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Santiago I, Figueiredo N, Parés O, Matos C. MRI of rectal cancer-relevant anatomy and staging key points. Insights Imaging 2020; 11:100. [PMID: 32880782 PMCID: PMC7471246 DOI: 10.1186/s13244-020-00890-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/26/2020] [Indexed: 02/14/2023] Open
Abstract
Rectal cancer has the eighth highest cancer incidence worldwide, and it is increasing in young individuals. However, in countries with a high human development index, mortality is decreasing, which may reflect better patient management, imaging being key. We rely on imaging to establish the great majority of clinical tumour features for therapeutic decision-making, namely tumour location, depth of invasion, lymph node involvement, circumferential resection margin status and extramural venous invasion. Despite major improvements in technique resulting in better image quality, and notwithstanding the dissemination of guidelines and examples of standardised reports, rectal cancer staging is still challenging on the day-to-day practice, and we believe there are three reasons. First, the normal posterior pelvic compartment anatomy and variants are not common knowledge to radiologists; second, not all rectal cancers fit in review paper models, namely the very early, the very low and the mucinous; and third, the key clinical tumour features may be tricky to analyse. In this review, we discuss the normal anatomy of the rectum and posterior compartment of the pelvis, systematise all rectal cancer staging key points and elaborate on the particularities of early, low and mucinous tumours. We also include our suggested reporting templates and a discussion of its comparison to the reporting templates provided by ESGAR and SAR.
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Affiliation(s)
- Inês Santiago
- Radiology Department, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal. .,Nova Medical School, Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal. .,Champalimaud Research, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal.
| | - Nuno Figueiredo
- Colorectal Surgery, Digestive Unit, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal
| | - Oriol Parés
- Radiation Oncology Department, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal
| | - Celso Matos
- Radiology Department, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal.,Champalimaud Research, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal
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Ryan ÉJ, Creavin B, Sheahan K. Delivery of Personalized Care for Locally Advanced Rectal Cancer: Incorporating Pathological, Molecular Genetic, and Immunological Biomarkers Into the Multimodal Paradigm. Front Oncol 2020; 10:1369. [PMID: 32923389 PMCID: PMC7456909 DOI: 10.3389/fonc.2020.01369] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 06/29/2020] [Indexed: 12/13/2022] Open
Abstract
Approximately one-third of all newly diagnosed colorectal cancer (CRC) is composed of rectal cancer, with the incidence rising in younger patients. The principal neoadjuvant treatments consist of neoadjuvant short-course radiotherapy and long-course chemoradiation. Locally advanced rectal cancer (LARC) is particularly challenging to manage given the anatomical constrictions of the pelvis and the risk for local recurrence. In appropriately treated patients, 5- and 10-year overall survival is estimated at 60 and 50%, respectively. The prognosis for LARC has improved in recent years with more access to screening, advances in surgical techniques, and perioperative care. Furthermore, the refinement of the multidisciplinary team with combined-modality management strategies has improved outcomes. These advancements have been augmented by significant improvements in the understanding of the underlying tumor biology. However, there are many instances where patient outcomes do not match those for their tumor stage and accurate prognostic information for individual patients can be difficult to estimate owing to the heterogeneous nature of LARC. Many new combinations of chemotherapy with radiotherapy, including total neoadjuvant therapy with targeted therapies that aim to diminish toxicity and increase survival, are being evaluated in clinical trials. Despite these advances, local recurrence and distant metastasis remain an issue, with one-third of LARC patients dying within 5 years of initial treatment. Although much of the new pathological, molecular genetics, and immunological biomarkers allow refinement in the classification and prognostication of CRC, the relative importance of each of these factors with regards to the development and progression of LARC remains incompletely understood. These factors are often insufficiently validated and seldom consider the individual characteristics of the host, the tumor and its location, the local available expertise, or the probable location of recurrence. Appreciating the mechanisms behind these differences will allow for a more comprehensive, personalized approach and more informed treatment options, leading to ultimately superior outcomes. This review aims to first outline the current multidisciplinary context in which LARC care should be delivered and then discuss how some key prognosticators, including novel histopathological, molecular genetics, and immunological biomarkers, might fit into the wider context of personalized LARC management in the coming years.
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Affiliation(s)
- Éanna J. Ryan
- School of Medicine, University College Dublin, Dublin, Ireland
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ben Creavin
- School of Medicine, University College Dublin, Dublin, Ireland
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kieran Sheahan
- School of Medicine, University College Dublin, Dublin, Ireland
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Clinical Relevance and Practical Approach for Challenging Rectal Cancer MRI Findings. CURRENT RADIOLOGY REPORTS 2020. [DOI: 10.1007/s40134-020-00359-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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54
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Johncilla M, Yantiss RK. Histology of Colorectal Carcinoma: Proven and Purported Prognostic Factors. Surg Pathol Clin 2020; 13:503-520. [PMID: 32773197 DOI: 10.1016/j.path.2020.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Although tumor stage has a profound influence on prognosis, several histologic features are also important. These parameters predict biological behavior and can be used by clinicians to determine whether patients are at high risk for disease progression and, thus, are candidates for adjuvant therapy, particularly when they have localized (ie, stage II) disease. This article summarizes the evidence supporting the prognostic values of various histologic parameters evaluated by pathologists who assign pathologic stage to colorectal cancers. Criteria to be discussed include histologic subtype, tumor grade, lymphatic and perineural invasion, tumor budding, and host immune responses.
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Affiliation(s)
- Melanie Johncilla
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065, USA
| | - Rhonda K Yantiss
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065, USA.
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Liu M, Ma X, Shen F, Xia Y, Jia Y, Lu J. MRI-based radiomics nomogram to predict synchronous liver metastasis in primary rectal cancer patients. Cancer Med 2020; 9:5155-5163. [PMID: 32476295 PMCID: PMC7367643 DOI: 10.1002/cam4.3185] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/08/2020] [Accepted: 05/08/2020] [Indexed: 12/13/2022] Open
Abstract
At the time of diagnosis, approximately 15%-20% of patients with rectal cancer (RC) presented synchronous liver metastasis (SLM), which is the most common cause of death in patients with RC. Therefore, preoperative, noninvasive, and accurate prediction of SLM is crucial for personalized treatment strategies. Recently, radiomics has been considered as an advanced image analysis method to evaluate the neoplastic heterogeneity with respect to diagnosis of the tumor and prediction of prognosis. In this study, a total of 1409 radiomics features were extracted for each volume of interest (VOI) from high-resolution T2WI images of the primary RC. Subsequently, five optimal radiomics features were selected based on the training set using the least absolute shrinkage and selection operator (LASSO) method to construct the radiomics signature. In addition, radiomics signature combined with carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) was included in the multifactor logistic regression to construct the nomogram model. It showed an optimal predictive performance in the validation set as compared to that in the radiomics model. The favorable calibration of the radiomics nomogram showed a nonsignificant Hosmer-Lemeshow test statistic (P > .05). The decision curve analysis (DCA) showed that the radiomics nomogram is clinically superior to the radiomics model. Therefore, the nomogram amalgamating the radiomics signature and clinical risk factors serve as an effective quantitative approach to predict the SLM of primary RC.
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Affiliation(s)
- Minglu Liu
- Department of RadiologyChanghai HospitalShanghaiChina
| | - Xiaolu Ma
- Department of RadiologyChanghai HospitalShanghaiChina
| | - Fu Shen
- Department of RadiologyChanghai HospitalShanghaiChina
| | - Yuwei Xia
- Huiying Medical Technology Co., LtdBeijingChina
| | - Yan Jia
- Huiying Medical Technology Co., LtdBeijingChina
| | - Jianping Lu
- Department of RadiologyChanghai HospitalShanghaiChina
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Zhang J, Zhang W, Min M, Pan Y. Axillary accessory breast cancer with persistent leftsuperior vena cava: A case report and treatment controversy. Int J Surg Case Rep 2020; 73:71-74. [PMID: 32645595 PMCID: PMC7341053 DOI: 10.1016/j.ijscr.2020.05.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/21/2020] [Accepted: 05/21/2020] [Indexed: 11/27/2022] Open
Abstract
Accessory breast cancer with persistent left superior vena cava(PLSVC) is rare. The treatments of axillary accessory breast cancer should attract our attention. Patients with accessory breast cancer without breast invasion should undergo local enlarged resection and axillary lymph node dissection (ALND). We recommend routine axillary radiotherapy after accessory breast cancer surgery. It is imperative to organize multi-center accessory breast cancer research.
