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Performance of gadofosveset-enhanced MRI for staging rectal cancer nodes: can the initial promising results be reproduced?

  • Oncology
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

A previous study showed promising results for gadofosveset-trisodium as a lymph node magnetic resonance imaging (MRI) contrast agent in rectal cancer. The aim of this study was to prospectively confirm the diagnostic performance of gadofosveset MRI for nodal (re)staging in rectal cancer in a second patient cohort.

Methods

Seventy-one rectal cancer patients were prospectively included, of whom 13 (group I) underwent a primary staging gadofosveset MRI (1.5-T) followed by surgery (± preoperative 5 × 5 Gy) and 58 (group II) underwent both primary staging and restaging gadofosveset MRI after a long course of chemoradiotherapy followed by surgery. Nodal status was scored as (y)cN0 or (y)cN+ by two independent readers (R1, R2) with different experience levels. Results were correlated with histology on a node-by-node basis.

Results

Sensitivity, specificity and area under the receiver operating characteristics curve (AUC) were 94 %, 79 % and 0.89 for the more experienced R1 and 50 %, 83 % and 0.74 for the non-experienced R2. R2’s performance improved considerably after a learning curve, to an AUC of 0.83. Misinterpretations mainly occurred in nodes located in the superior mesorectum, nodes located in between vessels and nodes containing micrometastases.

Conclusions

This prospective study confirms the good diagnostic performance of gadofosveset MRI for nodal (re)staging in rectal cancer.

Key Points

• Gadofosveset-enhanced MRI shows high performance for nodal (re)staging in rectal cancer.

• Gadofosveset MRI may facilitate better selection of patients for personalised treatment.

• Results can be reproduced by non-expert readers.

• Experience of 50–60 cases is required to achieve required expertise level.

• Main pitfalls are nodes located between vessels and nodes containing micrometastases.

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References

  1. Habr-Gama A, Perez RO, Proscurshim I et al (2006) Patterns of failure and survival for nonoperative treatment of stage c0 distal rectal cancer following neoadjuvant chemoradiation therapy. J Gastrointest Surg 10:1319–1328

    Article  PubMed  Google Scholar 

  2. Lezoche G, Baldarelli M, Guerrieri M et al (2008) A prospective randomized study with a 5-year minimum follow-up evaluation of transanal endoscopic microsurgery versus laparoscopic total mesorectal excision after neoadjuvant therapy. Surg Endosc 22:352–358

    Article  CAS  PubMed  Google Scholar 

  3. Maas M, Beets-Tan RG, Lambregts DM et al (2011) Wait-and-see policy for clinical complete responders after chemoradiation for rectal cancer. J Clin Oncol 29:4633–4640

    Article  PubMed  Google Scholar 

  4. Bipat S, Glas AS, Slors FJ, Zwinderman AH, Bossuyt PM, Stoker J (2004) Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging—a meta-analysis. Radiology 232:773–783

    Article  PubMed  Google Scholar 

  5. 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

    Article  PubMed  Google Scholar 

  6. Dworak O (1989) Number and size of lymph nodes and node metastases in rectal carcinomas. Surg Endosc 3:96–99

    Article  CAS  PubMed  Google Scholar 

  7. Kim J, Beets G, Kim M-J, Kessels A, Beets-Tan R (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

    Article  PubMed  Google Scholar 

  8. Wang C, Zhou Z, Wang Z et al (2005) Patterns of neoplastic foci and lymph node micrometastasis within the mesorectum. Langenbecks Arch Surg 390:312–318

    Article  PubMed  Google Scholar 

  9. Fischbein NJ, Noworolski SM, Henry RG, Kaplan MJ, Dillon WP, Nelson SJ (2003) Assessment of metastatic cervical adenopathy using dynamic contrast-enhanced MR imaging. AJNR Am J Neuroradiol 24:301–311

    PubMed  Google Scholar 

  10. Jansen JF, Schoder H, Lee NY et al (2010) Noninvasive assessment of tumor microenvironment using dynamic contrast-enhanced magnetic resonance imaging and 18F-fluoromisonidazole positron emission tomography imaging in neck nodal metastases. Int J Radiat Oncol Biol Phys 77:1403–1410

    Article  PubMed Central  PubMed  Google Scholar 

  11. Kvistad KA, Rydland J, Smethurst HB, Lundgren S, Fjosne HE, Haraldseth O (2000) Axillary lymph node metastases in breast cancer: preoperative detection with dynamic contrast-enhanced MRI. Eur Radiol 10:1464–1471

    Article  CAS  PubMed  Google Scholar 

  12. Lambregts DM, Maas M, Riedl RG et al (2011) Value of ADC measurements for nodal staging after chemoradiation in locally advanced rectal cancer-a per lesion validation study. Eur Radiol 21:265–273

    Article  PubMed Central  PubMed  Google Scholar 

  13. Mir N, Sohaib SA, Collins D, Koh DM (2011) Fusion of high b-value diffusion-weighted and T2-weighted MR images improves identification of lymph nodes in the pelvis. J Med Imaging Radiat Oncol 54:358–364

    Article  Google Scholar 

  14. Mizukami Y, Ueda S, Mizumoto A et al (2011) Diffusion-weighted magnetic resonance imaging for detecting lymph node metastasis of rectal cancer. World J Surg 35:895–899

    Article  PubMed  Google Scholar 

  15. Lambregts DM, 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

    Article  PubMed  Google Scholar 

  16. Herborn CU, Lauenstein TC, Vogt FM, Lauffer RB, Debatin JF, Ruehm SG (2002) Interstitial MR lymphography with MS-325: characterization of normal and tumor-invaded lymph nodes in a rabbit model. AJR Am J Roentgenol 179:1567–1572

