MRI surveillance for the detection of local recurrence in rectal cancer after transanal endoscopic microsurgery
To evaluate diagnostic performance of follow-up MRI for detection of local recurrence of rectal cancer after transanal endoscopic microsurgery (TEM).
Between January 2006 and February 2014, 81 patients who underwent TEM were included. Two expert readers (R1 and R2), independently evaluated T2-weighted (T2W) MRI and diffusion-weighted (DWI) MRI for the detection of local recurrence, retrospectively, and recorded confidence on a five-point scale. Diagnostic performance of follow-up MRI was assessed using ROC-curve analysis and kappa statistics for the reproducibility between readers.
293 MRIs were performed, 203 included DWI. 18 (22%) patients developed a local recurrence: luminal 11, nodal two and both five. Areas under the curve (AUCs) for local recurrence detection were 0.72 (R1) and 0.80 (R2) for T2W-MRI. For DWI, AUCs were 0.70 (R1) and 0.89 (R2). For nodal recurrence AUCs were 0.72 (R1) and 0.80 (R2) for T2W-MRI. Reproducibility was good for T2W-MRI (κ0.68 for luminal and κ0.71 for nodal recurrence) and moderate for DWI (κ0.57). AUCs and reproducibility for recurrence detection increased during follow-up.
Follow-up with MRI after TEM for rectal cancer is feasible. Postoperative changes can be confusing at the first postoperative MRI, but during follow-up diagnostic performance and reproducibility increase.
• Follow-up with MRI is feasible for follow-up after TEM for rectal cancer.
• DWI-MRI is a useful addition to detect recurrences after TEM.
• Postoperative changes can be confusing and can lead to underestimation of recurrence.
• Appearance of intermediate signal at T2W-MRI is suspicious for recurrence.
• Nodal staging remains challenging.
KeywordsMagnetic resonance imaging Rectal neoplasms Transanal endoscopic microsurgery Follow-up Diffusion-weighted magnetic resonance imaging
Apparent diffusion coefficient
Area under the curve
Magnetic resonance imaging
- ROC curve
Receiver operating characteristic curve
Transanal endoscopic microsurgery
Compliance with ethical standards
The scientific guarantor of this publication is M. Maas.
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
The authors state that this work has not received any funding.
Statistics and biometry
Patty J. Nelemans kindly provided statistical advice for this manuscript.
According to our country’s national law, informed consent is not required for this study because of its retrospective nature.
According to our country’s national law, institutional review board approval is not required for this study because of its retrospective nature.
- 3.Verseveld M, de Graaf EJ, Verhoef C, van Meerten E, Punt CJ, de Hingh IH, et al. (2015) Chemoradiation therapy for rectal cancer in the distal rectum followed by organ-sparing transanal endoscopic microsurgery (CARTS study). The British J SurgGoogle Scholar
- 4.Lezoche E, Guerrieri M, Paganini AM, D'Ambrosio G, Baldarelli M, Lezoche G et al (2005) Transanal endoscopic versus total mesorectal laparoscopic resections of T2-N0 low rectal cancers after neoadjuvant treatment: a prospective randomized trial with a 3-years minimum follow-up period. Surg Endosc 19:751–756CrossRefPubMedGoogle Scholar
- 5.Restivo A, Zorcolo L, D'Alia G, Cocco F, Cossu A, Scintu F, et al. (2015) Risk of complications and long-term functional alterations after local excision of rectal tumors with transanal endoscopic microsurgery (TEM). Int J Colorectal DisGoogle Scholar
- 16.Lambregts DM, Lahaye MJ, Heijnen LA, Martens MH, Maas M, Beets GL et al (2016) MRI and diffusion-weighted MRI to diagnose a local tumour regrowth during long-term follow-up of rectal cancer patients treated with organ preservation after chemoradiotherapy. Eur Radiol 26:2118–2125CrossRefPubMedGoogle Scholar
- 17.Landelijke_Werkgroep_Gastro-Intestinale_Tumoren (2016) Landelijke Richtlijn Rectumcarcinoom (version 3.0). www.oncoline.nl
- 20.Rogers WH (1993) Regression standard errors in clustered samples. Stata Tech Bull Rep 3:88–94Google Scholar
- 28.Lambregts DM, Maas M, Bakers FC, Cappendijk VC, Lammering G, Beets GL et al (2011) Long-term follow-up features on rectal MRI during a wait-and-see approach after a clinical complete response in patients with rectal cancer treated with chemoradiotherapy. Dis Colon Rectum 54:1521–1528CrossRefPubMedGoogle Scholar