Techniques in Coloproctology

, Volume 21, Issue 1, pp 15–23 | Cite as

Histopathological and radiological reporting in rectal cancer: concepts and controversies, facts and fantasies

  • S. Balyasnikova
  • N. HaboubiEmail author
  • B. Moran
  • G. Brown
Challenges in Coloproctology


In rectal cancer patients, the stage of the disease, local spread and distant metastases status drive the treatment decisions to be made. Histopathology remains the gold standard, but preoperative staging, particularly magnetic resonance imaging (MRI), is pivotal for defining surgical planes and finding patients who could potentially benefit from preoperative regimes. Unfortunately, due to a lack of awareness, expertise and practise the quality of rectal cancer MRI and histopathology reporting varies among centres. This paper highlights the most important and frequently occurring radiological and histopathological discrepancies/mistakes to be aware of.


Rectal cancer Histopathological reporting MRI staging 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study formal consent is not required.


  1. 1.
    Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery–the clue to pelvic recurrence? Br J Surg 69:613–616CrossRefPubMedGoogle Scholar
  2. 2.
    Quirke P, Durdey P, Dixon MF, Williams NS (1986) Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet 2:996–999CrossRefPubMedGoogle Scholar
  3. 3.
    Taylor FG, Quirke P, Heald RJ et al (2011) Preoperative high-resolution magnetic resonance imaging can identify good prognosis stage I, II, and III rectal cancer best managed by surgery alone: a prospective, multicenter, European study. Ann Surg 253:711–719CrossRefPubMedGoogle Scholar
  4. 4.
    Ngan SY, Burmeister B, Fisher RJ et al (2012) Randomized trial of short-course radiotherapy versus long-course chemoradiation comparing rates of local recurrence in patients with T3 rectal cancer: Trans-Tasman Radiation Oncology Group trial 01.04. J Clin Oncol 30:3827–3833CrossRefPubMedGoogle Scholar
  5. 5.
    Mercury Study Group (2006) Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study. BMJ 14:779CrossRefGoogle Scholar
  6. 6.
    Smith NJ, Barbachano Y, Norman AR, Swift RI, Abulafi AM, Brown G (2008) Prognostic significance of magnetic resonance imaging-detected extramural vascular invasion in rectal cancer. Br J Surg 95:229–236CrossRefPubMedGoogle Scholar
  7. 7.
    Chand M, Swift RI, Chau I, Heald RJ, Tekkis PP, Brown G (2014) Adjuvant therapy decisions based on magnetic resonance imaging of extramural venous invasion and other prognostic factors in colorectal cancer. Ann R Coll Surg Engl 96:543–546CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Smith NJ, Shihab O, Arnaout A, Swift RI, Brown G (2008) MRI for detection of extramural vascular invasion in rectal cancer. AJR Am J Roentgenol 191:1517–1522CrossRefPubMedGoogle Scholar
  9. 9.
    McDonald JR, Renehan AG, O’Dwyer ST, Haboubi NY (2012) Lymph node harvest in colon and rectal cancer: current considerations. World J Gastrointest Surg 4:9–19CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Haboubi N, Berho M (2014) Lymph node harvest (LNH) in colorectal cancer; a critical appraisal. Pol Przegl Chir 86:497–504Google Scholar
  11. 11.
    Markl B, Wieberneit J, Kretsinger H et al (2016) Number of intratumoral T lymphocytes is associated with lymph node size, lymph node harvest, and outcome in node-negative colon cancer. Am J Clin Pathol 145:826–836CrossRefPubMedGoogle Scholar
  12. 12.
    Markl B, Schaller T, Kokot Y et al (2015) Lymph node size as a simple prognostic factor in node negative colon cancer and an alternative thesis to stage migration. Am J Surg 212:775–780CrossRefPubMedGoogle Scholar
  13. 13.
    Brown G, Richards CJ, Bourne MW et al (2003) Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison. Radiology 227:371–377CrossRefPubMedGoogle Scholar
  14. 14.
    Chand M, Heald RJ, Brown G (2013) The importance of not overstaging mesorectal lymph nodes seen on MRI. Colorectal Dis 15:1201–1204CrossRefPubMedGoogle Scholar
  15. 15.
    Chand M, Bhangu A, Wotherspoon A et al (2014) EMVI-positive stage II rectal cancer has similar clinical outcomes as stage III disease following pre-operative chemoradiotherapy. Ann Oncol 25:858–863CrossRefPubMedGoogle Scholar
  16. 16.
    Shihab OC, Quirke P, Heald RJ, Moran BJ, Brown G (2010) Magnetic resonance imaging-detected lymph nodes close to the mesorectal fascia are rarely a cause of margin involvement after total mesorectal excision. Br J Surg 97:1431–1436CrossRefPubMedGoogle Scholar
  17. 17.
    Knijn N, van Erning FN, Overbeek LI et al (2016) Limited effect of lymph node status on the metastatic pattern in colorectal cancer. Oncotarget 7:31699–31707PubMedPubMedCentralGoogle Scholar
  18. 18.
    Chand M, Evans J, Swift RI et al (2015) The prognostic significance of postchemoradiotherapy high-resolution MRI and histopathology detected extramural venous invasion in rectal cancer. Ann Surg 261:473–479CrossRefPubMedGoogle Scholar
  19. 19.
    Loughrey MB, Quirke P, Shepherd NA (2014) Dataset for colorectal cancer histopathology reports. R Coll Pathol.
