoints are: 1) Radical (R0-) resection rate; 2) Perceived burden and quality of life; 3) Cost effectiveness at 12 months; 4) Surgical referral rate at 12 months; 5) Complication rate; 6) Local recurrence rate at 6 months. For this non-inferiority trial, the total sample size of 198 is based on an expected local recurrence rate of 3% in the ESD group, 6% in the TAMIS group and considering a difference of less than 6% to be non-inferior. DISCUSSION This is the first European randomised controlled trial comparing the effectiveness and safety of TAMIS and ESD for the en bloc resection of large non-pedunculated rectal lesions. This is important as the detection rate of these adenomas is expected to further increase with the introduction of colorectal screening programs throughout Europe. This study will therefore support an optimal use of healthcare resources in the future. TRIAL REGISTRATION Netherlands Trial Register, NL7083 , 06 July 2018.
Collapse
Affiliation(s)
- Nik Dekkers
- Department of Gastroenterology & Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Jurjen J Boonstra
- Department of Gastroenterology & Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Leon M G Moons
- Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roel Hompes
- Department of Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Barbara A Bastiaansen
- Department of Gastroenterology & Hepatology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jurriaan B Tuynman
- Department of Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Arjun D Koch
- Department of Gastroenterology & Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bas L A M Weusten
- Department of Gastroenterology & Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Apollo Pronk
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | | | - Marinke Westerterp
- Department of Surgery, Haaglanden Medical Center, The Hague, The Netherlands
| | - Wilbert B van den Hout
- Department of Medical Decision Making & Quality of Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Alexandra M J Langers
- Department of Gastroenterology & Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Jolein van der Kraan
- Department of Gastroenterology & Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Alaa Alkhalaf
- Department of Gastroenterology & Hepatology, Isala hospital, Zwolle, The Netherlands
| | - Jonathan Y L Lai
- Department of Gastroenterology & Hepatology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Frank Ter Borg
- Department of Gastroenterology & Hepatology, Deventer Hospital, Deventer, The Netherlands
| | - Hans Fabry
- Department of Surgery, Bravis Hospital, Bergen op Zoom, The Netherlands
| | - Eric Halet
- Department of Gastroenterology & Hepatology, Bravis Hospital, Bergen op Zoom, The Netherlands
| | - Matthijs P Schwartz
- Departmet of Gastroenterology & Hepatology, Meander Medical Center, Amersfoort, The Netherlands
| | - Wouter B Nagengast
- Department of Gastroenterology & Hepatology, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan Willem A Straathof
- Department of Gastroenterology & Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rogier W R Ten Hove
- Department of Gastroenterology & Hepatology, Alrijne Hospital, Leiderdorp, The Netherlands
| | - Leendert H Oterdoom
- Department of Gastroenterology & Hepatology, Hagaziekenhuis, The Hague, The Netherlands
| | - Christiaan Hoff
- Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Eric J Th Belt
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - David D E Zimmerman
- Department of Surgery, Elisabeth-TweeSteden Ziekenhuis, Eindhoven, The Netherlands
| | - Muhammed Hadithi
- Department of Gastroenterology & Hepatology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Hans Morreau
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Hans F A Vasen
- Department of Gastroenterology & Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Monique E van Leerdam
- Department of Gastroenterology & Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Department of Gastroenterology and Hepatology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Eelco J R de Graaf
- Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, The Netherlands
| | - Pascal G Doornebosch
- Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, The Netherlands
| | - James C H Hardwick
- Department of Gastroenterology & Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| |
Collapse
|
|
17
|
Hope TA, Kassam Z, Loening A, McNamara MM, Paspulati R. The use of PET/MRI for imaging rectal cancer. Abdom Radiol (NY) 2019; 44:3559-3568. [PMID: 31201431 DOI: 10.1007/s00261-019-02089-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Combined PET/MRI is a proposed imaging modality for rectal cancer, leveraging the advantages of MRI and 18F-fluorodeoxyglucose PET. Rectal cancer PET/MRI protocols typically include dedicated pelvis bed positions utilizing small field-of-view T2-weighted imaging. For staging of the primary tumor, PET/MRI can help delineate the extent of tumor better as well as the extent of tumor beyond the muscularis propria. PET uptake may help characterize small lymph nodes, and the use of hepatobiliary phase imaging can improve the detection of small hepatic metastases. The most beneficial aspect of PET/MRI may be in treatment response, although current data are limited on how to combine PET and MRI data in this setting. Limitations of PET/MRI include the inability to detect small pulmonary nodules and issues related to attenuation correction, although the development of new attenuation correction techniques may address this issue. Overall PET/MRI can improve the staging of rectal cancer, although this potential has yet to be fulfilled.
Collapse
|
|
18
|
Role of MRI in rectal carcinoma after chemo irradiation therapy with pathological correlation. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2014.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
|
|
19
|
Chung E, Kang D, Lee HS, Cho ES, Kim JH, Park EJ, Baik SH, Lee KY, Kang J. Accuracy of pelvic MRI in measuring tumor height in rectal cancer patients with or without preoperative chemoradiotherapy. Eur J Surg Oncol 2019; 45:324-330. [DOI: 10.1016/j.ejso.2018.08.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 06/24/2018] [Accepted: 08/30/2018] [Indexed: 01/23/2023] Open
|
|
20
|
Yap KSK, Mehta OH, Lau WFE, Akhurst T, Warrier S, Heriot A, Hicks RJ. Does addition of a diagnostic contrast-enhanced CT to a contemporaneous PET/CT provide incremental value in patients for restaging of colorectal carcinoma? Eur J Hybrid Imaging 2018. [DOI: 10.1186/s41824-018-0046-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
|
21
|
Abstract
OBJECTIVE The purpose of this study was to determine if extended PET acquisition times in the pelvis during PET/MRI increase detection rates of potentially metastatic lymph nodes in patients with rectal cancer. MATERIALS AND METHODS Our study was approved by the institutional review board of the University of California, San Francisco. Twenty-two patients with biopsy-proven rectal cancer underwent imaging via simultaneous 3-T time-of-flight PET/MRI, with seven undergoing two separate PET/MRI examinations, for a total of 29 studies. Each examination included both a whole-body PET/MRI and a dedicated pelvic PET/MRI with both 3- and 15-minute PET acquisitions for the pelvis. Three radiologists interpreted each examination with PET only, MRI only, then combined PET and MRI examinations, using all available images. Additionally, the 3- and 15-minute PET acquisitions of the pelvis were reviewed separately by a single radiologist. RESULTS A total of 94 lymph nodes were identified as abnormal on PET, all with MRI anatomic correlates. Of these, 37 (39.4%) were seen only on the dedicated 15-minute acquisition. Fifty-seven (60.6%) nodes measured 5 mm or less, including 29 (30.9%) seen only on the 15-minute acquisition. Thirty-one (33.0%) nodes measured 5.1-10 mm, including eight (25.8%) seen only on the 15-minute acquisition. Of the 17 subjects imaged for initial staging, 11 (64.7%) were upstaged as a result of the increased PET acquisition time (10 from N1 to N2 and one from N0 to N1). CONCLUSION Longer PET acquisition times during PET/MRI for rectal cancer increases the number of FDG-avid lymph nodes detected without increasing scan time.
