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Computerized Tomography Criteria as a Tool for Simplifying the Assessment of Locally Advanced Rectal Cancer

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Abstract

Background

Rectal cancer represents a leading cause of mortality worldwide. Staging defines the local and distant extent of the disease, guides management, and predicts prognosis. Different modalities are available for staging including TRUS (transrectal ultrasound), CT (computed tomography), and MRI (magnetic resonance imaging).

Objective

The objective of this study was to screen and isolate CT imaging parameters suggestive of advanced rectal cancer and its utility as a tool in simplifying the staging protocol making further imaging studies unnecessary.

Design

Retrospective, single center study.

Patients and Settings

Seventy-five patients with rectal carcinoma were included and were divided into two groups according to their T score and nodal involvement status, as diagnosed by TRUS. Group 1 (n = 15) “local disease” (T1/T2 N0) and group 2 (n = 60) “locally advanced disease” are both eligible for neoadjuvant treatment (N/any T or T3/any N). For each patient, three CT imaging parameters that represent locally advanced disease, i.e., perirectal fat infiltration, local lymphadenopathy, and rectal wall thickening, were evaluated and compared between the two groups.

Main Outcome Measure

The capability of CT imaging to accurately predict locally advanced rectal carcinoma.

Results

Rectal wall thickening on CT was found to have 92% PPV and perirectal lymphadenopathy 96% PPV for predicting a locally advanced stage. A combination of those two parameters results in a predictive PPV of 98%.

Limitations

This was a single center retrospective study, with a relatively small cohort.

Conclusions

CT is a valuable tool in the assessment and management of rectal carcinoma as it can identify locally advanced rectal cancer. This enables treatment without any further unnecessary evaluation.

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References

  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68:394–424. https://doi.org/10.3322/caac.21492.

    Article  Google Scholar 

  2. Nerad E, Lahaye MJ, Maas M, Nelemans P, Bakers FCH, Beets GL, et al. Diagnostic accuracy of CT for local staging of colon cancer: a systematic review and meta-analysis. Am J Roentgenol. 2016;207:984–95. https://doi.org/10.2214/AJR.15.15785.

    Article  Google Scholar 

  3. Glimelius B, Tiret E, Cervantes A, Arnold D, Group W. clinical practice guidelines. Rectal cancer : ESMO Clinical Practice Guidelines clinical practice guidelines. 2013;24. https://doi.org/10.1093/annonc/mdt240.

    Article  Google Scholar 

  4. Wu JS. Rectal Cancer Staging. 2007;1:148–57. https://doi.org/10.1055/s-2007-984859.

    Article  Google Scholar 

  5. Crane CH, Skibber J. Preoperative chemoradiation for locally advanced rectal cancer: rationale, technique, and results of treatment. Semin Surg Oncol. 2003;21:265–70. https://doi.org/10.1002/ssu.10046.

    Article  PubMed  Google Scholar 

  6. Påhlman L, Glimelius B. Pre- or postoperative radiotherapy in rectal and rectosigmoid carcinoma. Report from a randomized multicenter trial. Ann Surg. 1990;211:187–95.

    Article  Google Scholar 

  7. Siddiqui AA, Fayiga Y, Huerta S. International seminars in surgical the role of endoscopic ultrasound in the evaluation of rectal cancer. 2006;7:1–7. https://doi.org/10.1186/1477-7800-3-36.

  8. Valentini V, Glimelius B, Minsky BD, Van Cutsem E, Bartelink H, Beets-Tan RGH, et al. The multidisciplinary rectal cancer treatment: Main convergences, controversial aspects and investigational areas which support the need for an European consensus. Radiother Oncol. 2005;76:241–50. https://doi.org/10.1016/j.radonc.2005.07.001.

    Article  PubMed  Google Scholar 

  9. Halligan S, Altman DG, Taylor SA, Mallett S, Deeks JJ, Bartram CI, et al. CT colonography in the detection of colorectal polyps and cancer: systematic review, meta-analysis, and proposed minimum data set for study level reporting. Radiology. 2005;237:893–904. https://doi.org/10.1148/radiol.2373050176.

    Article  PubMed  Google Scholar 

  10. Dewhurst C, Rosen MP, Blake MA, Baker ME, Cash BD, Fidler JL, et al. ACR appropriateness criteria pretreatment staging of colorectal cancer. J Am Coll Radiol. 2012;9:775–81. https://doi.org/10.1016/j.jacr.2012.07.025.

    Article  PubMed  Google Scholar 

  11. Puli SR, Reddy JBK, Bechtold ML, Choudhary A. Accuracy of endoscopic ultrasound to diagnose nodal invasion by rectal cancers: a meta-analysis and systematic review. 2009:1255–65. https://doi.org/10.1245/s10434-009-0337-4.

    Article  Google Scholar 

  12. Al-Sukhni E, Milot L, Fruitman M, Beyene J, Victor JC, Schmocker S, et al. Diagnostic accuracy of MRI for assessment of T category, lymph node metastases, and circumferential resection margin involvement in patients with rectal cancer: a systematic review and meta-analysis. Ann Surg Oncol. 2012;19:2212–23. https://doi.org/10.1245/s10434-011-2210-5.

