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Annals of Surgical Oncology

, Volume 7, Issue 10, pp 732–737 | Cite as

Preoperative Staging of Rectal Cancer With MRI: Accuracy and Clinical Usefulness

  • Nam Kyu Kim
  • Myeong Jin Kim
  • Jea Kun Park
  • Sung IL Park
  • Jin Sik Min
Editorial

Abstract

Background: Preoperative staging is essential for planning of optimal therapy for patients with rectal cancer. Recently, magnetic resonance imaging (MRI) is used frequently because of its benefits of clear pelvic image are better than other diagnostic methods. The purpose of this study was to determine accuracy rates and clinical usefulness of MRI in preoperative staging of rectal cancer.

Methods: Between February, 1997, and December, 1999, 217 patients with histologically proven rectal cancer were staged preoperatively and had surgical resections performed. MRI criteria for depth of invasion was determined by the degree of disruption of the rectal wall. Metastatic perirectal lymph nodes were considered to be present if they showed heterogenous texture, irregular margin, and enlargement (.10 mm).

Results: The accuracy of the MRI for determining depth of invasion was 176/217 (81%) and regional lymph node invasion was 110/217 (63%). In the T stage, accuracy rate of T1 was 3/4 (75%), T2 was 20/37 (54%), T3 was 141/162 (87%), and T4 was 12/14 (86%), respectively. The specificity of lymph node invasion was 45/110 (41%) and the sensitivity was 91/107 (85%). The accuracy rate of regional lymph node involvement was 136/217 (63%). T1 and T2 were overstaged in 1/4 (25%) and 17/37 (46%), respectively, and T3 was understaged in 15/162 (9.2%). The accuracy rate to detect metastatic lateral pelvic lymph node was 4/14 (29%) after lateral pelvic lymph node dissection was done in 14 patients under MRI. The accuracy rate in assessing levator ani muscle tumor involvement was 8/11 (72%).

Conclusions: MRI showed a good, comparable accuracy rate for determining depth of tumor invasion, compared with transrectal ultrasonography, which still has a low accuracy rate for detecting metastatic lymph node. MRI with endorectal coil may increase the accuracy rate of T1 and T2 lesions. In addition, clear sagittal and coronal sectional pelvic images can give a lot of information about adjacent organ invasion or any invasion of levator ani muscle. MRI can be useful for choosing an appropriate extent of lymph node dissection and type of surgery.

Key Words

Rectal cancer Preoperative staging Magnetic resonance imaging. 

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References

  1. 1.
    Herzog U, vonFlue M, Tondelli, Schuppisser JP. How accurate is endorectal ultrasound in the preoperative staging of rectal cancer? Dis Colon Rectum 1993;36:127–134.PubMedGoogle Scholar
  2. 2.
    Hildebrandt U, Feifel G, Preoperative staging of rectal cancer by intrarectal ultrasound. Dis Colon Rectum 1985;28:42–46.PubMedGoogle Scholar
  3. 3.
    Wazier A, Powsner E, Russo I, et al. Prospective compartive study of magnetic resonance imaging versus transrectal ultrasound for preoperative staging and follow up of rectal cancer: preliminary report. Dis Colon Rectum 1991;34:1068–1072.Google Scholar
  4. 4.
    Thaler W, Watzka S, Martin F, et al. Preoperative staging of rectal cancer by endoluminal ultrasound vs. magnetic resonance imaging: preliminary results of a prospective, comparative study. Dis Colon Rectum 1994;37:1189–1193.PubMedGoogle Scholar
  5. 5.
    Satoh N, Ihara M, Sarahina H, et al. Studies on diagnosis of rectal cancer using MRI, CT and intrarectal ultrasonography. Rinsho Hoshasen 1989;34:573–581.PubMedGoogle Scholar
  6. 6.
    Kim NK, Kim MJ, Yun SH, Sohn SK, Min JS. Comparative study of transrectal ultrasonography, pelvic computerized tomography, and magnetic resonance imaging in preoperative staging of rectal cancer. Dis Colon Rectum 1999;42:770–775.PubMedGoogle Scholar
  7. 7.
    Beynon J, Mortensen NJ, Foy DM, Channer JL, Rigby H, Virjee J. Preoperative assessment of mesorectal lymph node involvement in rectal cancer. Br J Surg 1989;76:276–279.PubMedGoogle Scholar
  8. 8.
    Akasu T, Sugihara K, Moriya Y, Fujita S. Limitations and pitfalls of transrectal ultrasonography for staging of rectal cancer. Dis Colon Rectum 1997;40(suppl):S10–S15.PubMedGoogle Scholar
  9. 9.
    Hildebrandt U, Klein T, Feifel G, Schwarz H-P, Koch B, Schmitt RM. Endosonography of pararectal lymph nodes: in vitro and in vivo evaluation. Dis Colon Rectum 1990;33:863–868.PubMedGoogle Scholar
  10. 10.
    Hildebrandt U, Feifel G. Endosonography in the diagnosis of lymph nodes. Endoscopy 1993;25:243–245.CrossRefPubMedGoogle Scholar
  11. 11.
    Chan TW, Kressel HY, Milestone B, et al. Rectal carcinoma: staging at MR imaging with endorectal surface coil. Work in progress. Radiology 1991;181:461–467.PubMedGoogle Scholar
  12. 12.
    McNicolas MM, Joyce WP, Dolan J, Gibney RG, MacErlaine DP, Hyland J. Magnetic resonance imaging of rectal carcinoma: a prospective study. Br J Surg 1994;81:911–914.Google Scholar
  13. 13.
    de Lange EE, Fechner RE, Edge SB, Spaulding CA. Preoperative staging of rectal carcinoma with MR imaging: surgical and histopathological correlation. Radiology 1990;176:623–628.PubMedGoogle Scholar
  14. 14.
    Urban M, Rosen HR, Hoelbling N, Feil W, Hochwarther G, Hruby W, Schiessel R. MR imaging for the preoperative planning of sphincter-saving surgery for tumors of the lower third of the rectum: Use of intravenous and endorectal contrast materials. Radiology 2000;214:503–508.PubMedGoogle Scholar

Copyright information

© The Society of Surgical Oncology, Inc. 2000

Authors and Affiliations

  • Nam Kyu Kim
    • 1
    • 2
  • Myeong Jin Kim
    • 1
  • Jea Kun Park
    • 1
  • Sung IL Park
    • 1
  • Jin Sik Min
    • 1
  1. 1.Departments of SurgeryDiagnostic Radiology, Yonsei University College of MedicineSeoulKorea
  2. 2.Department of SurgeryYonsei University College of MedicineSeoulKorea

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