Collapse
|
|
22
|
Polamraju P, Haque W, Verma V, Wiederhold L, Hatch S, Butler EB, Teh BS. Adjuvant Management of Pathologic Node-Positive Disease After Definitive Surgery for Clinical T1-2 N0 Rectal Cancer. Clin Colorectal Cancer 2018; 17:e519-e530. [PMID: 29753642 DOI: 10.1016/j.clcc.2018.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 04/14/2018] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Patients with cT1-2N0M0 rectal cancer are often treated with up-front surgical resection, with adjuvant treatment reserved for patients upstaged with pathologic node-positive (pN+) disease at surgery. This study evaluates practice patterns and clinical outcomes when comparing different forms of adjuvant treatment for this patient population. METHODS The National Cancer Data Base was queried for cT1-2N0M0 rectal cancer patients between 2004 and 2015 with postoperative pN+ disease treated without neoadjuvant treatment. Patients were divided into groups receiving observation, chemotherapy, or chemoradiotherapy (CRT). Multivariable logistic regression determined factors associated with receipt of adjuvant treatment. Kaplan-Meier curves compared overall survival (OS), and Cox regression determined patient factors associated with OS. RESULTS Altogether, 1466 patients met the inclusion criteria; 536 patients (36.6%) received adjuvant chemotherapy, 413 (28.2%) received adjuvant CRT, and 517 (35.3%) were observed postoperatively. Use of adjuvant treatment was associated with superior median OS (124.1 vs. 51.1 months, P < .001), persisting after propensity score matching (124.0 vs. 61.9 months, P < .001), but not between adjuvant CRT versus chemotherapy on subset analysis. Patients with positive surgical margins receiving adjuvant CRT showed a trend toward OS improvement compared to patients managed with chemotherapy (54.9 vs. 47.4 months, P = .10). Increased age, pN2 status, positive margin status, and observation were associated with poorer OS. CONCLUSION Most patients found to have pN+ disease after up-front surgery for cT1-2N0 rectal cancer receive adjuvant treatment, which is associated with improved OS. Chemotherapy or CRT are appropriate options, although there was a trend toward higher OS for patients with positive surgical margins receiving CRT.
Collapse
Affiliation(s)
- Praveen Polamraju
- Department of Radiation Oncology, University of Texas Medical Branch, Galveston, TX
| | - Waqar Haque
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX.
| | - Vivek Verma
- Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA
| | - Lee Wiederhold
- Department of Radiation Oncology, University of Texas Medical Branch, Galveston, TX
| | - Sandra Hatch
- Department of Radiation Oncology, University of Texas Medical Branch, Galveston, TX
| | - E Brian Butler
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX
| | - Bin S Teh
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX
| |
Collapse
|
|
23
|
Fowler KJ, Kaur H, Cash BD, Feig BW, Gage KL, Garcia EM, Hara AK, Herman JM, Kim DH, Lambert DL, Levy AD, Peterson CM, Scheirey CD, Small W, Smith MP, Lalani T, Carucci LR. ACR Appropriateness Criteria ® Pretreatment Staging of Colorectal Cancer. J Am Coll Radiol 2018; 14:S234-S244. [PMID: 28473079 DOI: 10.1016/j.jacr.2017.02.012] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 01/27/2017] [Accepted: 02/02/2017] [Indexed: 12/17/2022]
Abstract
Colorectal cancers are common tumors in the United States and appropriate imaging is essential to direct appropriate care. Staging and treatment differs between tumors arising in the colon versus the rectum. Local staging for colon cancer is less integral to directing therapy given radical resection is often standard. Surgical options for rectal carcinoma are more varied and rely on accurate assessment of the sphincter, circumferential resection margins, and peritoneal reflection. These important anatomic landmarks are best appreciated on high-resolution imaging with transrectal ultrasound or MRI. When metastatic disease is suspected, imaging modalities that provide a global view of the body, such as CT with contrast or PET/CT may be indicated. Rectal cancer often metastasizes to the liver and so MRI of the liver with and without contrast provides accurate staging for liver metastases. This article focuses on local and distant staging and reviews the appropriateness of different imaging for both variants. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Collapse
Affiliation(s)
- Kathryn J Fowler
- Principal Author, Mallinckrodt Institute of Radiology, Saint Louis, Missouri.