    Article  PubMed  Google Scholar 

  13. Bianchi P, Ceriani C, Rottoli M, Torzilli G, Pompili G, Malesci A, et al. Endoscopic ultrasonography and magnetic resonance in preoperative staging of rectal cancer: comparison with histologic findings. J Gastrointest Surg. 2005;9:1222–8. https://doi.org/10.1016/j.gassur.2005.07.008.

    Article  PubMed  Google Scholar 

  14. Kristina Gregory NM, Lisa Gurski O, Benson AB, Venook AP, Helen Diller Family U, Al-Hawary MM, et al. Continue NCCN guidelines panel disclosures. 2018.

  15. Harewood GC, Wiersema MJ. Cost-effectiveness of endoscopic ultrasonography in the evaluation of proximal rectal cancer. Am J Gastroenterol. 2002;97:874–82. https://doi.org/10.1111/j.1572-0241.2002.05603.x.

    Article  PubMed  Google Scholar 

  16. Kauer WKH, Prantl L, Dittler HJ, Siewert JR. The value of endosonographic rectal carcinoma staging in routine diagnostics: a 10-year analysis. Surg Endosc. 2004;18:1075–8. https://doi.org/10.1007/s00464-003-9088-7.

    Article  CAS  PubMed  Google Scholar 

  17. Harewood GC, Wiersema MJ, Nelson H, Maccarty RL, Olson JE, Clain JE, et al. A prospective, blinded assessment of the impact of preoperative staging on the management of rectal cancer. Gastroenterology. 2002;123:24–32.

    Article  Google Scholar 

  18. Puli SR, Reddy JBK, Bechtold ML, Choudhary A, Antillon MR, Brugge WR. Accuracy of endoscopic ultrasound to diagnose nodal invasion by rectal cancers: a meta-analysis and systematic review. Ann Surg Oncol. 2009;16:1255–65. https://doi.org/10.1245/s10434-009-0337-4.

    Article  PubMed  Google Scholar 

  19. Raman SP, Chen Y, Fishman EK. Evolution of imaging in rectal cancer: multimodality imaging with MDCT, MRI, and PET. J Gastrointest Oncol. 2015;6:172–84. https://doi.org/10.3978/j.issn.2078-6891.2014.108.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Juchems MS, Ernst AS, Kornmann M, Barth TF, Kramer K, Brambs H-J, et al. Value of MDCT in preoperative local staging of rectal cancer for predicting the necessity for neoadjuvant radiochemotherapy. Rofo. 2009;181:1168–74. https://doi.org/10.1055/s-0028-1109356.

    Article  CAS  PubMed  Google Scholar 

  21. Vliegen R, Dresen R, Beets G, Daniels-Gooszen A, Kessels A, van Engelshoven J, et al. The accuracy of multi-detector row CT for the assessment of tumor invasion of the mesorectal fascia in primary rectal cancer. Abdom Imaging. 2008;33:604–10. https://doi.org/10.1007/s00261-007-9341-y.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kanamoto T, Matsuki M, Okuda J, Inada Y, Tatsugami F, Tanikake M, et al. Preoperative evaluation of local invasion and metastatic lymph nodes of colorectal cancer and mesenteric vascular variations using multidetector-row computed tomography before laparoscopic surgery. J Comput Assist Tomogr. 2007;31:831–9. https://doi.org/10.1097/RCT.0b013e3180517af3.

    Article  PubMed  Google Scholar 

  23. Taylor A, Slater A, Mapstone N, Taylor S, Halligan S. Staging rectal cancer: MRI compared to MDCT. Abdom Imaging. 2007;32:323–7. https://doi.org/10.1007/s00261-006-9081-4.

    Article  PubMed  Google Scholar 

  24. Sinha R, Verma R, Rajesh A, Richards CJ. Diagnostic value of multidetector row CT in rectal cancer staging: comparison of multiplanar and axial images with histopathology. Clin Radiol. 2006;61:924–31. https://doi.org/10.1016/j.crad.2006.03.019.

    Article  CAS  PubMed  Google Scholar 

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Author notes

  1. Oren Gal MD and Dan Feldman MD contributed equally to this work.

Authors and Affiliations

  1. Gastroenterology Department, Hillel Yaffe Medical Center, Hashalom Street, Hadera, Israel

    Oren Gal, Dan Feldman, Amir Mari, Fadi Abu Baker & Yael Kopelman

  2. Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel

    Oren Gal, Dan Feldman, Amir Mari, Fadi Abu Baker, Dan Hebron & Yael Kopelman

  3. Gastroenterology Department, Nazareth Hospital EMMS, Nazareth, Israel

    Amir Mari

  4. Radiology Department, Hillel Yaffe Medical Center, Hadera, Israel

    Dan Hebron

Authors
  1. Oren Gal
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  2. Dan Feldman
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  4. Fadi Abu Baker
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Correspondence to Dan Feldman.

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Gal, O., Feldman, D., Mari, A. et al. Computerized Tomography Criteria as a Tool for Simplifying the Assessment of Locally Advanced Rectal Cancer. J Gastrointest Canc 51, 130–134 (2020). https://doi.org/10.1007/s12029-019-00220-1

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  • DOI: https://doi.org/10.1007/s12029-019-00220-1

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