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Accuracy of Various Lymph Node Staging Criteria in Rectal Cancer with Magnetic Resonance Imaging

  • 2017 SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

The accuracy of pretherapeutic staging of lymph nodes (LN) in rectal cancer by MR imaging (MRI) is still limited. The aim of the study was to determine the sensitivity and specificity of different morphological criteria in nodal staging.

Material and Methods

LN were analyzed by MRI in 60 patients with rectal cancer and primary surgery. Signs of LN metastasis (cN+) were spiculated/indistinct border contour, inhomogeneous signal intensity, or LN size. The accuracy of these signs for clinical LN staging was analyzed with conclusive postoperative histological lymph node examination.

Results

68.3% of patients with nodal metastasis (pN+) were correctly identified by size with a cutoff value of 7.2 mm. This, however, was not inferior to the 76.7% identified using the inhomogeneous morphological signal intensity and spiculated/indistinct border contour criteria (p = 0.096). 3.3 versus 5% were overstaged, and 28.3 versus 18.3% understaged by these criteria. Sensitivities/specificities for (a) size, (b) spiculated/indistinct border contour, and (c) inhomogeneous signal intensity and spiculated/indistinct border contour were (a) 32%/94%, (b) 56%/86%, and (c) 56%/91%, respectively.

Conclusions

The accuracy of LN staging in rectal cancer was not improved by morphological criteria. These limitations suggest being reticent when recommending neoadjuvant chemoradiation merely based on preoperative positive LN staging.

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Author notes

  1. Jörn Gröne and Florian N. Loch contributed equally as first authors

Authors and Affiliations

  1. Department of Surgery, Campus Benjamin Franklin, Charité University Medicine, Hindenburgdamm 30, 12200, Berlin, Germany

    Jörn Gröne, Florian N. Loch & Martin E. Kreis

  2. Department of Surgery, Rotes Kreuz Krankenhaus, Bremen, Germany

    Jörn Gröne

  3. Department of Radiology, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany

    Matthias Taupitz & C. Schmidt

Authors
  1. Jörn Gröne
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  2. Florian N. Loch
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  3. Matthias Taupitz
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  4. C. Schmidt
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  5. Martin E. Kreis
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Contributions

Jörn Gröne, Florian N. Loch, Martin E. Kreis—study conception and design, acquisition, analysis and interpretation of data, drafting, and critical revision of the manuscript

M. Taupitz—study conception and design, MRI image interpretation, and drafting of the manuscript

C. Schmidt—acquisition of data and assistance in MRI image interpretation

Corresponding author

Correspondence to Florian N. Loch.

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Gröne, J., Loch, F.N., Taupitz, M. et al. Accuracy of Various Lymph Node Staging Criteria in Rectal Cancer with Magnetic Resonance Imaging. J Gastrointest Surg 22, 146–153 (2018). https://doi.org/10.1007/s11605-017-3568-x

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  • DOI: https://doi.org/10.1007/s11605-017-3568-x

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