| | - Harmeet Kaur
- Co-author, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Brooks D Cash
- University of South Alabama, Mobile, Alabama; American Gastroenterological Association
| | - Barry W Feig
- University of Texas MD Anderson Cancer Center, Houston, Texas; American College of Surgeons
| | | | - Evelyn M Garcia
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | | | - Joseph M Herman
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, Maryland
| | - David H Kim
- University of Wisconsin Hospital and Clinic, Madison, Wisconsin
| | - Drew L Lambert
- University of Virginia Health System, Charlottesville, Virginia
| | - Angela D Levy
- Georgetown University Hospital, Washington, District of Columbia
| | | | | | - William Small
- Stritch School of Medicine Loyola University Chicago, Maywood, Illinois
| | - Martin P Smith
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Tasneem Lalani
- Speciality Chair, Inland Imaging Associates and University of Washington, Seattle, Washington
| | - Laura R Carucci
- Panel Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia
| |
Collapse
|
|
24
|
Hotta M, Minamimoto R, Yano H, Gohda Y, Shuno Y. Diagnostic performance of 18F-FDG PET/CT using point spread function reconstruction on initial staging of rectal cancer: a comparison study with conventional PET/CT and pelvic MRI. Cancer Imaging 2018; 18:4. [PMID: 29378659 PMCID: PMC5789619 DOI: 10.1186/s40644-018-0137-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 01/23/2018] [Indexed: 02/06/2023] Open
Abstract
Background Accurate staging is crucial for treatment selection and prognosis prediction in patients with rectal cancer. Point spread function (PSF) reconstruction can improve spatial resolution and signal-to-noise ratio of PET imaging. The aim of this study was to evaluate the effectiveness of 18F-FDG PET/CT with PSF reconstruction for initial staging in rectal cancer compared with conventional PET/CT and pelvic MRI. Methods A total of 59 patients with rectal cancer underwent preoperative 18F-FDG PET/CT and pelvic MRI. The maximum standardized uptake value (SUVmax) and lesion to background (L/B) ratio of possible metastatic lymph nodes, and metabolic tumor volumes (MTVs) of primary tumors were calculated. For N and T (T1-2 vs T3-4) staging, sensitivities, specificities, positive predictive values, negative predictive values, and accuracies were compared between conventional PET/CT [reconstructed with ordered subset expectation maximization (OSEM)], PSF-PET/CT (reconstructed with OSEM+PSF), and pelvic MRI. Histopathologic analysis was the reference standard. Results For N staging, PSF-PET/CT provided higher sensitivity (78.6%) than conventional PET/CT (64.3%), and pelvic MRI (57.1%), and all techniques showed high specificity (PSF-PET: 95.4%, conventional PET: 96.7%, pelvic MRI: 93.5%). SUVmax and L/B ratio were significantly higher in PSF-PET/CT than conventional-PET/CT (p < 0.001). The accuracy for T staging in PSF-PET/CT (69.4%) was not significantly different to conventional PET/CT (73.5%) and pelvic MRI (73.5%). MTVs of PSF and conventional PET showed a significant difference among T stages (p < 0.001), with higher values in advanced stages. In M staging, both PSF and conventional PET/CT diagnosed all distant metastases correctly. Conclusions PSF-PET/CT produced images with higher lesion-to-background contrast than conventional PET/CT, which allowed improved detection of lymph node metastasis without compromising specificity, and showed comparable diagnostic value to MRI in local staging. PSF-PET/CT is likely to have a great value for initial staging in rectal cancer.
Collapse
Affiliation(s)
- Masatoshi Hotta
- Division of Nuclear Medicine, Department of Radiology, National Center for Global Health and Medicine, 1-21-1, Shinjuku-ku, Toyama, Tokyo, 162-8655, Japan.
| | - Ryogo Minamimoto
- Division of Nuclear Medicine, Department of Radiology, National Center for Global Health and Medicine, 1-21-1, Shinjuku-ku, Toyama, Tokyo, 162-8655, Japan
| | - Hideaki Yano
- Department of Surgery, National Center for Global Health and Medicine, 1-21-1, Shinjuku-ku, Toyama, Tokyo, 162-8655, Japan
| | - Yoshimasa Gohda
- Department of Surgery, National Center for Global Health and Medicine, 1-21-1, Shinjuku-ku, Toyama, Tokyo, 162-8655, Japan
| | - Yasutaka Shuno
- Department of Surgery, National Center for Global Health and Medicine, 1-21-1, Shinjuku-ku, Toyama, Tokyo, 162-8655, Japan
| |
Collapse
|
|
25
|
Fan WH, Xiao J, An X, Jiang W, Li LR, Gao YH, Chen G, Kong LH, Lin JZ, Wang JP, Pan ZZ, Ding PR. Patterns of recurrence in patients achieving pathologic complete response after neoadjuvant chemoradiotherapy for rectal cancer. J Cancer Res Clin Oncol 2017; 143:1461-1467. [PMID: 28386648 PMCID: PMC5504135 DOI: 10.1007/s00432-017-2383-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 02/21/2017] [Indexed: 12/20/2022]
Abstract
PURPOSE The aim of this study was to characterize the patterns of recurrence in patients achieving pathologic complete response (pCR) after neoadjuvant chemoradiotherapy (CRT) for locally advanced rectal cancer. METHODS Patients with locally advanced rectal cancer treated with neoadjuvant CRT and who achieved pCR from January 2004 to December 2012 were collected. The primary outcome measurement was the patterns of recurrence. RESULTS Among 195 patients who achieved pCR, 18 developed recurrence. Furthermore, local recurrence occurred in 1.5% of patients (3/195), while distant metastases occurred in 7.7% of patients (15/195), which included 7 lung metastases, 1 liver metastasis, and 8 metastases in other locations. CONCLUSIONS Our study indicated that patients achieving pCR following neoadjuvant CRT have a favorable prognosis, with distant metastases predominating in all recurrences. Among patients with distant metastases, non-liver metastases were the predominant pattern.
Collapse
Affiliation(s)
- Wen-Hua Fan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.,Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Jian Xiao
- Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Xin An
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Wu Jiang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.,Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Li-Ren Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.,Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Yuan-Hong Gao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Gong Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.,Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Ling-Heng Kong
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.,Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Jun-Zhong Lin
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.,Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Jian-Ping Wang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China.
| | - Zhi-Zhong Pan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China. .,Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.
| | - Pei-Rong Ding
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China. .,Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.
| |
Collapse
|
|
26
|
Catalano OA, Masch WR, Catana C, Mahmood U, Sahani DV, Gee MS, Menezes L, Soricelli A, Salvatore M, Gervais D, Rosen BR. An overview of PET/MR, focused on clinical applications. Abdom Radiol (NY) 2017; 42:631-644. [PMID: 27624499 DOI: 10.1007/s00261-016-0894-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Hybrid PET/MR scanners are innovative imaging devices that simultaneously or sequentially acquire and fuse anatomical and functional data from magnetic resonance (MR) with metabolic information from positron emission tomography (PET) (Delso et al. in J Nucl Med 52:1914-1922, 2011; Zaidi et al. in Phys Med Biol 56:3091-3106, 2011). Hybrid PET/MR scanners have the potential to greatly impact not only on medical research but also, and more importantly, on patient management. Although their clinical applications are still under investigation, the increased worldwide availability of PET/MR scanners, and the growing published literature are important determinants in their rising utilization for primarily clinical applications. In this manuscript, we provide a summary of the physical features of PET/MR, including its limitations, which are most relevant to clinical PET/MR implementation and to interpretation. Thereafter, we discuss the most important current and emergent clinical applications of such hybrid technology in the abdomen and pelvis, both in the field of oncologic and non-oncologic imaging, and we provide, when possible, a comparison with clinically consolidated imaging techniques, like for example PET/CT.