Introduction Axillary accessory breast cancer and persistent left superior vena cava (PLSVC) are rare clinically. Many controversial treatments for accessory breast cancer are worth discussing and learning. Presentation of the case A 48-year-old woman presented with biopsy histopathology confirmed. Right axillary mass biopsy pathology showed mucinous adenocarcinoma of accessory breast. She concerned that the axillary accessory breast cancer was more likely to metastasize and unsure about whether to remove the breast. She accepted extended right axillary accessory breast resection plus ipsilateral axillary lymph node dissection (ALND) and received chemotherapy. She was found to have a PLSVC before chemotherapy. Discussion Is there a need to remove the breast and perform ALND during axillary accessory breast cancer surgery? Is sentinel lymph node biopsy (SLNB) appropriate for axillary accessory breast cancer surgery? Can negative SLNB for axillary accessory breast cancer avoid ALND? Does accessory breast cancer without axillary lymph node metastasis require local radiotherapy? Does PLSVC impact the use of peripherally inserted central catheters (PICC) tubes during chemotherapy? Patients with accessory breast cancer without breast invasion should undergo local extended resection and ALND. SLNB for accessory breast cancer cannot instead of ALND. We recommend routine axillary radiotherapy after accessory breast cancer surgery. If it is determined that the tip of PICC is not in the coronary sinus of PLSVC, PLSVC does not affect chemotherapy. Conclusion Many treatment strategies for accessory breast cancer require more evidence from evidence-based medicine. It is imperative to conduct multi-center accessory breast cancer research.
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Affiliation(s)
- Jun Zhang
- Wuxi Hospital Affiliated to Nanjing University of Chinese Medicine, Wuxi, China
| | - Weidong Zhang
- Wuxi Hospital Affiliated to Nanjing University of Chinese Medicine, Wuxi, China
| | - Meilin Min
- Wuxi Hospital Affiliated to Nanjing University of Chinese Medicine, Wuxi, China
| | - Yunbo Pan
- Wuxi Higher Health Vocational Technology School, Wuxi, China.
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Li ZY, Wang XD, Li M, Liu XJ, Ye Z, Song B, Yuan F, Yuan Y, Xia CC, Zhang X, Li Q. Multi-modal radiomics model to predict treatment response to neoadjuvant chemotherapy for locally advanced rectal cancer. World J Gastroenterol 2020; 26:2388-2402. [PMID: 32476800 PMCID: PMC7243642 DOI: 10.3748/wjg.v26.i19.2388] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/27/2020] [Accepted: 04/20/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Neoadjuvant chemotherapy is currently recommended as preoperative treatment for locally advanced rectal cancer (LARC); however, evaluation of treatment response to neoadjuvant chemotherapy is still challenging.
AIM To create a multi-modal radiomics model to assess therapeutic response after neoadjuvant chemotherapy for LARC.
METHODS This retrospective study consecutively included 118 patients with LARC who underwent both computed tomography (CT) and magnetic resonance imaging (MRI) before neoadjuvant chemotherapy between October 2016 and June 2019. Histopathological findings were used as the reference standard for pathological response. Patients were randomly divided into a training set (n = 70) and a validation set (n = 48). The performance of different models based on CT and MRI, including apparent diffusion coefficient (ADC), dynamic contrast enhanced T1 images (DCE-T1), high resolution T2-weighted imaging (HR-T2WI), and imaging features, was assessed by using the receiver operating characteristic curve analysis. This was demonstrated as area under the curve (AUC) and accuracy (ACC). Calibration plots with Hosmer-Lemeshow tests were used to investigate the agreement and performance characteristics of the nomogram.
RESULTS Eighty out of 118 patients (68%) achieved a pathological response. For an individual radiomics model, HR-T2WI performed better (AUC = 0.859, ACC = 0.896) than CT (AUC = 0.766, ACC = 0.792), DCE-T1 (AUC = 0.812, ACC = 0.854), and ADC (AUC = 0.828, ACC = 0.833) in the validation set. The imaging performance for extramural venous invasion detection was relatively low in both the training (AUC = 0.73, ACC = 0.714) and validation (AUC = 0.578, ACC = 0.583) sets. The multi-modal radiomics model reached an AUC of 0.925 and ACC of 0.886 in the training set, and an AUC of 0.93 and ACC of 0.875 in the validation set. For the clinical radiomics nomogram, good agreement was found between the nomogram prediction and actual observation.
CONCLUSION A multi-modal nomogram using traditional imaging features and radiomics of preoperative CT and MRI adds accuracy to the prediction of treatment outcome, and thus contributes to the personalized selection of neoadjuvant chemotherapy for LARC.
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Affiliation(s)
- Zheng-Yan Li
- Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xiao-Dong Wang
- Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Mou Li
- Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xi-Jiao Liu
- Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Zheng Ye
- Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Bin Song
- Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Fang Yuan
- Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yuan Yuan
- Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Chun-Chao Xia
- Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xin Zhang
- Life Science, PDx, IPM team, GE Healthcare, Shanghai 210000, China
| | - Qian Li
- Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
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Multi-modal radiomics model to predict treatment response to neoadjuvant chemotherapy for locally advanced rectal cancer. World J Gastroenterol 2020. [DOI: 10.3748/wjg.v26.i19.2387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
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Yu X, Song W, Guo D, Liu H, Zhang H, He X, Song J, Zhou J, Liu X. Preoperative Prediction of Extramural Venous Invasion in Rectal Cancer: Comparison of the Diagnostic Efficacy of Radiomics Models and Quantitative Dynamic Contrast-Enhanced Magnetic Resonance Imaging. Front Oncol 2020; 10:459. [PMID: 32328461 PMCID: PMC7160694 DOI: 10.3389/fonc.2020.00459] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 03/13/2020] [Indexed: 02/01/2023] Open
Abstract
Background: To compare the diagnostic performance of radiomics models with that of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) perfusion parameters for the preoperative prediction of extramural venous invasion (EMVI) in rectal cancer patients and to develop a preoperative nomogram for predicting the EMVI status. Methods: In total, 106 rectal cancer patients were enrolled in our study. All patients under went preoperative rectal high-resolution MRI and DCE-MRI. We built five models based on the perfusion parameters of DCE-MRI (quantitative model), the radiomics of T2-weighted (T2W) CUBE imaging (R1 model), DCE-MRI (R2 model), clinical features (clinical model), and clinical-radiomics features. The predictive efficacy of the radiomics signature was assessed and internally verified. The area under the receiver operating curve (AUC) was used to compare the diagnostic performance of different radiomics models and DCE-MRI quantitative parameters. The radiomics score and clinical-pathologic risk factors were incorporated into an easy-to-use nomogram. Results: The quantitative parameters K trans and Ve were significantly higher in the EMVI-positive group than in the EMVI-negative group (both P =0.02). K trans combined with Ve showed a fair degree of accuracy (AUC 0.680 in the training cohort and AUC 0.715 in the validation cohort) compared with K trans or Ve alone. The AUCs of the R1 and R2 models were 0.826, 0.715 and 0.872, 0.812 in the training and validation cohorts, respectively. In addition, the R2-C model yielded an AUC of 0.904 in the training cohort and 0.812 in the validation cohort. The nomogram was presented based on the clinical-radiomics model. The calibration curves showed good agreement. Conclusion: The radiomics nomogram that incorporates the radiomics score, histopathological grade and T stage demonstrated better diagnostic accuracy than the DCE-MRI quantitative parameters and may have significant clinical implications for the preoperative individualized prediction of EMVI in rectal cancer patients.