    Article  PubMed  Google Scholar 

  17. Lahaye MJ, Beets GL, Engelen SME (2009) Gadofosveset Trisodium (Vasovist®) enhanced MR lymph node detection: initial observations. Open Magn Reson J 2:1–5

    Article  Google Scholar 

  18. Lahaye MJ, Engelen SM, Kessels AG et al (2008) USPIO-enhanced MR imaging for nodal staging in patients with primary rectal cancer: predictive criteria. Radiology 246:804–811

    Article  PubMed  Google Scholar 

  19. Will O, Purkayastha S, Chan C et al (2006) Diagnostic precision of nanoparticle-enhanced MRI for lymph-node metastases: a meta-analysis. Lancet Oncol 7:52–60

    Article  PubMed  Google Scholar 

  20. Valentini V, Coco C, Gambacorta M, Barba M, Meldolesi E (2010) Evidence and research perspectives for surgeons in the European Rectal Cancer Consensus Conference (EURECA-CC2). Acta Chir Iugosl 57:9–16

    Article  CAS  PubMed  Google Scholar 

  21. Marijnen CA, Nagtegaal ID, Klein Kranenbarg E et al (2001) No downstaging after short-term preoperative radiotherapy in rectal cancer patients. J Clin Oncol 19:1976–1984

    CAS  PubMed  Google Scholar 

  22. Hatfield P, Hingorani M, Radhakrishna G et al (2009) Short-course radiotherapy, with elective delay prior to surgery, in patients with unresectable rectal cancer who have poor performance status or significant co-morbidity. Radiother Oncol 92:210–214

    Article  PubMed  Google Scholar 

  23. Radu C, Berglund A, Pahlman L, Glimelius B (2008) Short-course preoperative radiotherapy with delayed surgery in rectal cancer—a retrospective study. Radiother Oncol 87:343–349

    Article  PubMed  Google Scholar 

  24. Rödel C, Trojan J, Bechstein W, Woeste G (2012) Neoadjuvant short- or long-term radio(chemo)therapy for rectal cancer: how and who should be treated? Dig Dis 30:102–108

    Article  PubMed  Google Scholar 

  25. Lambregts D, Heijnen L, Maas M et al (2013) Gadofosveset-enhanced MRI for the assessment of rectal cancer lymph nodes: predictive criteria. Abdom Imaging 38:720–727

    Article  PubMed  Google Scholar 

  26. Cohen J (1986) Weighted kappa: nominal scale agreement with provision for scaled disagreement or partial credit. Psychol Bull 70:213–220

    Article  CAS  Google Scholar 

  27. Perez R, Pereira D, Proscurshim I et al (2009) Lymph node size in rectal cancer following neoadjuvant chemoradiation—can we rely on radiologic nodal staging after chemoradiation? Dis Colon Rectum 52:1278–1284

    Article  PubMed  Google Scholar 

  28. Habr-Gama A, Perez RO, Proscurshim I et al (2008) Interval between surgery and neoadjuvant chemoradiation therapy for distal rectal cancer: does delayed surgery have an impact on outcome? Int J Radiat Oncol Biol Phys 71:1181–1188

    Article  PubMed  Google Scholar 

  29. Kerr SF, Norton S, Glynne-Jones R (2008) Delaying surgery after neoadjuvant chemoradiotherapy for rectal cancer may reduce postoperative morbidity without compromising prognosis. Br J Surg 95:1534–1540

    Article  CAS  PubMed  Google Scholar 

  30. Nicastri DG, Doucette JT, Godfrey TE, Hughes SJ (2007) Is occult lymph node disease in colorectal cancer patients clinically significant? A review of the relevant literature. J Mol Diagn 9:563–571

    Article  PubMed Central  PubMed  Google Scholar 

  31. Perez RO, Habr-Gama A, Nishida Arazawa ST et al (2005) Lymph node micrometastasis in stage II distal rectal cancer following neoadjuvant chemoradiation therapy. Int J Colorectal Dis 20:434–439

    Article  PubMed  Google Scholar 

  32. Wolthuis AM, Penninckx F, Haustermans K et al (2012) Impact of interval between neoadjuvant chemoradiotherapy and TME for locally advanced rectal cancer on pathologic response and oncologic outcome. Ann Surg Oncol 19:2833–2841

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands

    Luc A. Heijnen, Doenja M. J. Lambregts, Milou H. Martens, Monique Maas, Frans C. H. Bakers & Regina G. H. Beets-Tan

  2. Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands

    Luc A. Heijnen, Milou H. Martens & Geerard L. Beets

  3. Department of Radiology, Jeroen Bosch Ziekenhuis, ‘s Hertogenbosch, The Netherlands

    Vincent C. Cappendijk

  4. Department of Radiology, Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Portugal

    Pedro Oliveira

  5. Radiation Oncology, Maastro Clinic, Maastricht, The Netherlands

    Guido Lammering

  6. Department of Pathology, Maastricht University Medical Center, Maastricht, The Netherlands

    Robert G. Riedl

  7. GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands

    Luc A. Heijnen, Milou H. Martens, Guido Lammering, Geerard L. Beets & Regina G. H. Beets-Tan

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  1. Luc A. Heijnen
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  2. Doenja M. J. Lambregts
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  4. Monique Maas
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  7. Pedro Oliveira
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  10. Geerard L. Beets
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  11. Regina G. H. Beets-Tan
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Correspondence to Regina G. H. Beets-Tan.

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Heijnen, L.A., Lambregts, D.M.J., Martens, M.H. et al. Performance of gadofosveset-enhanced MRI for staging rectal cancer nodes: can the initial promising results be reproduced?. Eur Radiol 24, 371–379 (2014). https://doi.org/10.1007/s00330-013-3016-6

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  • DOI: https://doi.org/10.1007/s00330-013-3016-6

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