Collapse
Affiliation(s)
- Onofrio Antonio Catalano
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 49 13th St, Charlestown, MA, 02129, USA.
- Abdominal Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA.
| | - William Roger Masch
- Department of Radiology, Abdominal Imaging, University of Michigan Health System, 1550E Medical Center Dr, SPC5030, Ann Arbor, MI, 48109, USA
| | - Ciprian Catana
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 49 13th St, Charlestown, MA, 02129, USA
| | - Umar Mahmood
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 49 13th St, Charlestown, MA, 02129, USA
- Institute of Precision Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Dushyant Vasudeo Sahani
- Abdominal Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Michael Stanley Gee
- Abdominal Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
- Martinos Center for Pediatric Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Leon Menezes
- Institute of Nuclear Medicine, University College Hospital, 235 Euston Rd, Fitzrovia, London, NW1 2BU, UK
| | - Andrea Soricelli
- University of Naples "Parthenope", Via Medina 40, 80133, Naples, Italy
| | - Marco Salvatore
- Medicina Nucleare, Fondazione SDN, Via Gianturco 113, Naples, 80113, Italy
| | - Debra Gervais
- Abdominal Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Bruce Robert Rosen
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 49 13th St, Charlestown, MA, 02129, USA
| |
Collapse
|
|
27
|
Initial Staging of Locally Advanced Rectal Cancer and Regional Lymph Nodes: Comparison of Diffusion-Weighted MRI With 18F-FDG-PET/CT. Clin Nucl Med 2016; 41:289-95. [PMID: 26828149 PMCID: PMC4851242 DOI: 10.1097/rlu.0000000000001172] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Purpose The aim of the study was to compare diffusion-weighted MRI (DW-MRI) parameters with 18F-FDG PET/CT in primary locally advanced rectal cancer (LARC). Methods From October 2012 to September 2014, 24 patients with histologically confirmed and untreated LARC (T3–T4) prospectively underwent a pelvic 1.5-T DW-MRI (b = 0 s/mm2, b = 600 s/mm2) and a whole-body 18F-FDG PET/CT, before neoadjuvant therapy. The 2 examinations were performed on the same day. Two readers measured 18F-FDG SUVmax and SUVmean of the rectal tumor and of the pathological regional lymph nodes on PET/CT and compared these with minimum and mean values of the ADC (ADCmin and ADCmean) on maps generated from DW-MRI. The diagnostic performance of ADC values in identifying pathological lymph nodes was also assessed. Results Regarding tumors (n = 24), we found a significant negative correlation between SUVmean and corresponding ADCmean values (ρ = −0.61, P = 0.0017) and between ADCmin and SUVmax (ρ = −0.66, P = 0.0005). Regarding the lymph nodes (n = 63), there was a significant negative correlation between ADCmean and SUVmean values (ρ = −0.38, P = 0.0021), but not between ADCmin and SUVmax values (ρ = −0.11, P = 0.41). Neither ADCmean nor ADCmin values helped distinguish pathological from benign lymph nodes (AUC of 0.24 [confidence interval, 0.10–0.38] and 0.41 [confidence interval, 0.22–0.60], respectively). Conclusions The correlations between ADCmean and SUVmean suggest an association between tumor cellularity and metabolic activity in untreated LARC and in regional lymph nodes. However, compared with 18F-FDG PET/CT, ADC values are not reliable for identifying pathological lymph nodes.
Collapse
|
|
28
|
Abstract
INTRODUCTION The treatment of rectal cancer has diversified in recent years, presenting the clinician and patient with increasingly challenging management decisions. At the heart of this decision-making process are two competing interests; more radical but more morbid treatments which optimize oncological outcome, and less radical treatments which preserve organs and function but may pose a greater risk of disease recurrence. AREAS COVERED Imaging plays a vital role informing this decision-making process, both by providing prognostic details about the cancer before the start of treatment and by updating this picture as the cancer responds or fails to respond to treatment. There is a range of available imaging modalities, each with its strengths and weaknesses. Optimizing rectal cancer treatment requires a clear understanding of the important questions that imaging needs to answer and the optimum imaging strategy. Expert Commentary: This article provides an evidence-based review of the available imaging techniques and an expert commentary on the best imaging strategy.
Collapse
Affiliation(s)
- Chris Hunter
- a Department of Colorectal Surgery , Hull and East Yorkshire NHS Trust , Hull , UK.,b Department of Surgery and Cancer , Imperial College London , London , UK
| | - Gina Brown
- b Department of Surgery and Cancer , Imperial College London , London , UK.,c Department of Academic Radiology , The Royal Marsden Hospital , Sutton , UK
| |
Collapse
|
|
29
|
Diagnostic Accuracy of MRI for Assessment of T Category and Circumferential Resection Margin Involvement in Patients With Rectal Cancer: A Meta-Analysis. Dis Colon Rectum 2016; 59:789-99. [PMID: 27384098 DOI: 10.1097/dcr.0000000000000611] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The prognosis of rectal cancer is directly related to the stage of the tumor at diagnosis. Accurate preoperative staging is essential for selecting patients to receive optimal treatment. OBJECTIVE The purpose of this study was to evaluate the diagnostic performance of MRI in tumor staging and circumferential resection margin involvement in rectal cancer. DATA SOURCES A systematic literature search was performed in MEDLINE, EMBASE, PubMed, Cochrane Database of Systematic Reviews, and Web of Science database. STUDY SELECTION Original articles from 2000 to 2016 on the diagnostic performance of MRI in the staging of rectal cancer and/or assessment of mesorectal fascia status were eligible. MAIN OUTCOME MEASURES Pooled diagnostic statistics including sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were calculated for invasion of muscularis propria, perirectal tissue, and adjacent organs and for circumferential resection margin involvement through bivariate random-effects modeling. Summary receiver operating characteristic curves were fitted, and areas under summary receiver operating characteristic curves were counted to evaluate the diagnostic performance of MRI for each outcome. RESULTS Thirty-five studies were eligible for this meta-analysis. Preoperative MRI revealed the highest sensitivity of 0.97 (95% CI, 0.96-0.98) and specificity of 0.97 (95% CI, 0.96-0.98) for muscularis propria invasion and adjacent organ invasion. Areas under summary receiver operating characteristic curves indicated good diagnostic accuracy for each outcome, with the highest of 0.9515 for the assessment of adjacent organ invasion. Significant heterogeneity existed among studies. There was no notable publication bias for each outcome. LIMITATIONS This meta-analysis revealed relatively high diagnostic accuracy for preoperative MRI, although significant heterogeneity existed. Therefore, exploration should be focused on standardized interpretation criteria and optimal MRI protocols for future studies. CONCLUSIONS MRI showed relatively high diagnostic accuracy for preoperative T staging and circumferential resection margin assessment and should be reliable for clinical decision making.
