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Diagnostic performance of magnetic resonance to assess treatment response after neoadjuvant therapy in patients with locally advanced rectal cancer

  • Special Section: Rectal Cancer
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

Our study aimed to evaluate the diagnostic performance of rectal magnetic resonance imaging (MRI) for local restaging in patients with non-metastatic locally advanced rectal cancer (LARC) after neoadjuvant chemoradiotherapy (CRT) using surgical histopathology of total mesorectal excision as the reference standard.

Methods

Ninety-five patients with LARC who underwent rectal MRI after CRT between January 2014 and December 2016 were included. Accuracy, sensitivity, specificity, positive, and negative predictive value for local staging regarding T-stage, N-stage, circumferential resection margin, and MRI tumor regression grade (ymriTRG) were calculated, and inter-test agreements were assessed.

Results

22/95 (23.2%) patients had radiological complete response (rCR), whereas 20/95 (21.1%) had pathological complete response (pCR). Among the patients with pCR, 11/20 (55%) had rCR. Fair agreement was demonstrated between ymriTRG and pathological TRG (ypTRG) (κ = 0.255). The sensitivity and specificity for detection of pCR were 61.1% (95% CI 35.7–82.7) and 89.6% (95% CI 80.6–95.4). For the detection of ypTRG grades 1 and 2, the corresponding values were 67.2% (95% CI 54.3–78.4) and 51.6 (95% CI 33.1–69.8). The accuracy of ymriTRG was 24.2% (95% CI 15.6–32.8). Inter-test agreement in TRG between MRI and pathology was overall fair (κ = 0.255) and slight (κ = 0.179), if TRG 1 + 2.

Conclusion

Qualitative assessment on MRI for diagnosing pCR showed moderate sensitivity and high specificity, whereas the diagnosis of TRG had moderate sensitivity and low specificity with slight to fair inter-test agreement when compared with pathological specimens.

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Funding

The authors have no support or funding to report.

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Authors and Affiliations

  1. Department of Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil

    Sergio Carlos Nahas, Caio Sergio Rizkallah Nahas, Gerson Montoya Cama, Carlos Frederico Sparapan Marques, Ulysses Ribeiro Junior & Ivan Cecconello

  2. Department of Surgery, Hospital Sírio-Libanês, São Paulo, Brazil

    Sergio Carlos Nahas, Caio Sergio Rizkallah Nahas, Carlos Frederico Sparapan Marques & Ivan Cecconello

  3. Department of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil

    Rodrigo Lautert de Azambuja, Natally Horvat & Marcos Roberto Menezes

  4. Department of Radiology, Hospital Sírio-Libanês, São Paulo, Brazil

    Rodrigo Lautert de Azambuja, Natally Horvat & Marcos Roberto Menezes

Authors
  1. Sergio Carlos Nahas
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  2. Caio Sergio Rizkallah Nahas
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  3. Gerson Montoya Cama
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  4. Rodrigo Lautert de Azambuja
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  5. Natally Horvat
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  6. Carlos Frederico Sparapan Marques
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  7. Marcos Roberto Menezes
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  8. Ulysses Ribeiro Junior
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  9. Ivan Cecconello
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Corresponding author

Correspondence to Natally Horvat.

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For this type of study formal consent is not required. This article does not contain any studies with animals performed by any of the authors.

Appendix

Appendix

See Table 8.

Table 8 MRI parameters at our institution
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Nahas, S.C., Nahas, C.S.R., Cama, G.M. et al. Diagnostic performance of magnetic resonance to assess treatment response after neoadjuvant therapy in patients with locally advanced rectal cancer. Abdom Radiol 44, 3632–3640 (2019). https://doi.org/10.1007/s00261-019-01894-8

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  • DOI: https://doi.org/10.1007/s00261-019-01894-8

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