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Affiliation(s)
- Xiangling Yu
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenlong Song
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dajing Guo
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | | | - Haiping Zhang
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaojing He
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Junjie Song
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Zhou
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinjie Liu
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Tripathi P, Guo W, Rao S, Zeng M, Hu D. Additional value of MRI-detected EMVI scoring system in rectal cancer: applicability in predicting synchronous metastasis. TUMORI JOURNAL 2020; 106:286-294. [PMID: 32116150 DOI: 10.1177/0300891620901745] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Extramural vascular invasion (EMVI) has been recommended as an independent prognostic factor for poor overall survival rate in rectal cancer and can be used as a potential biomarker. Early prediction of prevalence of synchronous metastasis can elevate the disease-free survival rate. We aimed to evaluate the magnetic resonance imaging (MRI)-detected EMVI (mrEMVI) scoring system in predicting distant metastasis in T3 rectal cancer. METHODS Patients with postoperative histopathologically confirmed T3 rectal cancer without previous treatment from July 2014 to December 2015 were enrolled in this study. Two blinded radiologists evaluated mrEMVI status. mrEMVI was categorized as EMVI-positive or EMVI-negative in T2-weighted images using an mrEMVI scoring system. The results, along with other clinical characteristics (age, sex, tumor location, MRI-detected distance of mesorectal extension, lymphatic invasion, perineural invasion, mrEMVI score, and carcinoembryonic antigen [CEA]), were then correlated with synchronous metastases to determine the risk factors using univariate and multivariate analysis. RESULTS Of 180 patients, 38 were confirmed to be mrEMVI-positive, 142 mrEMVI-negative. There were 34 patients with synchronous metastasis, of whom 25 were mrEMVI-positive and 9 were mrEMVI-negative. Three factors were significantly associated with synchronous metastasis: mrEMVI (p = 0.001; odds ratio = 8.665), histopathologic lymphatic invasion (p = 0.001; odds ratio = 12.940), and preoperative CEA (p = 0.026; odds ratio = 4.124). mrEMVI score 4 was more likely for synchronous metastasis (p = 0.044; odds ratio = 9.429) than mrEMVI score 3 in rectal cancer. CONCLUSIONS mrEMVI positivity is an independent risk factor for synchronous distant metastasis in rectal cancer. mrEMVI score 4 is a stronger risk factor for synchronous metastasis than mrEMVI score 3 in rectal cancer.
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Affiliation(s)
- Pratik Tripathi
- Department of Radiology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China.,Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Weifeng Guo
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shengxiang Rao
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Daoyu Hu
- Department of Radiology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
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Fornell-Perez R, Vivas-Escalona V, Aranda-Sanchez J, Gonzalez-Dominguez MC, Rubio-Garcia J, Aleman-Flores P, Lozano-Rodriguez A, Porcel-de-Peralta G, Loro-Ferrer JF. Primary and post-chemoradiotherapy MRI detection of extramural venous invasion in rectal cancer: the role of diffusion-weighted imaging. Radiol Med 2020; 125:522-530. [PMID: 32020526 DOI: 10.1007/s11547-020-01137-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/16/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To assess the added value of diffusion-weighted imaging (DWI) to high-resolution T2-weighted sequences (HRT2w) in MRI detection of extramural venous infiltration (EMVI), according to the previous experience of radiologists. METHODS A cross-sectional study of a retrospective database including 1.5 T MRI records from 100 patients with biopsy-proven rectal cancer (2011-2016; 75 male/25 female, average 63 y/o), which included primary staging (54) and post-chemoradiotherapy follow-up MRIs (46). The reference standard was histology of surgical specimens. All cases were individually blindly reviewed by ten radiologists: three specialists in abdominal radiology, three specialized in different areas and four residents. In each case, the presence of EMVI was assessed twice: first, using just HRT2w; second, with DWI added to HRT2w. The results were pooled by experience, analyzing sensitivity, specificity, accuracy (area under ROC curve), likelihood ratios, predictive values and overstaging/understaging. RESULTS Addition of DWI improved diagnostic performance by specialists radiologists, particularly post-chemoradiotherapy (accuracy 0.74-0.84; positive likelihood ratio 3.9-9.1; overstaging 16-8%), less so at primary staging (specificity 76-87.2%; overstaging 21-11%). Non-specialist radiologists also improved, but only at primary staging (accuracy 0.59-0.63). Residents showed small changes, except for notably increased sensitivity in both primary staging (35.7-43%) and post-chemoradiotherapy (41.7-58.3%) staging, at the expense of increased overstaging. CONCLUSIONS The addition of DWI improved the diagnostic performance of EMVI by experienced radiologists, downgrading overstaging, especially in post-chemoradiotherapy follow-up. It resulted in fewer changes for inexperienced radiologists (enhanced primary staging) and residents (increased sensitivity).
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Affiliation(s)
- Roberto Fornell-Perez
- Departamento de Ciencias Clínicas, Facultad de Ciencias de la Salud, Universidad de Las Palmas de Gran Canaria, Paseo Blas Cabrera Felipe, s/n. 35016, Las Palmas de Gran Canaria, Spain.
| | - Valentina Vivas-Escalona
- Servicio de Radiodiagnóstico, Complejo Hospitalario Universitario Insular Materno-Infantil, Av. Marítima, s/n, 35016, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Joel Aranda-Sanchez
- Servicio de Radiodiagnóstico, Complejo Hospitalario Universitario Insular Materno-Infantil, Av. Marítima, s/n, 35016, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - M Carmen Gonzalez-Dominguez
- Servicio de Radiodiagnóstico, Complejo Hospitalario Universitario Insular Materno-Infantil, Av. Marítima, s/n, 35016, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Jano Rubio-Garcia
- Servicio de Radiodiagnóstico, Complejo Hospitalario Universitario Insular Materno-Infantil, Av. Marítima, s/n, 35016, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Patricia Aleman-Flores
- Servicio de Radiodiagnóstico, Complejo Hospitalario Universitario Insular Materno-Infantil, Av. Marítima, s/n, 35016, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Alvaro Lozano-Rodriguez
- Servicio de Radiodiagnóstico, Complejo Hospitalario Universitario Insular Materno-Infantil, Av. Marítima, s/n, 35016, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Gabriela Porcel-de-Peralta
- Servicio de Radiodiagnóstico, Complejo Hospitalario Universitario Insular Materno-Infantil, Av. Marítima, s/n, 35016, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Juan Francisco Loro-Ferrer
- Departamento de Ciencias Clínicas, Facultad de Ciencias de la Salud, Universidad de Las Palmas de Gran Canaria, Paseo Blas Cabrera Felipe, s/n. 35016, Las Palmas de Gran Canaria, Spain
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D’Souza N, Shaw A, Lord A, Balyasnikova S, Abulafi M, Tekkis P, Brown G. Assessment of a Staging System for Sigmoid Colon Cancer Based on Tumor Deposits and Extramural Venous Invasion on Computed Tomography. JAMA Netw Open 2019; 2:e1916987. [PMID: 31808924 PMCID: PMC6902773 DOI: 10.1001/jamanetworkopen.2019.16987] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Preoperative TNM stratification of colon cancer on computed tomography (CT) does not identify patients who are at high risk of recurrence that could be selected for preoperative treatment. OBJECTIVE To evaluate the utility of CT findings for prognosis of sigmoid colon cancer. DESIGN, SETTING, AND PARTICIPANTS This prognostic study used retrospective data from patients who underwent bowel resection for sigmoid colon cancer between January 1, 2006, and January 1, 2015, at a tertiary care center receiving international and national referrals for colorectal cancer. Statistical analysis was performed in April 2019. MAIN OUTCOMES AND MEASURES Cox proportional hazards regression analysis was performed to investigate CT findings associated with disease recurrence. Kaplan-Meier survival plots were calculated for disease-free survival using CT staging systems. RESULTS Of the 414 patients who had sigmoid colon cancer (248 [60.0%] men; mean [SD] age, 66.1 [12.7] years), with median follow-up of 61 months (interquartile range, 40-87 months), 122 patients (29.5%) developed disease recurrence. On multivariate analysis, nodal disease was not associated with disease recurrence; only tumor deposits (hazard ratio [HR], 1.90; 95% CI, 1.21-2.98; P = .006) and extramural venous invasion (HR, 1.97; 95% CI, 1.26-3.06; P = .003) on CT were associated with disease recurrence. Significant differences in disease-free survival were found using CT-T3 substage classification (HR, 1.88; 95% CI, 1.32-2.68) but not CT-TNM (HR, 1.55; 95% CI, 0.94-2.55). The presence of tumor deposits or extramural venous invasion on CT (HR, 2.45; 95% CI, 1.68-3.56) had the strongest association with poor outcome. CONCLUSIONS AND RELEVANCE In this study, T3 substaging and detection of tumor deposits or extramural venous invasion on preoperative CT scans of sigmoid colon cancer were prognostic factors for disease-free survival, whereas TNM and nodal staging on CT had no prognostic value. T3 substaging and detection of tumor deposits or extramural venous invasion of sigmoid colon cancer was superior to TNM on CT and could be used to preoperatively identify patients at high risk of recurrence.