Collapse
|
|
30
|
Abstract
BACKGROUND Radiological imaging plays an important role in the setting of staging, follow-up, and imaging-guided treatment of colorectal carcinoma (CRC). METHODS This review aims to summarize the current state of the art of the different radiological imaging procedures in CRC including an overview over recently published national and European guidelines and consensus statements concerning the imaging of CRC patients. RESULTS AND CONCLUSION Radiological imaging is widely embedded in national and international guidelines, and structured reporting is recommended.
Collapse
Affiliation(s)
- Bettina Baeßler
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
| | - David Maintz
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
| | - Thorsten Persigehl
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
| |
Collapse
|
|
31
|
Albandar MH, Cho MS, Bae SU, Kim NK. Surgical management of extra-regional lymph node metastasis in colorectal cancer. Expert Rev Anticancer Ther 2016; 16:503-513. [PMID: 26950286 DOI: 10.1586/14737140.2016.1162718] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
Abstract
One of the major problems in rectal cancer surgery is local recurrence, found in an average of 21% to 46% cases in 1990. However, the advent of chemo-radiotherapy (CRT) and total mesorectal excision (TME) improve local control and enhances survival rates in colorectal cancer (CRC). Regional lymph node involvement is determined to be an independent prognostic factor in local recurrence; however, extra-regional lymph node (ERLN) metastasis has a higher recurrence rate (up to 58.1%). Lack of supportive data in management of ERLN metastasis in CRC has added further strain and challenges to structure a unique treatment strategy. ERLN refers to extra-mesenteric involvement either in the para-aortic lymph node (PALN) or the lateral pelvic lymph node (LPLN). Treatment of ERLN metastasis is challenging because of the shortage of the resources. Here, we will outline and summarize approaches and management of ERLN metastasis. We also aim to clarify the role of surgical intervention in CRC.
Collapse
Affiliation(s)
- Mahdi H Albandar
- a Department of Surgery, College of Medicine , Yonsei University , Seoul , Korea
| | - Min Soo Cho
- a Department of Surgery, College of Medicine , Yonsei University , Seoul , Korea
| | - Sung Uk Bae
- a Department of Surgery, College of Medicine , Yonsei University , Seoul , Korea
| | - Nam Kyu Kim
- a Department of Surgery, College of Medicine , Yonsei University , Seoul , Korea
| |
Collapse
|
|
32
|
Slater A, Betts M, Anderson EM, Cunningham C. Transanal endoscopic microsurgery for rectal cancer. Clin Radiol 2015; 71:e121-9. [PMID: 26654131 DOI: 10.1016/j.crad.2015.10.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/27/2015] [Accepted: 10/20/2015] [Indexed: 01/29/2023]
Abstract
Since its introduction in the 1980s, total mesorectal excision (TME) has been the standard surgical technique for treating rectal cancer. This procedure involves removing the rectum and the surrounding envelope of fat along the plane of the mesorectal fascia. Resecting this embryological unit reduces the local recurrence rate by removing all local lymph nodes, including those with occult metastatic disease; however, this surgery is associated with mortality and morbidity. Complications include incontinence for patients given an anastomosis, long-term stoma formation, and sexual and bladder dysfunction. Local excision of rectal cancer using the transanal endoscopic microsurgery (TEM) technique is associated with fewer complications, and therefore, is used as an alternative in specific circumstances. We outline the technique, its indications, imaging appearances and complications.
Collapse
Affiliation(s)
- A Slater
- Department of Radiology, Oxford University Hospitals NHS Trust, Headley Way, Oxford OX3 9DU, UK.
| | - M Betts
- Department of Radiology, Oxford University Hospitals NHS Trust, Headley Way, Oxford OX3 9DU, UK
| | - E M Anderson
- Department of Radiology, Oxford University Hospitals NHS Trust, Headley Way, Oxford OX3 9DU, UK
| | - C Cunningham
- Department of Surgery, Oxford University Hospitals NHS Trust, Headley Way, Oxford OX3 9DU, UK
| |
Collapse
|
|
33
|
[Combined PET-MRI of the abdomen]. Radiologe 2015; 55:1104-10. [PMID: 26610681 DOI: 10.1007/s00117-015-0046-x] [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: 10/22/2022]
Abstract
The first fully integrated combined positron emission tomography-magnetic resonance imaging (PET-MRI) scanners have been clinically available since 2010. Large prospective studies regarding indications and diagnostic accuracy of this new modality are not yet available; however, preliminary studies have shown a higher diagnostic accuracy and confidence compared to PET-computed tomography (PET-CT) in regions where MRI is known to be superior to CT, such as the liver. The benefit of MRI in accurate lesion characterization and the additional value of diffusion-weighted imaging (DWI) as a complementary functional modality by means of the apparent diffusion coefficient (ADC) is apparent in entities with low tracer uptake (e.g. due to small size) and a decreased or absent accumulation pattern on PET.
Collapse
|
|
34
|
Abstract
Magnetic resonance imaging (MRI) with rectal protocol modification is a reliable staging modality which is rapidly replacing transrectal ultrasound for staging. The added information delivered by MRI includes wide circumferential radial margin compromise, distant lymph node metastasis in the pelvis, and level of sphincter compromise in the low rectum. As more information becomes available through ongoing studies, MRI may be able to contribute the decision to treat rectal cancer nonoperatively.
