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MRI assessment of rectal cancer response to neoadjuvant therapy: a multireader study

  • Gastrointestina
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Abstract

Objectives

A watch and wait strategy with the goal of organ preservation is an emerging treatment paradigm for rectal cancer following neoadjuvant treatment. However, the selection of appropriate patients remains a challenge. Most previous efforts to measure the accuracy of MRI in assessing rectal cancer response used a small number of radiologists and did not report variability among them.

Methods

Twelve radiologists from 8 institutions assessed baseline and restaging MRI scans of 39 patients. The participating radiologists were asked to assess MRI features and to categorize the overall response as complete or incomplete. The reference standard was pathological complete response or a sustained clinical response for > 2 years.

Results

We measured the accuracy and described the interobserver variability of interpretation of rectal cancer response between radiologists at different medical centers. Overall accuracy was 64%, with a sensitivity of 65% for detecting complete response and specificity of 63% for detecting residual tumor. Interpretation of the overall response was more accurate than the interpretation of any individual feature. Variability of interpretation was dependent on the patient and imaging feature investigated. In general, variability and accuracy were inversely correlated.

Conclusions

MRI-based evaluation of response at restaging is insufficiently accurate and has substantial variability of interpretation. Although some patients’ response to neoadjuvant treatment on MRI may be easily recognizable, as seen by high accuracy and low variability, that is not the case for most patients.

Key Points

• The overall accuracy of MRI-based response assessment is low and radiologists differed in their interpretation of key imaging features.

• Some patients’ scans were interpreted with high accuracy and low variability, suggesting that these patients’ pattern of response is easier to interpret.

• The most accurate assessments were those of the overall response, which took into consideration both T2W and DWI sequences and the assessment of both the primary tumor and the lymph nodes.

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Abbreviations

Cap-OX:

Capecitabine-oxaliplatin

cCR:

Clinical complete response

CRT:

Chemoradiotherapy

FOLFOX:

Leucovorin-fluorouracil-oxaliplatin

NAT:

Neoadjuvant treatment

T2W:

T2 weighted

TME:

Total mesorectal excision

TNT:

Total neoadjuvant therapy

WW:

Watch and wait

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Acknowledgements

The authors thank Arthur Gelmis, BS, for editing the manuscript and Floris S. Verheij for help with production of the manuscript. JBY acknowledges Yael Renert-Yuval for insightful conversations.

Funding

Research at Memorial Sloan Kettering is funded in part by grant P30 CA008748 from the National Cancer Institute. JBY’s research fellowship at Memorial Sloan Kettering was funded in part by grant T32 CA009501 from the National Cancer Institute.

Author information

Authors and Affiliations

  1. Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, USA

    Jonathan B. Yuval, Dana M. Omer & Julio Garcia-Aguilar

  2. Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Jonathan B. Yuval

  3. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, USA

    Sujata Patil

  4. Department of Radiology, Memorial Sloan Kettering Cancer Center, NY, USA

    Natalie Gangai & Marc J. Gollub

  5. Department of Radiology, University of Vermont, Burlington, USA

    Dmitriy G. Akselrod

  6. Department of Radiology, Oregon Health & Sciences University, Portland, USA

    Alice Fung

  7. Department of Radiology, University of Chicago, Chicago, USA

    Carla B. Harmath

  8. Department of Radiology, University of California Irvine, Irvine, USA

    Rony Kampalath & Sonia Lee

  9. Department of Radiology, Creighton University Medical Center – Bergan Mercy, Omaha, USA

    Kyle Krehbiel

  10. Department of Radiology, Cleveland Clinic, Cleveland, USA

    Peter S. Liu, Andrei S. Purysko & Joseph C. Veniero

  11. Department of Radiology, University of Michigan, Ann Arbor, USA

    John D. Millet & Ashish P. Wasnik

  12. Department of Radiology, University of Washington, Seattle, USA

    Ryan B. O’Malley

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  1. Jonathan B. Yuval
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  2. Sujata Patil
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Corresponding author

Correspondence to Marc J. Gollub.

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Guarantor

The scientific guarantor of this publication is Marc J. Gollub.

Conflict of interest

Patil is a consultant for ByHeart. Julio Garcia-Aguilar has received honoraria from Medtronic, Intuitive Surgical, and Johnson & Johnson and owns stock in Intuitive Surgical. Marc J. Gollub holds stocks in Pfizer. All other authors have no disclosures to declare. Other authors have no conflicts of interest to disclose.

Statistics and biometry

SP is an experienced biostatistician and is one of the authors.

Informed consent

Written informed consent was waived by the institutional review board.

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Institutional review board approval was obtained.

Methodology

• retrospective

• observational

• multicenter study

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Yuval, J.B., Patil, S., Gangai, N. et al. MRI assessment of rectal cancer response to neoadjuvant therapy: a multireader study. Eur Radiol 33, 5761–5768 (2023). https://doi.org/10.1007/s00330-023-09480-9

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  • DOI: https://doi.org/10.1007/s00330-023-09480-9

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