  20. 20.
    Messenger DE, Driman DK, Kirsch R (2012) Developments in the assessment of venous invasion in colorectal cancer: implications for future practice and patient outcome. Hum Pathol 43(7):965–973. doi: 10.1016/j.humpath.2011.11.015 CrossRefPubMedGoogle Scholar
  21. 21.
    Balyasnikova JR, Swift I, Wotherspoon A, Tait D, Brown G (2014) MRI staging of early rectal cancer. Paper presented at the ESCP, 2014, Barcelona, SpainGoogle Scholar
  22. 22.
    Absar MS, Haboubi NY (2004) Colonic neoplastic polyps: biopsy is not efficient to exclude malignancy. The Trafford experience. Tech Coloproctol 8(Suppl 2):s257–s260CrossRefPubMedGoogle Scholar
  23. 23.
    Serra-Aracil X, Caro-Tarrago A, Mora-Lopez L, Casalots A, Rebasa P, Navarro-Soto S (2014) Transanal endoscopic surgery with total wall excision is required with rectal adenomas due to the high frequency of adenocarcinoma. Dis Colon Rectum 57:823–829CrossRefPubMedGoogle Scholar
  24. 24.
    Jeziorska M, Haboubi NY, Schofield PF, Ogata Y, Nagase H, Woolley DE (1994) Distribution of gelatinase B (MMP-9) and type IV collagen in colorectal carcinoma. Int J Colorectal Dis 9:141–148CrossRefPubMedGoogle Scholar
  25. 25.
    Haboubi N (2013) Experienced histopathologists can accurately diagnose colorectal carcinoma in the absence of Muscularis Mucosa. Colorectal Dis 15(5):78Google Scholar
  26. 26.
    Haboubi N, Salmo E (2013) Are we accurately measuring the depth of the submucosal invasion in early colorectal cancer by equating the Kikuchi submucosa levels with distances measured in fractions of a millimetre? Colorectal Dis 15:775–777CrossRefPubMedGoogle Scholar
  27. 27.
    Taylor FG, Quirke P, Heald RJ, Mercury study gruop et al (2011) One millimetre is the safe cut-off for magnetic resonance imaging prediction of surgical margin status in rectal cancer. Br J Surg 98:872–879CrossRefPubMedGoogle Scholar
  28. 28.
    Shihab OC, How P, West N et al (2011) Can a novel MRI staging system for low rectal cancer aid surgical planning? Dis Colon Rectum 54:1260–1264CrossRefPubMedGoogle Scholar
  29. 29.
    Moran BJ, Holm T, Brannagan G et al (2014) The English national low rectal cancer development programme: key messages and future perspectives. Colorectal Dis 16:173–178CrossRefPubMedGoogle Scholar
  30. 30.
    Morris KA, Haboubi NY (2015) Pelvic radiation therapy: between delight and disaster. World J Gastrointest Surg 7:279–288CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Birgisson H, Pahlman L, Gunnarsson U, Glimelius B (2005) Occurrence of second cancers in patients treated with radiotherapy for rectal cancer. J Clin Oncol 23:6126–6131CrossRefPubMedGoogle Scholar
  32. 32.
    Patel UB, Blomqvist LK, Taylor F et al (2012) MRI after treatment of locally advanced rectal cancer: how to report tumor response–the MERCURY experience. AJR Am J Roentgenol 199:W486–W495CrossRefPubMedGoogle Scholar
  33. 33.
    Siddiqui MR, Gormly KL, Bhoday J et al (2016) Interobserver agreement of radiologists assessing the response of rectal cancers to preoperative chemoradiation using the MRI tumour regression grading (mrTRG). Clin Radiol 71:854–862CrossRefPubMedGoogle Scholar
  34. 34.
    Rutten H, Glynne-Jones R, Rullier E et al (2006) Capecitabine, oxaliplatin, radiotherapy, and excision (CORE) in patients with MRI-defined locally advanced rectal adenocarcinoma: results of an international multicenter phase II study. J Clin Oncol 24 (153 suppl) abstr 3528Google Scholar
  35. 35.
    Patel UB, Taylor F, Blomqvist L et al (2011) Magnetic resonance imaging-detected tumor response for locally advanced rectal cancer predicts survival outcomes: MERCURY experience. J Clin Oncol 29:3753–3760CrossRefPubMedGoogle Scholar
  36. 36.
    Battersby NJ, Moran B, Stelzner S et al (2016) Reply to: does MRI restaging of rectal cancer after chemoradiotherapy actually permit a change in surgical management? Ann Surg. doi: 10.1097/SLA.0000000000001791 Google Scholar
  37. 37.
    Nagtegaal I, Gaspar C, Marijnen C, Van De Velde C, Fodde R, Van Krieken H (2004) Morphological changes in tumour type after radiotherapy are accompanied by changes in gene expression profile but not in clinical behaviour. J Pathol 204:183–192CrossRefPubMedGoogle Scholar
  38. 38.
    Yu SK, Chand M, Tait DM, Brown G (2014) Magnetic resonance imaging defined mucinous rectal carcinoma is an independent imaging biomarker for poor prognosis and poor response to preoperative chemoradiotherapy. Eur J Cancer 50:920–927CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2016

Authors and Affiliations

  • S. Balyasnikova
    • 1
    • 2
    • 3
  • N. Haboubi
    • 4
    Email author
  • B. Moran
    • 5
  • G. Brown
    • 1
    • 2
    • 3
  1. 1.Department of RadiologyThe Royal Marsden NHS Foundation TrustSuttonUK
  2. 2.Department of RadiologyThe Royal Marsden NHS Foundation TrustFulhamUK
  3. 3.Imperial College LondonLondonUK
  4. 4.Department of HistopathologySpire Hospital Healthcare TrustManchesterUK
  5. 5.Department of Colorectal SurgeryNorth Hampshire HospitalBasingstokeUK

Personalised recommendations