Collapse
Affiliation(s)
- Gregory dePrisco
- Department of Radiology, Body MRI Division, Baylor University Medical Center, Dallas, Texas
| |
Collapse
|
|
35
|
Abstract
OBJECTIVE MRI is the modality of choice for rectal cancer staging. The high soft-tissue contrast of MRI accurately assesses the extramural tumor spread and relation to mesorectal fascia and the sphincter complex. This article reviews the role of MRI in the staging and treatment of rectal cancer. The relevant anatomy, MRI techniques, preoperative staging, post-chemoradiation therapy (CRT) imaging, and tumor recurrence are discussed with special attention to recent advances in knowledge. CONCLUSION MRI is the modality of choice for staging rectal cancer to assist surgeons in obtaining negative surgical margins. MRI facilitates the accurate assessment of mesorectal fascia and the sphincter complex for surgical planning. Multiparametric MRI may also help in the prediction and estimation of response to treatment and in the detection of recurrent disease.
Collapse
|
|
36
|
Brendle C, Schwenzer NF, Rempp H, Schmidt H, Pfannenberg C, la Fougère C, Nikolaou K, Schraml C. Assessment of metastatic colorectal cancer with hybrid imaging: comparison of reading performance using different combinations of anatomical and functional imaging techniques in PET/MRI and PET/CT in a short case series. Eur J Nucl Med Mol Imaging 2015. [DOI: 10.1007/s00259-015-3137-z] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
|
37
|
Fan WH, Wang FL, Lu ZH, Pan ZZ, Li LR, Gao YH, Chen G, Wu XJ, Ding PR, Zeng ZF, Wan DS. Surgery with versus without preoperative concurrent chemoradiotherapy for mid/low rectal cancer: an interim analysis of a prospective, randomized trial. CHINESE JOURNAL OF CANCER 2015; 34:394-403. [PMID: 26111932 PMCID: PMC4593338 DOI: 10.1186/s40880-015-0024-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 04/02/2015] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Multimodality therapy, including preoperative chemoradiotherapy (CRT) and total mesorectal excision (TME), has effectively reduced local recurrence rates of rectal cancer over the past decade. However, the benefits and risks of the addition of neoadjuvant CRT to surgery need to be evaluated. This study was to compare the efficacy of TME with versus without preoperative concurrent chemoradiotherapy (CCRT) involving XELOX regimen (oxaliplatin plus capecitabine) in Chinese patients with stages II and III mid/low rectal adenocarcinoma. METHODS We randomly assigned patients to the TME group (TME without preoperative CCRT) or CCRT + TME group (TME with preoperative CCRT). The primary endpoint was disease-free survival (DFS); the secondary endpoints were overall survival (OS), local and distant recurrence, tumor response to CRT, toxicity, sphincter preservation, and surgical complications. An interim analysis of the potential inferiority of DFS in the CCRT + TME group was planned when the first 180 patients had been followed up for at least 6 months. RESULTS A total of 94 patients in the TME group and 90 patients in the CCRT + TME group were able to be evaluated. The 3-year DFS and OS rates were 86.3 % and 91.5 % in the whole cohort, respectively. The 3-year DFS rates of the TME and CCRT + TME groups were 85.7% and 87.9 % (P = 0.766), respectively, and the 3-year OS rates were 90.7 % and 92.3 % (P = 0.855), respectively. The functional sphincter preservation rates of the TME and CCRT + TME groups were 71.3 % and 70.0 % (P = 0.849), respectively. In the TME group, 16 (17.0 %) patients were proven to have pTNM stage I disease after surgery. In the CCRT + TME group, 32 (35.6 %) patients achieved a pathologic complete response (pCR). CONCLUSIONS Preliminary results indicated no significant differences in the DFS, OS, or functional sphincter preservation rates between the TME and CCRT + TME groups. However, preoperative CCRT with XELOX yielded a high pCR rate. Newer techniques are needed to improve the staging accuracy, and further investigation is warranted. CLINICAL TRIAL REGISTRATION NUMBER Chi CTR-TRC-08000122.
Collapse
Affiliation(s)
- Wen-Hua Fan
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China. .,Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China.
| | - Fu-Long Wang
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China. .,Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China.
| | - Zhen-Hai Lu
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China. .,Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China.
| | - Zhi-Zhong Pan
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China. .,Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China.
| | - Li-Ren Li
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China. .,Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China.
| | - Yuan-Hong Gao
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China. .,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China.
| | - Gong Chen
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China. .,Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China.
| | - Xiao-Jun Wu
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China. .,Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China.
| | - Pei-Rong Ding
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China. .,Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China.
| | - Zhi-Fan Zeng
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China. .,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China.
| | - De-Sen Wan
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China. .,Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China.
| |
Collapse
|
|
38
|
Yi HJ, Hong KS, Moon N, Chung SS, Lee RA, Kim KH. Reliability of (18)f-fluorodeoxyglucose positron emission tomography/computed tomography in the nodal staging of colorectal cancer patients. Ann Coloproctol 2014; 30:259-65. [PMID: 25580412 PMCID: PMC4286772 DOI: 10.3393/ac.2014.30.6.259] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 10/14/2014] [Indexed: 12/16/2022] Open
Abstract
Purpose Lymph-node metastasis is considered as critical prognostic factor in colorectal cancer. A preoperative evaluation of lymph-node metastasis can also help to determine the range of distant lymph node dissection. However, the reliability of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in the detection of lymph-node metastasis is not fully known. Methods The medical records of 433 patients diagnosed with colorectal cancer were reviewed retrospectively. FDG-PET/CT and CT were performed on all patients. Lymph nodes were classified into regional and distant lymph nodes according to the American Joint Committee on Cancer (AJCC) Cancer Staging Manual, 7th edition. Results The patients included 231 males (53.3%) and 202 females (46.7%), with a mean age of 64.7 ± 19.0 years. For regional lymph nodes, the sensitivity of FDG-PET/CT was lower than that of CT (57.1% vs. 73.5%, P < 0.001). For distant lymph nodes, the sensitivity of FDG-PET/CT was higher than that of CT (64.7% vs. 52.9%, P = 0.012). The sensitivity of FDG-PET/CT for regional lymph nodes was higher in patients with larger primary tumors. The positivity of lymph-node metastasis for FDG-PET/CT was affected by carcinoembryonic antigen levels, tumor location, and cancer stage for regional lymph nodes and by age and cancer stage for distant lymph nodes (P < 0.05). Conclusion The sensitivity of FDG-PET/CT for regional lymph-node metastasis was not superior to that of CT. However, FDG-PET/CT provides helpful information for determining surgical plan especially in high risk patients group.