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Affiliation(s)
- Nigel D’Souza
- Department of Colorectal Surgery, Croydon University Hospital, London, United Kingdom
- Imperial College, London, United Kingdom
- Department of Gastrointestinal Imaging, Royal Marsden Hospital, London, United Kingdom
| | - Annabel Shaw
- Department of Colorectal Surgery, Croydon University Hospital, London, United Kingdom
- Imperial College, London, United Kingdom
- Department of Gastrointestinal Imaging, Royal Marsden Hospital, London, United Kingdom
| | - Amy Lord
- Department of Colorectal Surgery, Croydon University Hospital, London, United Kingdom
- Imperial College, London, United Kingdom
- Department of Gastrointestinal Imaging, Royal Marsden Hospital, London, United Kingdom
| | - Svetlana Balyasnikova
- Imperial College, London, United Kingdom
- Department of Gastrointestinal Imaging, Royal Marsden Hospital, London, United Kingdom
| | - Muti Abulafi
- Department of Colorectal Surgery, Croydon University Hospital, London, United Kingdom
| | - Paris Tekkis
- Imperial College, London, United Kingdom
- Department of Colorectal Surgery, Royal Marsden Hospital, London, United Kingdom
| | - Gina Brown
- Imperial College, London, United Kingdom
- Department of Gastrointestinal Imaging, Royal Marsden Hospital, London, United Kingdom
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MRI morphologic and clinicopathologic characteristics for predicting outcomes in patients with locally advanced rectal cancer. Abdom Radiol (NY) 2019; 44:3652-3663. [PMID: 30456561 DOI: 10.1007/s00261-018-1828-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE The aim of this study was to investigate the value of MRI morphologic and clinicopathologic factors for predicting 3-year disease-free survival (DFS) in patients with locally advanced rectal cancer (LARC). METHOD In this retrospective study, pre- and post-neoadjuvant chemoradiotherapy (nCRT) MRI morphologic (e.g., pre-nCRT MRI-detected extramural venous invasion) and clinicopathologic variabilities (e.g., pathological complete response) were evaluated in all patients. Three-year DFS was estimated using Kaplan-Meier product-limit method, and Cox proportional hazards models were used to determine associations between morphologic or clinicopathologic variabilities and survival outcomes. RESULTS A total of 115 patients (39 females and 76 males; median age, 54 years; age range, 28-82 years) with LARC treated with nCRT were enrolled. With a median follow-up of 48.0 months, the 3-year DFS was 79.0% for all patients. During follow-up, 18 patients died, 28 patients experienced relapse (26 distant, one local, and one both), and 69 patients were censored. MRI-detected extramural venous invasion (mrEMVI) was the only significantly independent factor of long-term survival, while HR was 2.308 (95% CI 1.151-4.629, P = 0.018) on univariate and 2.495 (95% CI 1.243-5.012, P = 0.010) on multivariate analysis. The 3-year cumulative survival rate in patients with mrEMVI negativity compared with positivity were 86.6% versus 65.0% (P = 0.015), respectively. CONCLUSION In conclusion, pre-nCRT mrEMVI status was the independent significant risk factor for long-term outcomes in LARC patients treated with nCRT, while the other morphologic and clinicopathologic characteristics were not related to the patient survival.
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Juchems MS, Wessling J. [Rational staging and follow-up of colorectal cancer : Do guidelines provide further help?]. Radiologe 2019; 59:820-827. [PMID: 31455978 DOI: 10.1007/s00117-019-0578-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
CLINICAL/METHODICAL ISSUE Colorectal cancer is one of the most common malignant tumors. Preoperative imaging is crucial in rectal cancer as patients can only receive optimal treatment when accurate staging is performed. The N‑staging is often difficult with the available options and must be called into question as a staging parameter. STANDARD RADIOLOGICAL METHODS Endoscopic ultrasound (EUS) and magnetic resonance imaging (MRI) are particularly suitable for local staging. Multiparametric MRI with diffusion imaging is indispensable for tumor follow-up. METHODICAL INNOVATIONS The assessment of infiltration of the mesorectal fascia is best accomplished using high-resolution MRI. In addition, extramural vascular infiltration (EMVI) has become established as another important prognostic factor. After neoadjuvant therapy and restaging of locally advanced rectal cancer, the identification and validation of prognostically relevant image parameters are prioritized. Multiparametric MRI of the rectum including diffusion imaging as well as the application of radiological and pathological scores (MR-TRG) are becoming increasingly more important in this context. ASSESSMENT For the radiologist it is important to become familiar with indicators of the resectability of rectal cancer and to be able to reliably read prognostically relevant imaging parameters in the tumor follow-up. PRACTICAL RECOMMENDATIONS For the practical application, the establishment of a fixed MRI protocol is essential. In addition to a guideline-compliant TNM classification, the radiologist must provide the clinician with information on infiltration of the mesorectal fascia and extramural vascular infiltration. The MR-TRGs are becoming increasingly more important in tumor follow-up.
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Affiliation(s)
- M S Juchems
- Diagnostische und Interventionelle Radiologie, Klinikum Konstanz, Mainaustr. 35, 78464, Konstanz, Deutschland.
| | - J Wessling
- Zentrum für Radiologie, Neuroradiologie und Nuklearmedizin, Clemenshospital Münster, Münster, Deutschland
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Gu C, Yang X, Zhang X, Zheng E, Deng X, Hu T, Wu Q, Bi L, Wu B, Su M, Wang Z. The prognostic significance of MRI-detected extramural venous invasion, mesorectal extension, and lymph node status in clinical T3 mid-low rectal cancer. Sci Rep 2019; 9:12523. [PMID: 31467313 PMCID: PMC6715653 DOI: 10.1038/s41598-019-47466-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 03/21/2019] [Indexed: 02/06/2023] Open
Abstract
The purpose of this study was to evaluate the prognostic significance of the magnetic resonance imaging-detected extramural venous invasion (MR-EMVI), the depth of mesorectal extension (MR-DME), and lymph node status (MR-LN) in clinical T3 mid-low rectal cancer. One hundred and forty-six patients with clinical T3 mid-low rectal cancer underwent curative surgery were identified. Pretreatment high-resolution MRI was independently reviewed by two experienced radiologists to evaluate MR-EMVI score (0–4), MR-DME (≤4 mm or >4 mm), and MR-LN (positive or negative). The Cox-multivariate regression analysis revealed that the MR-EMVI was the only independent prognostic factor that correlated with overall 3-year disease-free survival (DFS) (p = 0.01). The survival analysis showed that patients with positive MR-EMVI, MR-DME > 4 mm, and positive MR-LN had a poorer prognosis in the overall 3-year DFS (HR 3.557, 95% CI 2.028 to 13.32, p < 0.01; HR 3.744, 95% CI:1.165 to 5.992, p = 0.002; HR 2.946, 95% CI: 1.386 to 6.699, p < 0.01). By combining MR-EMVI with MR-DME or MR-LN, the prognostic significance was more remarkable. Our study suggested that the MR-EMVI, MR-DME, and MR-LN were the important prognostic factors for patients with clinical T3 mid-low rectal cancer and the MR-EMVI was an independent prognostic factor.
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Affiliation(s)
- Chaoyang Gu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan Province, China
| | - Xuyang Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan Province, China
| | - Xubing Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan Province, China
| | - Erliang Zheng
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan Province, China
| | - Xiangbing Deng
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan Province, China
| | - Tao Hu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan Province, China
| | - Qingbin Wu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan Province, China
| | - Liang Bi
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan Province, China
| | - Bing Wu
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan Province, China
| | - Minggang Su
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan Province, China
| | - Ziqiang Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan Province, China.
