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Imaging of Anal Squamous Cell Carcinoma: Survey Results and Expert Opinion from the Rectal and Anal Cancer Disease-Focused Panel of the Society of Abdominal Radiology

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Abstract

The role and method of image-based staging of anal cancer has evolved with the rapid development of newer imaging modalities and the need to address the rising incidence of this rare cancer. In 2014, the European Society of Medical Oncology mandated pelvic magnetic resonance imaging (MRI) for anal cancer and subsequently other societies such as the National Comprehensive Cancer Network followed suit with similar recommendations. Nevertheless, great variability exists from center to center and even within individual centers. Notably, this is in stark contrast to the imaging of the anatomically nearby rectal cancer. As participating team members for this malignancy, we embarked on a comprehensive literature review of anal cancer imaging to understand the relative merits of these new technologies which developed after computed tomography (CT), e.g., MRI and positron emission tomography/computed tomography (PET/CT). The results of this literature review helped to inform our next stage: questionnaire development regarding the imaging of anal cancer. Next, we distributed the questionnaire to members of the Society of Abdominal Radiology (SAR) Rectal and Anal Disease-Focused Panel, a group of abdominal radiologists with special interest, experience, and expertise in rectal and anal cancer, to provide expert radiologist opinion on the appropriate anal cancer imaging strategy. In our expert opinion survey, experts advocated the use of MRI in general (65% overall and 91–100% for primary staging clinical scenarios) and acknowledged the superiority of PET/CT for nodal assessment (52–56% agreement for using PET/CT in primary staging clinical scenarios compared to 30% for using MRI). We therefore support the use of MRI and PET and suggest further exploration of PET/MRI as an optimal combined evaluation. Our questionnaire responses emphasized the heterogeneity in imaging practice as performed at numerous academic cancer centers across the United States and underscore the need for further reconciliation and establishment of best imaging practice guidelines for optimized patient care in anal cancer.

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Acknowledgements

The authors would like to thank Kendra Godwin and Andrew Chua for their help in the literature review process; Doenja Lembregts MD, PhD, for her help in organizing and displaying the data results, and Joanne Chin for her help in preparation of the manuscript.

Funding

This work was partially supported by the NIH/NCI Cancer Center Support Grant P30 CA008748.

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Authors and Affiliations

  1. Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA

    Jennifer S. Golia Pernicka, Natalie Gangai, David D. B. Bates, Natally Horvat & Marc J. Gollub

  2. Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Gaiane M. Rauch & Randy Ernst

  3. Departments of Radiology and Biomedical Imaging and Pharmaceutical Chemistry, University of California San Francisco, San Francisco, CA, USA

    Thomas A. Hope

  4. Department of Radiology, Mayo Clinic, Rochester, MN, USA

    Shannon P. Sheedy

  5. 530 E 74th St, Room 07118, New York, NY, 10021, USA

    Jennifer S. Golia Pernicka

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  1. Jennifer S. Golia Pernicka
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Correspondence to Jennifer S. Golia Pernicka.

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DDBB is a consultant for the Boston Imaging Core Lab. The remaining authors have no conflicts of interest to declare.

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Golia Pernicka, J.S., Rauch, G.M., Gangai, N. et al. Imaging of Anal Squamous Cell Carcinoma: Survey Results and Expert Opinion from the Rectal and Anal Cancer Disease-Focused Panel of the Society of Abdominal Radiology. Abdom Radiol 48, 3022–3032 (2023). https://doi.org/10.1007/s00261-023-03863-8

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