Collapse
Affiliation(s)
- Hee Jung Yi
- Department of Surgery, Ewha Womans University School of Medicine, Seoul, Korea
| | - Kyung Sook Hong
- Department of Surgery, Ewha Womans University School of Medicine, Seoul, Korea
| | - Nara Moon
- Department of Surgery, Ewha Womans University School of Medicine, Seoul, Korea
| | - Soon Sup Chung
- Department of Surgery, Ewha Womans University School of Medicine, Seoul, Korea
| | - Ryung-Ah Lee
- Department of Surgery, Ewha Womans University School of Medicine, Seoul, Korea
| | - Kwang Ho Kim
- Department of Surgery, Ewha Womans University School of Medicine, Seoul, Korea
| |
Collapse
|
|
39
|
Evaluation of lateral pelvic nodes in patients with advanced rectal cancer. AJR Am J Roentgenol 2014; 202:1245-55. [PMID: 24848821 DOI: 10.2214/ajr.13.11228] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The purpose of this article is to discuss the importance of lateral pelvic lymph node metastasis as a predictor of local recurrence and survival in patients with advanced rectal cancer. CONCLUSION Prediction of lateral pelvic nodal staging on MRI shows high accuracy compared with the other imaging modalities. Diffusion-weighted MRI or (18)F-FDG PET/CT may be helpful to assesses lateral pelvic lymph node metastasis.
Collapse
|
|
40
|
Saklani AP, Bae SU, Clayton A, Kim NK. Magnetic resonance imaging in rectal cancer: a surgeon's perspective. World J Gastroenterol 2014; 20:2030-2041. [PMID: 24616572 PMCID: PMC3934473 DOI: 10.3748/wjg.v20.i8.2030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 11/27/2013] [Accepted: 01/14/2014] [Indexed: 02/06/2023] Open
Abstract
Magnetic resonance imaging (MRI) in rectal cancer was first investigated in 1999 and has become almost mandatory in planning rectal cancer treatment. MRI has a high accuracy in predicting circumferential resection margin involvement and is used to plan neoadjuvant therapy. The accuracy of MRI in assessing mesorectal lymph nodes remains moderate, as there are no reliable criteria to assess nodal involvement. MRI seems to be good in assessing peritoneal involvement in upper rectal cancer; this however has been assessed in only a few studies and needs further research. For low rectal cancers, mesorectum is thin at the level of levator ani especially in relation to prostate; so predicting circumferential resection margin involvement is not easy. However high spatial resolution coronal imaging shows levator muscles, sphincter complex and intersphincteric plane accurately. This is used to stage low rectal tumors and plan plane of surgery (standard surgery, intersphincteric resection, Extralevator abdominoperineal resection). While most centres perform MRI post chemoradiotherapy, its role in accurate staging post neoadjuvant therapy remains debatable. THe role of Diffusion weighted MRI post neoadjuvant therapy is being evaluated in research settings.
Collapse
|
|
41
|
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]
|
|
42
|
Nardi PD, Carvello M. How reliable is current imaging in restaging rectal cancer after neoadjuvant therapy? World J Gastroenterol 2013; 19:5964-5972. [PMID: 24106396 PMCID: PMC3785617 DOI: 10.3748/wjg.v19.i36.5964] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 05/21/2013] [Accepted: 07/17/2013] [Indexed: 02/06/2023] Open
Abstract
In patients with advanced rectal cancer, neoadjuvant chemo radiotherapy provides tumor downstaging and downsizing and complete pathological response in up to 30% of cases. After proctectomy complete pathological response is associated with low rates of local recurrence and excellent long term survival. Several authors claim a less invasive surgery or a non operative policy in patients with partial or clinical complete response respectively, however to identify patients with true complete pathological response before surgical resection remains a challenge. Current imaging techniques have been reported to be highly accurate in the primary staging of rectal cancer, however neoadjuvant therapy course produces deep modifications on cancer tissue and on surrounding structures such as overgrowth fibrosis, deep stroma alteration, wall thickness, muscle disarrangement, tumor necrosis, calcification, and inflammatory infiltration. As a result, the same imaging techniques, when used for restaging, are far less accurate. Local tumor extent may be overestimated or underestimated. The diagnostic accuracy of clinical examination, rectal ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography using 18F-fluoro-2'-deoxy-D-glucose ranges between 25% and 75% being less than 60% in most studies, both for rectal wall invasion and for lymph nodes involvement. In particular the ability to predict complete pathological response, in order to tailor the surgical approach, remains low. Due to the radio-induced tissue modifications, combined with imaging technical aspects, low rate accuracy is achieved, making modern imaging techniques still unreliable in restaging rectal cancer after chemo-radiotherapy.
Collapse
|
|
43
|
Partovi S, Robbin MR, Steinbach OC, Kohan A, Rubbert C, Vercher-Conejero JL, Kolthammer JA, Faulhaber P, Paspulati RM, Ros PR. Initial experience of MR/PET in a clinical cancer center. J Magn Reson Imaging 2013; 39:768-80. [PMID: 24006287 DOI: 10.1002/jmri.24334] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 07/09/2013] [Indexed: 12/20/2022] Open
Abstract
Magentic Resonance/positron emission tomography (PET) has been introduced recently for imaging of clinical patients. This hybrid imaging technology combines the inherent strengths of MRI with its high soft-tissue contrast and biological sequences with the inherent strengths of PET, enabling imaging of metabolism with a high sensitivity. In this article, we describe the initial experience of MR/PET in a clinical cancer center along with a review of the literature. For establishing MR/PET in a clinical setting, technical challenges, such as attenuation correction and organizational challenges, such as workflow and reimbursement, have to be overcome. The most promising initial results of MR/PET have been achieved in anatomical areas where high soft-tissue and contrast resolution is of benefit. Head and neck cancer and pelvic imaging are potential applications of this hybrid imaging technology. In the pediatric population, MR/PET can decrease the lifetime radiation dose. MR/PET protocols tailored to different types of malignancies need to be developed. After the initial exploration phase, large multicenter trials are warranted to determine clinical indications for this exciting hybrid imaging technology and thereby opening new horizons in molecular imaging.
