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Clinical relevance of morphologic MRI criteria for the assessment of lymph nodes in patients with rectal cancer

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Aim

The aim of this study is the evaluation of lymph node staging by magnetic resonance imaging (MRI) within clinical routine in patients with rectal cancer.

Method

Routine MRI reports (3 T) of 65 consecutive patients with rectal cancer were retrospectively categorized in lymph node tumor positive or negative (mriN+; mriN0) and compared to the final histopathological results (pN+; pN0). Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy were calculated. The original MRI readings were then reanalyzed in order to identify the longest short-axis lymph node diameter for each patient. A receiver operating characteristic (ROC) curve was used to calculate a possible cutoff value for the short-axis lymph node diameter.

Results

Overall sensitivity was 94 %, specificity 13 %, NPV 86 %, PPV 28 %, and accuracy 34 %. The best accuracy could be calculated for a short-diameter cutoff of ≤5 mm (83 %); pN+ and pN0 groups were then significantly different (p < 0.0001).

Conclusion

In clinical routine, lymph node assessment in patients with rectal cancer through MRI tends to overstage malignant lymphadenopathy. A ≤5-mm cutoff value for the short-axis lymph node diameter of benign nodes is able to improve the accuracy and has potential to lower the risk of overstaging.

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References

  1. Schmiegel W, Pox C, Reinacher-Schick A et al (2008) S3-Leitlinie “Kolorektales Karzinom” Ergebnisse evidenzbasierter Konsensuskonferenzen am 6./7. Februar 2004 und am 8./9. Juni 2007 (für die Themenkomplexe IV, VI und VII). Z Gastroenterol 46:1–73

    Article  Google Scholar 

  2. Al-Sukhni E, Milot L, Fruitman M et al (2012) Diagnostic accuracy of MRI for assessment of T category, lymph node metastases, and circumferential resection margin involvement in patients with rectal cancer: a systematic review and meta-analysis. Ann Surg Oncol 19:2212–2223. doi:10.1245/s10434-011-2210-5

    Article  PubMed  Google Scholar 

  3. Attenberger UI, Pilz LR, Morelli JN et al (2014) Multi-parametric MRI of rectal cancer—do quantitative functional MR measurements correlate with radiologic and pathologic tumor stages? Eur J Radiol 83:1036–1043. doi:10.1016/j.ejrad.2014.03.012

    Article  CAS  PubMed  Google Scholar 

  4. Youden WJ (1950) Index for rating diagnostic tests. Cancer 3:32–35

    Article  CAS  PubMed  Google Scholar 

  5. Kim JH, Beets GL, Kim M-J et al (2004) High-resolution MR imaging for nodal staging in rectal cancer: are there any criteria in addition to the size? Eur J Radiol 52:78–83. doi:10.1016/j.ejrad.2003.12.005

    Article  PubMed  Google Scholar 

  6. Kim CK, Kim SH, Chun HK et al (2006) Preoperative staging of rectal cancer: accuracy of 3-Tesla magnetic resonance imaging. Eur Radiol 16:972–980. doi:10.1007/s00330-005-0084-2

    Article  PubMed  Google Scholar 

  7. Lambregts DMJ, Beets GL, Maas M et al (2011) Accuracy of Gadofosveset-enhanced MRI for nodal staging and restaging in rectal cancer. Ann Surg 253:539–545. doi:10.1097/SLA.0b013e31820b01f1

    Article  PubMed  Google Scholar 

  8. Brown G, Richards CJ, Bourne MW et al (2003) Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison. Radiology 227:371–377. doi:10.1148/radiol.2272011747

    Article  PubMed  Google Scholar 

  9. Kim NK, Baik SH, Seong JS et al (2006) Oncologic outcomes after neoadjuvant chemoradiation followed by curative resection with tumor-specific mesorectal excision for fixed locally advanced rectal cancer: impact of postirradiated pathologic downstaging on local recurrence and survival. Ann Surg 244:1024–1030. doi:10.1097/01.sla.0000225360.99257.73

    Article  PubMed Central  PubMed  Google Scholar 

  10. Kim TH, Chang HJ, Kim DY et al (2010) Pathologic nodal classification is the most discriminating prognostic factor for disease-free survival in rectal cancer patients treated with preoperative chemoradiotherapy and curative resection. Int J Radiat Oncol Biol Phys 77:1158–1165. doi:10.1016/j.ijrobp.2009.06.019