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Nougaret S, Castan F, de Forges H, Vargas HA, Gallix B, Gourgou S, Rouanet P. Early MRI predictors of disease-free survival in locally advanced rectal cancer from the GRECCAR 4 trial. Br J Surg 2019; 106:1530-1541. [PMID: 31436325 DOI: 10.1002/bjs.11233] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 04/05/2019] [Accepted: 04/14/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Tailored neoadjuvant treatment of locally advanced rectal cancer (LARC) may improve outcomes. The aim of this study was to determine early MRI prognostic parameters with which to stratify neoadjuvant treatment in patients with LARC. METHODS All patients from a prospective, phase II, multicentre randomized study (GRECCAR4; NCT01333709) were included, and underwent rectal MRI before treatment, 4 weeks after induction chemotherapy and after completion of chemoradiotherapy (CRT). Tumour volumetry, MRI tumour regression grade (mrTRG), T and N categories, circumferential resection margin (CRM) status and extramural vascular invasion identified by MRI (mrEMVI) were evaluated. RESULTS A total of 133 randomized patients were analysed. Median follow-up was 41·4 (95 per cent c.i. 36·6 to 45·2) months. Thirty-one patients (23·3 per cent) developed tumour recurrence. In univariable analysis, mrEMVI at baseline was the only prognostic factor associated with poorer outcome (P = 0·015). After induction chemotherapy, a larger tumour volume on MRI (P = 0·019), tumour volume regression of 60 per cent or less (P = 0·002), involvement of the CRM (P = 0·037), mrEMVI (P = 0·026) and a poor mrTRG (P = 0·023) were associated with poor outcome. After completion of CRT, the absence of complete response on MRI (P = 0·004), mrEMVI (P = 0·038) and a poor mrTRG (P = 0·005) were associated with shorter disease-free survival. A final multivariable model including all significant variables (baseline, after induction, after CRT) revealed that Eastern Cooperative Oncology Group performance status (P = 0·011), sphincter involvement (P = 0·009), mrEMVI at baseline (P = 0·002) and early tumour volume regression of 60 per cent or less after induction (P = 0·007) were associated with relapse. CONCLUSION Baseline and early post-treatment MRI parameters are associated with prognosis in LARC. Future preoperative treatment should stratify treatment according to baseline mrEMVI status and early tumour volume regression.
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Affiliation(s)
- S Nougaret
- Department of Radiology, Institut du Cancer de Montpellier, University of Montpellier, Montpellier, France.,Institut de Recherche en Cancérologie de Montpellier, Institut National de la Santé et de la Recherche Médicale, U1194, Montpellier, France
| | - F Castan
- Biometrics Unit, Institut du Cancer de Montpellier, University of Montpellier, Montpellier, France
| | - H de Forges
- Clinical Research Unit, Institut du Cancer de Montpellier, University of Montpellier, Montpellier, France
| | - H A Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - B Gallix
- Department of Radiology, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - S Gourgou
- Biometrics Unit, Institut du Cancer de Montpellier, University of Montpellier, Montpellier, France
| | - P Rouanet
- Department of Surgical Oncology, Institut du Cancer de Montpellier, University of Montpellier, Montpellier, France
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Chen Y, Yang X, Wen Z, Liu Y, Lu B, Yu S, Xiao X. Association between high-resolution MRI-detected extramural vascular invasion and tumour microcirculation estimated by dynamic contrast-enhanced MRI in rectal cancer: preliminary results. BMC Cancer 2019; 19:498. [PMID: 31133005 PMCID: PMC6537147 DOI: 10.1186/s12885-019-5732-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 05/17/2019] [Indexed: 02/07/2023] Open
Abstract
Background To determine whether magnetic resonance imaging (MRI)-detected extramural vascular invasion (mrEMVI) status is associated with quantitative perfusion parameters derived from dynamic contrast-enhanced MRI (DCE-MRI) in rectal cancer. Methods Seventy-two patients with rectal adenocarcinoma who underwent curative surgery alone within 2 weeks following rectal MRI were enrolled in this retrospective study. mrEMVI status was determined based on high-resolution MRI. The quantitative perfusion parameters (Ktrans, kep and ve) derived from DCE-MRI were calculated from all sections containing tumours. DCE-MRI parameters and clinicopathological variables in patients with different mrEMVI statuses were compared. Results For patients who were mrEMVI positive, the tumours demonstrated significantly lower kep values (P = 0.012) and higher ve values (P = 0.021) than tumours of patients who were mrEMVI negative, while the Ktrans value displayed no significant difference (P = 0.390). The patients who were mrEMVI positive had larger tumour size, higher pathological tumour stage and increased regional nodal metastases compared to those who were mrEMVI negative (2.9 cm vs. 3.5 cm, P = 0.011; 63.8% vs. 92.0%, P = 0.010; 36.2% vs. 76.0%, P = 0.001; respectively). Conclusions This study demonstrated for the first time that tumour microcirculation is altered in mrEMVI-positive patients with rectal adenocarcinoma, as evidenced by significantly lower kep and higher ve values. In addition, these patients were more likely to have a larger tumour size, a higher pathological tumour stage and regional nodal metastases than mrEMVI-negative patients.
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Affiliation(s)
- Yan Chen
- Department of Radiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Xinyue Yang
- Department of Radiology, Zhujiang Hospital of Southern Medical University, Guangzhou, 510282, China
| | - Ziqiang Wen
- Department of Radiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Yiyan Liu
- Department of Radiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Baolan Lu
- Department of Radiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Shenping Yu
- Department of Radiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China.
| | - Xiaojuan Xiao
- Department of Radiology, the Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518036, China.
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The Diagnostic Performance of MRI for Detection of Extramural Venous Invasion in Colorectal Cancer: A Systematic Review and Meta-Analysis of the Literature. AJR Am J Roentgenol 2019; 213:575-585. [PMID: 31063424 DOI: 10.2214/ajr.19.21112] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE. The purpose of this article is to perform a systematic review and meta-analysis regarding the diagnostic test accuracy of MRI for detecting extramural venous invasion (EMVI) in patients with colorectal cancer. MATERIALS AND METHODS. PubMed and EMBASE were searched up to November 9, 2018. We included diagnostic accuracy studies that used MRI for EMVI detection in patients with colorectal cancer, using pathologic analysis as the reference standard. The methodologic quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Sensitivity and specificity were pooled and plotted in a hierarchic summary ROC plot. Metaregression analysis using several clinically relevant covariates was performed. RESULTS. Fourteen studies (n = 1751 patients) were included. Study quality was moderate in general. Pooled sensitivity was 0.61 (95% CI, 0.49-0.71), and pooled specificity was 0.87 (95% CI, 0.79-0.92). There was substantial heterogeneity according to the Cochran Q test (p < 0.01) and Higgins I2 heterogeneity index (98% and 95% for sensitivity and specificity, respectively). Publication bias was present (p = 0.01). Higher rates of advanced T category, use of high-resolution MRI, and use of antispasmodic drugs were shown to significantly affect heterogeneity (p < 0.01). Location of primary tumor, preoperative treatment status, study design, definition of reference standard, magnetic field strength, and use of functional MRI were not statistically significant (p = 0.17-0.92). CONCLUSION. MRI shows moderate sensitivity and good specificity for the detection of EMVI in colorectal cancer. The use of high-resolution MRI may improve diagnostic performance.