Collapse
Affiliation(s)
- Sasan Partovi
- Department of Radiology, UH Seidman Cancer Center, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
44
|
Uçar A, Obuz F, Sökmen S, Terzi C, Sağol O, Sarıoğlu S, Füzün M. Efficacy of high resolution magnetic resonance imaging in preoperative local staging of rectal cancer. Mol Imaging Radionucl Ther 2013; 22:42-8. [PMID: 24003396 PMCID: PMC3759308 DOI: 10.4274/mirt.43153] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 04/13/2013] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To assess the efficacy of high-resolution magnetic resonance imaging (HRMRI) for preoperative local staging in patients with rectal cancer who did not receive preoperative radiochemotherapy. METHODS In this retrospective study, 30 patients with biopsy proved primary rectal cancer were evaluated by HRMRI. Two observers independently scored the tumour and lymph node stages, and circumferential resection margin (CRM) involvement. The sensitivity, specificity, the negative predictive value and the positive predictive value of HRMRI findings were calculated within the 95% confidence interval. The area under the curve was measured for each result. Agreement between two observers was assessed by means of the Kappa test. RESULTS In T staging the accuracy rate of HRMRI was 47-67%, overstaging was 10-21%, and understaging was 13-43%. In the prediction of extramural invasion with HRMRI, the sensitivity was 79-89%, the specificity was 72-100%, the PPV was 85-100%, the NPV was 73-86%, and the area under the curve was 0.81-0.89. In the prediction of lymph node metastasis, the sensitivity was 58-58%, the specificity was 50-55%, the PPV was 43-46%, and the NPV was 64-66%. The area under the curve was 0.54-0.57. When the cut off value was selected as 1 mm, the sensitivity of HRMRI was 38-42%, the specificity was 73-82%, the PPV was 33-42%, and NPV was 79-81% in the prediction of the CRM involvement. The correlation between the two observers was moderate for tumour staging, substantial for lymph node staging and predicting of CRM involvement. CONCLUSION Preoperative HRMRI provides good predictive data for extramural invasion but poor prediction of lymph node status and CRM involvement. CONFLICT OF INTEREST None declared.
Collapse
Affiliation(s)
- Aysun Uçar
- Dokuz Eylül University, Department of Radiology, İzmir, Turkey
| | | | | | | | | | | | | |
Collapse
|
|
45
|
Beets-Tan RGH. Pretreatment MRI of lymph nodes in rectal cancer: an opinion-based review. Colorectal Dis 2013; 15:781-4. [PMID: 23701484 DOI: 10.1111/codi.12300] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 05/16/2013] [Indexed: 02/08/2023]
Affiliation(s)
- R G H Beets-Tan
- Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands.
| |
Collapse
|
|
46
|
Pace L, Nicolai E, Aiello M, Catalano OA, Salvatore M. Whole-body PET/MRI in oncology: current status and clinical applications. Clin Transl Imaging 2013. [DOI: 10.1007/s40336-013-0012-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
|
47
|
A systematic review and meta-analysis of pretherapeutic lymph node staging of colorectal cancer by 18F-FDG PET or PET/CT. Nucl Med Commun 2013; 33:1127-33. [PMID: 23000829 DOI: 10.1097/mnm.0b013e328357b2d9] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The purpose of the present study was to conduct a systematic review and meta-analysis of the published literature to evaluate the diagnostic performance of fluorine-18 2-fluoro-2-deoxy-D-glucose (18F-FDG) PET in the pretherapeutic assessment of nodal staging in patients with colorectal cancer (CRC). We conducted a systematic MEDLINE search of articles in the published literature (last update, February 2012). Two reviewers independently assessed the methodological quality of each study. We estimated pooled sensitivity, specificity, summary receiver operating characteristic curves, and summary likelihood ratios. A total of 409 patients from 10 studies were analyzed. The pooled estimates of sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of 18F-FDG PET [PET/computed tomography (CT)] in the detection of pretherapeutic lymph node involvement in patients with CRC were 42.9% [95% confidence interval (CI): 36.0-50.0%], 87.9% (95% CI: 82.6-92.0%), 2.82 (95% CI: 1.96-4.07), and 0.69 (95% CI: 0.62-0.78), respectively. There is no solid evidence to support the routine clinical application of 18F-FDG PET (PET/CT) in the pretherapeutic evaluation of lymph node status in patients with CRC. However, 18F-FDG PET (PET/CT) could be used to strengthen the possibility of suspected metastatic lymph nodes detected by other imaging modalities.
Collapse
|
|
48
|
Pretherapeutic Diagnosis and Staging. Updates Surg 2013. [DOI: 10.1007/978-88-470-2670-4_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
|
49
|
Abstract
CLINICAL/METHODICAL ISSUE Staging and follow-up of colorectal cancer are usually performed with multimodal imaging strategies. These can be time-intensive and potentially lead to examiner-dependent bias. Alternatively, whole body magnetic resonance imaging (WB-MRI) provides oncologic imaging with a systemic approach. STANDARD RADIOLOGICAL METHODS Ultrasound, multislice computed tomography (MSCT), dedicated MRI and positron emission tomography/CT (PET/CT). METHODICAL INNOVATIONS High-resolution WB-MRI with focused examination of various organs, such as the pelvis and abdomen, lungs, brain and skeletal system, using different sequence and contrast techniques. PERFORMANCE Detection of colorectal tumor recurrence with WB-MRI provides 83% accuracy (lymph node metastases 80%, organ metastases 86%). ACHIEVEMENTS Potential cost reduction through decreased examination time and personnel costs. PRACTICAL RECOMMENDATIONS Whole body MRI is a radiation-free alternative to standard sequential algorithms of staging and follow-up of colorectal cancer.
Collapse
Affiliation(s)
- G Schmidt
- Institut für klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland.
| |
Collapse
|
|
50
|
Buchbender C, Heusner TA, Lauenstein TC, Bockisch A, Antoch G. Oncologic PET/MRI, Part 1: Tumors of the Brain, Head and Neck, Chest, Abdomen, and Pelvis. J Nucl Med 2012; 53:928-38. [DOI: 10.2967/jnumed.112.105338] [Citation(s) in RCA: 161] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
|