    Article  PubMed  Google Scholar 

  11. Krook JE, Moertel CG, Gunderson LL et al (1991) Effective surgical adjuvant therapy for high-risk rectal carcinoma. N Engl J Med 324:709–715. doi:10.1056/NEJM199103143241101

    Article  CAS  PubMed  Google Scholar 

  12. Maier AG, Kersting-Sommerhoff B, Reeders JW et al (2000) Staging of rectal cancer by double-contrast MR imaging using the rectally administered superparamagnetic iron oxide contrast agent ferristene and IV gadodiamide injection: results of a multicenter phase II trial. J Magn Reson Imaging 12:651–660

    Article  CAS  PubMed  Google Scholar 

  13. Gagliardi G, Bayar S, Smith R, Salem RR (2002) Preoperative staging of rectal cancer using magnetic resonance imaging with external phase-arrayed coils. Arch Surg (Chicago, Ill: 1960) 137:447–451

    Article  Google Scholar 

  14. Rödel C, Hofheinz R, Liersch T (2012) Rectal cancer. Curr Opin Oncol 24:441–447. doi:10.1097/CCO.0b013e328352ea02

    Article  PubMed  Google Scholar 

  15. Schmiegel W, Reinacher-Schick A, Arnold D et al (2008) Update S3-guideline “colorectal cancer” 2008. In: Z Gastroenterol. pp 799–840

  16. Taylor FGM, Quirke P, Heald RJ et al (2011) Preoperative high-resolution magnetic resonance imaging can identify good prognosis stage I, II, and III rectal cancer best managed by surgery alone. Ann Surg 253:711–719. doi:10.1097/SLA.0b013e31820b8d52

    Article  PubMed  Google Scholar 

  17. Salerno GV, Daniels IR, Moran BJ et al (2009) Magnetic resonance imaging prediction of an involved surgical resection margin in low rectal cancer. Dis Colon Rectum 52:632–639. doi:10.1007/DCR.0b013e3181a0a37e

    Article  PubMed  Google Scholar 

  18. Taylor FGM, Quirke P, Heald RJ et al (2011) One millimetre is the safe cut-off for magnetic resonance imaging prediction of surgical margin status in rectal cancer. Br J Surg 98:872–879. doi:10.1002/bjs.7458

    Article  CAS  PubMed  Google Scholar 

  19. Lambregts DMJ, Heijnen LA, Maas M et al (2012) Gadofosveset-enhanced MRI for the assessment of rectal cancer lymph nodes: predictive criteria. Abdom Imaging. doi:10.1007/s00261-012-9957-4

    PubMed Central  PubMed  Google Scholar 

  20. Lahaye MJ, Engelen SME, Kessels AGH et al (2008) USPIO-enhanced MR imaging for nodal staging in patients with primary rectal cancer: predictive criteria. Radiology 246:804–811. doi:10.1148/radiol.2463070221

    Article  PubMed  Google Scholar 

  21. Lahaye MJ, Beets GL, Engelen SME et al (2009) Locally advanced rectal cancer: MR imaging for restaging after neoadjuvant radiation therapy with concomitant chemotherapy. Part II. What are the criteria to predict involved lymph nodes? Radiology 252:81–91. doi:10.1148/radiol.2521081364

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of General Surgery, University Medical Centre Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    Fabian Doyon, Stefan Post & Peter Kienle

  2. Institute of Clinical Radiology and Nuclear Medicine, University Medical Centre Mannheim, University of Heidelberg, Heidelberg, Germany

    Ulrike I. Attenberger, Dietmar J. Dinter & Stefan O. Schoenberg

Authors
  1. Fabian Doyon
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  2. Ulrike I. Attenberger
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  3. Dietmar J. Dinter
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  4. Stefan O. Schoenberg
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  5. Stefan Post
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  6. Peter Kienle
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Correspondence to Fabian Doyon.

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Doyon, F., Attenberger, U.I., Dinter, D.J. et al. Clinical relevance of morphologic MRI criteria for the assessment of lymph nodes in patients with rectal cancer. Int J Colorectal Dis 30, 1541–1546 (2015). https://doi.org/10.1007/s00384-015-2339-y

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  • DOI: https://doi.org/10.1007/s00384-015-2339-y

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