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Shu Z, Fang S, Ding Z, Mao D, Cai R, Chen Y, Pang P, Gong X. MRI-based Radiomics nomogram to detect primary rectal cancer with synchronous liver metastases. Sci Rep 2019; 9:3374. [PMID: 30833648 PMCID: PMC6399278 DOI: 10.1038/s41598-019-39651-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 01/29/2019] [Indexed: 12/30/2022] Open
Abstract
Synchronous liver metastasis (SLM) remains a major challenge for rectal cancer. Early detection of SLM is a key factor to improve the survival rate of rectal cancer. In this radiomics study, we predicted the SLM based on the radiomics of primary rectal cancer. A total of 328 radiomics features were extracted from the T2WI images of 194 patients. The least absolute shrinkage and selection operator (LASSO) regression was used to reduce the feature dimension and to construct the radiomics signature. after LASSO, principal component analysis (PCA) was used to sort the features of the surplus characteristics, and selected the features of the total contribution of 85%. Then the prediction model was built by linear regression, and the decision curve analysis was used to judge the net benefit of LASSO and PCA. In addition, we used two independent cohorts for training (n = 135) and validation (n = 159). We found that the model based on LASSO dimensionality construction had the maximum net benefit (in the training set (AUC [95% confidence interval], 0.857 [0.787–0.912]) and in the validation set (0.834 [0.714–0.918]). The radiomics nomogram combined with clinical risk factors and LASSO features showed a good predictive performance in the training set (0.921 [0.862–0.961]) and validation set (0.912 [0.809–0.97]). Our study indicated that radiomics based on primary rectal cancer could provide a non-invasive way to predict the risk of SLM in clinical practice.
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Affiliation(s)
- Zhenyu Shu
- Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Songhua Fang
- Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Zhongxiang Ding
- Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Dewang Mao
- Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Rui Cai
- Department of Anorectal, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, China
| | | | | | - Xiangyang Gong
- Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, China.
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Ahn JH, Kim SH, Son JH, Jo SJ. Added value of diffusion-weighted imaging for evaluation of extramural venous invasion in patients with primary rectal cancer. Br J Radiol 2019; 92:20180821. [PMID: 30698998 DOI: 10.1259/bjr.20180821] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE: To evaluate the added value of diffusion-weighted imaging (DWI) to T 2 weighted imaging (T 2WI) for detection of extramural venous invasion (EMVI) in patients with primary rectal cancer. METHODS: 79 patients (50 men, 29 females, mean age 67.4 years, range 37-87 years) who had undergone rectal MRI and subsequently received surgical resection were included. The rectal MRI consisted of T 2WI in three planes and axial DWI (b-values, 0, 1000 s mm-2). Two radiologists blinded to the pathologic results independently reviewed the T 2WI first, and then the combined T 2WI and DWI 4 weeks later. They recorded their confidence scores for EMVI on a 5-point scale (0: definitely negative and 4: definitely positive). The diagnostic performance of each reading session for each reader was compared by pairwise comparison of receiver operating characteristic curves. The area under the ROC curve (AUC) was considered as the diagnostic performance. The result of a histopathological examination served as the reference standard for EMVI. RESULTS: For both readers, the diagnostic performance was not significantly different between the two image sets (for reader 1, AUC, 0.828 and 0.825, p = 0.9426 and for reader 2, AUC, 0.723 and 0.726, p = 0.9244, respectively). CONCLUSION: There was no added value of DWI to T2WI for detection of EMVI in patients with primary rectal cancer. ADVANCES IN KNOWLEDGE: High-resolution T2WI alone is sufficient to assess EMVI and a supplementary DWI has no added value in patients with primary rectal cancer.
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Affiliation(s)
- Ju Hee Ahn
- 1 Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital , Busan , Korea
| | - Seung Ho Kim
- 1 Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital , Busan , Korea
| | - Jung Hee Son
- 1 Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital , Busan , Korea
| | - Sung Jae Jo
- 1 Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital , Busan , Korea
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Prognostic value of MRI in assessing extramural venous invasion in rectal cancer: multi-readers' diagnostic performance. Eur Radiol 2019; 29:4379-4388. [PMID: 30617483 DOI: 10.1007/s00330-018-5926-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/07/2018] [Accepted: 11/28/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study was conducted in order to determine the prognostic value of MRI for extramural venous invasion (EMVI) in rectal cancer compared to pathology and to assess the diagnostic performance of multireaders. METHODS We retrospectively enrolled 222 patients (M:F = 148:74; mean age ± standard deviation, 61.5 ± 12 years) with histopathologically proven rectal cancers who underwent preoperative MRI between 2007 and 2016. Among them, 74 patients had positive EMVI on pathology (pEMVI) and 148 patients had negative pEMVI. Three radiologists with 7 (reviewer 1), 3 (reviewer 2), and 1 (reviewer 3) year of experience in rectal MR imaging determined the presence of EMVI on MRI (mrEMVI) using a 5-point grading system. Using histopathologic results as the reference standard, radiologists' performances were analyzed and compared with receiver operating characteristic (ROC) analysis. For assessment of interobserver variation, intraclass correlation coefficients (ICC) were used. Lastly, Kaplan-Meier estimation and Cox proportional hazard models were used for survival analysis. RESULTS The area under the ROC curve (AUC) was highest in reviewer 1 (0.829), followed by reviewer 2 (0.798) and reviewer 3 (0.658). Differences in AUCs between reviewer 1 or 2 and reviewer 3 were statistically significant (p < 0.001). ICC was substantial between reviewers 1 and 2. Overall survival (OS) was significantly different according to the positive circumferential resection margin, adjuvant treatment, and the presence of mrEMVI, but not by the presence of pEMVI. CONCLUSIONS For experienced radiologists, the diagnostic performance of mrEMVI was good, resulting in better prediction of OS than with pEMVI, with substantial interobserver agreement. KEY POINTS • When read by experienced radiologists, MR can provide reliable diagnostic performance in assessing EMVI for patients with rectal cancer. • Positive mrEMVI is an adverse prognostic factor of overall survival and may influence the clinical decision-making.
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Ale Ali H, Kirsch R, Razaz S, Jhaveri A, Thipphavong S, Kennedy ED, Jhaveri KS. Extramural venous invasion in rectal cancer: overview of imaging, histopathology, and clinical implications. Abdom Radiol (NY) 2019; 44:1-10. [PMID: 29967984 DOI: 10.1007/s00261-018-1673-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Extramural venous invasion (EMVI) is an independent prognostic factor for prediction of overall unfavorable outcomes in rectal cancer. While EMVI has traditionally been detected in postoperative pathologic specimens, MRI can provide this important piece of information preoperatively. This article reviews the methods of EMVI detection and their clinical implications for treatment and outcomes of rectal cancer. CONCLUSION EMVI has fundamental implications for rectal cancer prognosis and long-term outcomes. Since MRI has the advantage of preoperative detection of EMVI, it has been suggested that MRI-detected EMVI be incorporated for preoperative chemoradiotherapy (CRT) treatment stratification of rectal cancer for better patient triage and outcomes.
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Liu H, Zhang C, Wang L, Luo R, Li J, Zheng H, Yin Q, Zhang Z, Duan S, Li X, Wang D. MRI radiomics analysis for predicting preoperative synchronous distant metastasis in patients with rectal cancer. Eur Radiol 2018; 29:4418-4426. [PMID: 30413955 DOI: 10.1007/s00330-018-5802-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 09/12/2018] [Accepted: 09/25/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To investigate the value of MRI radiomics based on T2-weighted (T2W) images in predicting preoperative synchronous distant metastasis (SDM) in patients with rectal cancer. METHODS This retrospective study enrolled 177 patients with histopathology-confirmed rectal adenocarcinoma (123 patients in the training cohort and 54 in the validation cohort). A total of 385 radiomics features were extracted from pretreatment T2W images. Five steps, including univariate statistical tests and a random forest algorithm, were performed to select the best preforming features for predicting SDM. Multivariate logistic regression analysis was conducted to build the clinical and clinical-radiomics combined models in the training cohort. The predictive performance was validated by receiver operating characteristics curve (ROC) analysis and clinical utility implementing a nomogram and decision curve analysis. RESULTS Fifty-nine patients (33.3%) were confirmed to have SDM. Six radiomics features and four clinical characteristics were selected for predicting SDM. The clinical-radiomics combined model performed better than the clinical model in both the training and validation datasets. A threshold of 0.44 yielded an area under the ROC (AUC) value of 0.827 (95% confidence interval (CI), 0.6963-0.9580), a sensitivity of 72.2%, a specificity of 94.4%, and an accuracy of 87.0% in the validation cohort for the combined model. A clinical-radiomics nomogram and decision curve analysis confirmed the clinical utility of the combined model. CONCLUSIONS Our proposed clinical-radiomics combined model could be utilized as a noninvasive biomarker for identifying patients at high risk of SDM, which could aid in tailoring treatment strategies. KEY POINTS • T2WI-based radiomics analysis helps predict synchronous distant metastasis (SDM) of rectal cancer. • The clinical-radiomics combined model could be utilized as a noninvasive biomarker for predicting SDM. • Personalized treatment can be carried out with greater confidence based on the risk stratification for SDM in rectal cancer.
