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Accuracy of MRI for nodal restaging in rectal cancer: a retrospective study of 166 cases

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Abstract

Aim

Assessing metastatic mesorectal nodal involvement is a challenge in rectal cancer, especially in the post chemoradiation setting. We aim to assess the accuracy of MRI for nodal restaging and the validity of SAR criteria (≥ 5 mm size being metastatic).

Materials and methods

This was an IRB-approved retrospective study of 166 patients with locally advanced rectal cancers, operated after neoadjuvant treatment. Two dedicated oncoradiologists reviewed the 166 post-chemoradiation presurgical MRIs in consensus. Nodal size and morphology (shape, margins, and signal intensity) were noted. The most accurate cut-off for size for predicting positive pN status was determined using the Youden index.

Results

MRI understaged 30/166 (18%) and overstaged 40/166 (24%) patients using the SAR criteria. The most accurate cut-off for node size was 5.5 mm, with a sensitivity of 75%, specificity of 60.2%, PPV of 40.7%, NPV of 86.9% (95% CI:78–92.5%), accuracy of 64.2%, and area under the curve (AUC) 0.657 (95% CI—0.524–0.79). Morphological characteristics were not significant to determine involvement, with positive nodes including 42% of round and 31% of oval nodes, 40% of heterogeneous and 45% of homogeneous nodes, and 31% irregularly marginated and 46% nodes with regular margins being positive on pathology. MRI was accurate in predicting pathology for mucinous nodes in 9/29 (31%) cases. Seven cases which were yN2 on MRI and yN0 on pathology demonstrated mucinous changes on MRI and had acellular mucin on histopathology.

Conclusions

MRI has good negative predictive value, poor positive predictive value and moderate accuracy in nodal restaging. The cut-off of 5.5 mm demonstrated in our study is close to the SAR cut-off of 5 mm in the post-treatment setting. MRI accuracy is lower in patients with mucinous nodes.

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Authors and Affiliations

  1. Department of Radio-Diagnosis, Tata Memorial Centre, Mumbai, India

    Sayali Pangarkar, Kunal Mistry, Amit Choudhari, Vasundhara Smriti, Ankita Ahuja, Aparna Katdare & Akshay D. Baheti

  2. Homi Bhabha National Institute, Mumbai, India

    Sayali Pangarkar, Kunal Mistry, Amit Choudhari, Vasundhara Smriti, Ankita Ahuja, Aparna Katdare, Reena Engineer, Vikas Ostwal, Mukta Ramadwar, Avanish Saklani & Akshay D. Baheti

  3. Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India

    Reena Engineer

  4. Department of Medical Oncology, Tata Memorial Centre, Mumbai, India

    Vikas Ostwal

  5. Department of Pathology, Tata Memorial Centre, Mumbai, India

    Mukta Ramadwar

  6. Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India

    Avanish Saklani

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  1. Sayali Pangarkar
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Appendix

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Table 4 MRI parameters on 1.5 T scanner
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Table 5 MRI parameters on 3 T scanner
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Pangarkar, S., Mistry, K., Choudhari, A. et al. Accuracy of MRI for nodal restaging in rectal cancer: a retrospective study of 166 cases. Abdom Radiol 46, 498–505 (2021). https://doi.org/10.1007/s00261-020-02708-y

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