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Nodal staging with MRI after neoadjuvant chemo-radiotherapy for locally advanced rectal cancer: a fast and reliable method

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

In patients with locally advanced rectal carcinoma (LARC), negative nodal status after neoadjuvant chemoradiotherapy (nCRT) may allow for rectum-sparing protocols rather than total mesorectal excision; however, current MRI criteria for nodal staging have suboptimal accuracy. The aim of this study was to compare the diagnostic accuracy of different MRI dimensional criteria for nodal staging after nCRT in patients with LARC.

Materials and methods

Patients who underwent MRI after nCRT for LARC followed by surgery were retrospectively included and divided into a training and a validation cohort of 100 and 39 patients, respectively. Short-, long-, and cranial-caudal axes and volume of the largest mesorectal node and nodal status based on European Society of Gastrointestinal Radiology consensus guidelines (i.e., ESGAR method) were assessed by two radiologists independently. Inter-reader agreement was assessed in the training cohort. Histopathology was the reference standard. ROC curves and the best cut-off were calculated, and accuracies compared with the McNemar test.

Results

The study population included 139 patients (median age 62 years [IQR 55–72], 94 men). Inter-reader agreement was high for long axis (κ = 0.81), volume (κ = 0.85), and ESGAR method (κ = 0.88) and low for short axis (κ = 0.11). Accuracy was similar (p > 0.05) for long axis, volume, and ESGAR method both in the training (71%, 74%, and 65%, respectively) and in the validation (83%, 78%, and 75%, respectively) cohorts.

Conclusion

Accuracy of the measurement of long axis and volume of the largest lymph node is not inferior to the ESGAR method for nodal staging after nCRT in LARC.

Clinical relevance statement

In MRI restaging of rectal cancer, measurement of the long axis or volume of largest mesorectal lymph node after preoperative chemoradiotherapy is a faster and reliable alternative to ESGAR criteria for nodal staging.

Key Points

• Current MRI criteria for nodal staging in locally advanced rectal cancer after chemo-radiotherapy have suboptimal accuracy and are time-consuming.

• Measurement of long axis or volume of the largest mesorectal lymph node on MRI showed good accuracy for assessment of loco-regional nodal status in locally advanced rectal cancer.

• MRI measurement of the long axis and volume of largest mesorectal lymph node after chemo-radiotherapy could be a faster and reliable alternative to ESGAR criteria for nodal staging.

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Abbreviations

ADC:

Apparent diffusion coefficient

DWI:

Diffusion-weighted imaging

ESGAR:

European Society of Gastrointestinal and Abdominal Radiology

ESMO:

European Society of Medical Oncology

IQR:

Interquartile ranges

LARC:

Locally advanced rectal cancer

nCRT:

Neoadjuvant chemoradiotherapy

NPV:

Negative predictive value

PPV:

Positive predictive value

TME:

Total mesorectal excision

TSE:

Turbo spin echo sequences

VIBE:

Volumetric interpolated breath-hold examination

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Funding

The authors state that this work has not received any funding.

Author information

Author notes

  1. Filippo Crimì, Giulio Cabrelle, and Cristina Campi have equally contributed and share first authorship.

  2. Salvatore Pucciarelli, Federica Vernuccio, and Emilio Quaia have equally contributed and share last authorship.

Authors and Affiliations

  1. Institute of Radiology, Department of Medicine-DIMED, University of Padova, Padua, Italy

    Filippo Crimì, Alessio Schillaci, Alessia Pepe & Emilio Quaia

  2. Department of Radiology, University Hospital of Padova, Via Niccolò Giustiniani N.2, 35128, Padua, Italy

    Giulio Cabrelle & Federica Vernuccio

  3. Department of Mathematics, University of Genova, Genoa, Italy

    Cristina Campi

  4. IRCCS Ospedale Policlinico San Martino, Genoa, Italy

    Cristina Campi

  5. General Surgery 3, Department of Surgical, Oncological, and Gastroenterological Sciences (DiSCOG), University of Padova, Padua, Italy

    Quoc Riccardo Bao, Gaya Spolverato & Salvatore Pucciarelli

Authors
  1. Filippo Crimì
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  2. Giulio Cabrelle
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Corresponding author

Correspondence to Federica Vernuccio.

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Guarantor

The scientific guarantor of this publication is Prof. Emilio Quaia.

Conflict of interest

Dr. Federica Vernuccio served as Junior Deputy Editor for European Radiology. She has not taken part in the review or selection process of this article. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Prof. Cristina Campi, Associate Professor in the Department of Mathematics at University of Genova, Italy, performed statistical analysis and is co-author of the paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained. Local ethical committee of University Hospital of Padua approved the study (protocol number 326N/AO/23, approved on January 19, 2023).

Study subjects or cohorts overlap

No cohorts overlap.

Methodology

• retrospective

• diagnostic study

• performed at one institution

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Crimì, F., Cabrelle, G., Campi, C. et al. Nodal staging with MRI after neoadjuvant chemo-radiotherapy for locally advanced rectal cancer: a fast and reliable method. Eur Radiol (2023). https://doi.org/10.1007/s00330-023-10265-3

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  • DOI: https://doi.org/10.1007/s00330-023-10265-3

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