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Affiliation(s)
- Huanhuan Liu
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Shanghai, 200092, China
| | - Caiyuan Zhang
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Shanghai, 200092, China
| | - Lijun Wang
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Shanghai, 200092, China
| | - Ran Luo
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Shanghai, 200092, China
| | - Jinning Li
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Shanghai, 200092, China
| | - Hui Zheng
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Shanghai, 200092, China
| | - Qiufeng Yin
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Shanghai, 200092, China
| | - Zhongyang Zhang
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Shanghai, 200092, China
| | - Shaofeng Duan
- GE Healthcare, Pudong New Town, No.1, Huatuo Road, Shanghai, 210000, China
| | - Xin Li
- GE Healthcare, Pudong New Town, No.1, Huatuo Road, Shanghai, 210000, China
| | - Dengbin Wang
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Shanghai, 200092, China.
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Sun Y, Li J, Shen L, Wang X, Tong T, Gu Y. Predictive value of MRI-detected extramural vascular invasion in stage T3 rectal cancer patients before neoadjuvant chemoradiation. ACTA ACUST UNITED AC 2018; 24:128-134. [PMID: 29770764 DOI: 10.5152/dir.2018.17286] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE We set out to explore the probability of MRI-detected extramural vascular invasion (mr-EMVI) before chemoradiation to predict responses to chemoradiation and survival in stage T3 rectal cancer patients. METHODS A total of 100 patients with T3 rectal cancer who underwent MRI examination and received neoadjuvant chemoradiation and surgery were enrolled. The correlation between mr-EMVI and other clinical factors were analyzed by chi-square. Logistic regression model was performed to select the potential factors influencing tumor responses to neoadjuvant chemoradiation. A Cox proportional hazards regression model was performed to explore potential predictors of survival. RESULTS The positive mr-EMVI result was more likely to be present in patients with a higher T3 subgroup (T3a+b = 7.1% vs. T3c+d = 90.1%, P < 0.001) and more likely in patients with mesorectal fascia involvement than in those without MRF (65% vs. 38.8%, P = 0.034). Compared with mr-EMVI (+) patients, more mr-EMVI (-) patients showed a good response (staged ≤ ypT2N0) (odds ratio [OR], 3.020; 95% confidence interval [CI], 1.071-8.517; P = 0.037). In univariate analysis, mr-EMVI (+) (hazard ratio [HR], 5.374; 95% CI, 1.210-23.872; P = 0.027) and lower rectal cancers (HR, 3.326; 95% CI, 1.135-9.743; P = 0.028) were significantly associated with decreased disease-free survival. A positive mr-EMVI status (HR, 5.727; 95% CI, 1.286-25.594; P = 0.022) and lower rectal cancers (HR, 3.137; 95% CI, 1.127-8.729; P = 0.029) also served as prognostic factors related to decreased disease-free survival in multivariate analysis. CONCLUSION The mr-EMVI status before chemoradiation is a significant prognostic factor and could be used for identifying T3 rectal cancer patients who might benefit from neoadjuvant chemoradiation.
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Affiliation(s)
- Yiqun Sun
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China; Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jianwen Li
- Department of Urology, Shanxi Academy of Medical Science, Shanxi Dayi Hospital, Shanxi, China
| | - Lijun Shen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaolin Wang
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
| | - Tong Tong
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yajia Gu
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Zhang XY, Wang S, Li XT, Wang YP, Shi YJ, Wang L, Wu AW, Sun YS. MRI of Extramural Venous Invasion in Locally Advanced Rectal Cancer: Relationship to Tumor Recurrence and Overall Survival. Radiology 2018; 289:677-685. [PMID: 30152742 DOI: 10.1148/radiol.2018172889] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose To study the relationship between MRI-defined extramural venous invasion (EMVI) prior to treatment and prognosis in patients with locally advanced rectal cancer treated with neoadjuvant chemotherapy-radiation therapy followed by surgery. Materials and Methods This retrospective study included 517 patients with locally advanced rectal cancer evaluated from August 2008 to December 2014. Baseline and posttherapy MRI and follow-up data were retrieved for all patients. After training by using 328 cases with pathologic evaluation of EMVI after therapy, radiologists evaluated baseline MRI for EMVI status in addition to tumor size and characteristics, nodal status, and invasion of the mesorectal fascia. Reader reproducibility was determined by using κ coefficient. Kaplan-Meier curves and adjusted Cox models were used to determine the relationship of baseline MRI parameters to overall survival, metastasis-free survival, and local relapse-free survival. Results Among 517 patients, 335 (64.8%) were men; the mean age was 55.6 years ± 11.5 (standard deviation). At baseline, radiologists identified 259 of 517 (50%) patients with EMVI by using MRI. In adjusted analysis, EMVI and mesorectal fascial invasion at baseline MRI were predictors of metastasis-free survival (hazard ratio, 0.3 and 0.6; P ˂ .01 and P ˂ .02, respectively) and overall survival (hazard ratio, 0.5 and 0.5; P = .01 and P = .02, respectively). EMVI was the only factor associated with local relapse-free survival (hazard ratio, 0.3; P ˂ .01). The κ coefficient for determination of EMVI was 0.80. Conclusion Extramural venous invasion (EMVI) can be reliably evaluated with MRI. The presence of EMVI was associated with greater risk of local and distant tumor recurrence and overall death in patients with locally advanced rectal cancer treated with neoadjuvant chemotherapy-radiation therapy. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Xiao-Yan Zhang
- From the Departments of Radiology (X.Y.Z., S.W., X.T.L., Y.P.W., Y.J.S., Y.S.S.) and Gastrointestinal Surgery (L.W., A.W.W.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing 100142, China
| | - Shuai Wang
- From the Departments of Radiology (X.Y.Z., S.W., X.T.L., Y.P.W., Y.J.S., Y.S.S.) and Gastrointestinal Surgery (L.W., A.W.W.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing 100142, China
| | - Xiao-Ting Li
- From the Departments of Radiology (X.Y.Z., S.W., X.T.L., Y.P.W., Y.J.S., Y.S.S.) and Gastrointestinal Surgery (L.W., A.W.W.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing 100142, China
| | - Ying-Ping Wang
- From the Departments of Radiology (X.Y.Z., S.W., X.T.L., Y.P.W., Y.J.S., Y.S.S.) and Gastrointestinal Surgery (L.W., A.W.W.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing 100142, China
| | - Yan-Jie Shi
- From the Departments of Radiology (X.Y.Z., S.W., X.T.L., Y.P.W., Y.J.S., Y.S.S.) and Gastrointestinal Surgery (L.W., A.W.W.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing 100142, China
| | - Lin Wang
- From the Departments of Radiology (X.Y.Z., S.W., X.T.L., Y.P.W., Y.J.S., Y.S.S.) and Gastrointestinal Surgery (L.W., A.W.W.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing 100142, China
| | - Ai-Wen Wu
- From the Departments of Radiology (X.Y.Z., S.W., X.T.L., Y.P.W., Y.J.S., Y.S.S.) and Gastrointestinal Surgery (L.W., A.W.W.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing 100142, China
| | - Ying-Shi Sun
- From the Departments of Radiology (X.Y.Z., S.W., X.T.L., Y.P.W., Y.J.S., Y.S.S.) and Gastrointestinal Surgery (L.W., A.W.W.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing 100142, China
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Park CJ, Seo N, Hyung WJ, Koom WS, Kim HS, Kim MJ, Lim JS. Prognostic significance of preoperative CT findings in patients with advanced gastric cancer who underwent curative gastrectomy. PLoS One 2018; 13:e0202207. [PMID: 30092078 PMCID: PMC6084995 DOI: 10.1371/journal.pone.0202207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/14/2018] [Indexed: 12/23/2022] Open
Abstract
Background Preoperative therapy has gained wide interest in advanced gastric cancer patients due to its potential advantages of improved disease control. Selection of high risk patients based on preoperative staging is crucial to choose the candidates for neoadjuvant therapy. Methods Our institutional review board approved this retrospective study and waived the requirement for patient consent. We searched 394 advanced gastric cancer patients (pT2-4) who underwent curative resection in 2010 without neoadjuvant therapies. Two abdominal radiologists independently reviewed the preoperative CT including tumor depth on CT (CT-tumor depth), which was categorized as follows: intramural, minimal extramural(<1mm), spiculated extramural(≥1mm) and nodular extramural infiltration. The impact of clinicoradiologic factors on disease recurrence and disease free survival (DFS) was evaluated. Recursive partitioning analysis was performed to suggest prediction models for recurrence. Results Of total 394 patients, 86 patients (21.8%) experienced recurrence. Spiculated (≥1mm) and nodular extramural tumor infiltration and CT size of 5-10cm were independent predictors of disease recurrence and significantly associated with worse DFS. Lymph node involvement on CT was not significantly associated with patient outcome. Among patients with same pT4a stage, the recurrence rate rises and DFS gets worse as the extramural tumor infiltration progresses (P < 0.001). The prediction model for recurrence revealed that size and CT-tumor depth were the two major discriminating factors. Conclusion CT-tumor depth and size could be used as independent predictors for prognosis. Preoperative CT can be used for prognostic stratification to select high risk patients for whom neoadjuvant therapies might be considered.
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Affiliation(s)
- Chae Jung Park
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Nieun Seo
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Woo Jin Hyung
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Woong Sub Koom
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Song Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Myeong-Jin Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Seok Lim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- * E-mail:
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Athanasakis E, Xenaki S, Venianaki M, Chalkiadakis G, Chrysos E. Newly recognized extratumoral features of colorectal cancer challenge the current tumor-node-metastasis staging system. Ann Gastroenterol 2018; 31:525-534. [PMID: 30174388 PMCID: PMC6102465 DOI: 10.20524/aog.2018.0284] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 03/13/2018] [Indexed: 12/12/2022] Open
Abstract
One of the most common malignant tumors in humans, colorectal cancer has been extensively studied during the past few decades. Staging colorectal cancer allows clinicians to obtain precise prognostic information and apply specific treatment procedures. Apart from remote metastases, the depth of tumor infiltration and lymph node involvement have traditionally been recognized as the most important factors predicting outcome. Variations in the molecular signature of colorectal cancer have also revealed differences in phenotypic aggressiveness and therapeutic response rates. This article presents a review of the extratumoral environment in colorectal surgery.
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Affiliation(s)
- Elias Athanasakis
- Department of General Surgery, University Hospital of Heraklion Crete, Greece
| | - Sofia Xenaki
- Department of General Surgery, University Hospital of Heraklion Crete, Greece
| | - Maria Venianaki
- Department of General Surgery, University Hospital of Heraklion Crete, Greece
| | - George Chalkiadakis
- Department of General Surgery, University Hospital of Heraklion Crete, Greece
| | - Emmanuel Chrysos
- Department of General Surgery, University Hospital of Heraklion Crete, Greece
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Intravoxel Incoherent Motion MRI of Rectal Cancer: Correlation of Diffusion and Perfusion Characteristics With Prognostic Tumor Markers. AJR Am J Roentgenol 2018; 210:W139-W147. [PMID: 29446674 DOI: 10.2214/ajr.17.18342] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The objective of our study was to evaluate the intravoxel incoherent motion (IVIM)-DWI derived parameters and their relationships with tumor prognostic markers using 3-T MRI in patients with rectal cancer. SUBJECTS AND METHODS Fifty-two patients with histopathologically proven rectal cancer who underwent preoperative pelvic MRI were prospectively enrolled in this study. Diffusion and perfusion parameters including the apparent diffusion coefficient (ADC), pure diffusion coefficient, perfusion fraction, and pseudodiffusion coefficient derived from IVIMDWI were independently measured by two radiologists. Comparisons of IVIM-DWI-derived parameters in patients with different tumor prognostic markers were made using the independent-samples t test, ANOVA, and Mann-Whitney U test. The correlations between IVIM-DWI-derived parameters and tumor grade and tumor stage were further evaluated using Spearman correlation analysis. Interobserver agreement was evaluated using the intraclass correlation coefficient (ICC). RESULTS Excellent interobserver reproducibility was obtained for the IVIM-DWI-derived parameters (range of ICCs with 95% limits of agreement = 0.9309-0.9948, which is narrow). ADC, pseudodiffusion coefficient, and perfusion fraction tended to rise with greater tumor differentiation (r = 0.520, p < 0.001; r = 0.447, p = 0.001; r = 0.354, p = 0.010, respectively). The pure diffusion coefficient and pseudodiffusion coefficient showed a trend of decreasing with increasing tumor stages (r = 0.479, p < 0.001; r = 0.517, p < 0.001). The group of patients with extramural vascular invasion (EMVI) showed lower pseudodiffusion coefficient values than the group of patients with no EMVI (p < 0.05). CONCLUSION IVIM-DWI-derived parameters in patients with rectal cancer, especially the pseudodiffusion coefficient, are associated with tumor grade and tumor stage and show statistically significant differences between subjects with EMVI and those without EMVI. IVIM-DWI-derived parameters would be helpful in predicting tumor aggressiveness and prognosis.
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79
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Liu H, Cui Y, Shen W, Fan X, Cui L, Zhang C, Ren G, Fu J, Wang D. Pretreatment magnetic resonance imaging of regional lymph nodes with carcinoembryonic antigen in prediction of synchronous distant metastasis in patients with rectal cancer. Oncotarget 2017; 7:27199-207. [PMID: 27070083 PMCID: PMC5053642 DOI: 10.18632/oncotarget.7979] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 02/23/2016] [Indexed: 01/14/2023] Open
Abstract
Distant metastasis in patients with rectal cancer remains a problem influencing prognosis. Prediction of synchronous distant metastasis is important for the choice of personalized treatment strategies and postoperative follow-up protocol. So far, there are few studies about the predictive value of MRI features combined with clinical characteristics for synchronous distant metastasis in rectal cancer, especially for the lesions developed within 6 months after surgery. We retrospectively reviewed the pretreatment clinical characteristics and magnetic resonance imaging (MRI) features of 271 patients from January 2010 to December 2011with pathologically confirmed rectal adenocarcinoma and tried to identify independent risk factors for synchronous distant metastasis. Forty-nine patients (18.1%) were confirmed to have synchronous distant metastasis. Multivariate logistic regression model demonstrated that the elevated carcinoembryonic antigen (CEA), positive MRI-predicted lymph nodes staging (mrN), and MRI-predicted mesorectal fascia (mrMRF) involvement were independent risk factors. The odd ratios were 12.2 for elevated CEA, 5.4 for mrN1 and 7.6 for mrN2, and 3.8 for mrMRF involvement, respectively. The accuracy and specificity for predicting synchronous distant metastasis by evaluating the positive mrN combined with elevated CEA were improved to 87.8% and 94.6%, respectively. The accuracy, sensitivity and specificity of positive mrN assessment were 86.1%, 71.4% and 91.7%, respectively using the histopathologic results as the reference standard. Altogether, our findings suggest that pretreatment positive mrN and elevated CEA are independent risk factors for synchronous distant metastasis in rectal cancer and combination of both could help to recognize the patients with high risk for structuring personalized treatment protocol.
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Affiliation(s)
- Huanhuan Liu
- Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Yanfen Cui
- Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Wei Shen
- Department of Colorectal and Anal Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Xingwen Fan
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Long Cui
- Department of Colorectal and Anal Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Caiyuan Zhang
- Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Gang Ren
- Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Jihong Fu
- Department of Colorectal and Anal Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Dengbin Wang
- Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
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Bhoday J, Balyasnikova S, Wale A, Brown G. How Should Imaging Direct/Orient Management of Rectal Cancer? Clin Colon Rectal Surg 2017; 30:297-312. [PMID: 29184465 DOI: 10.1055/s-0037-1606107] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Modern rectal cancer management is dependent on preoperative staging, and radiological assessment is a crucial part of this process. Imaging must provide sufficient information to guide preoperative decision-making that is reliable and reproducible. Different methods have been used for local staging; however, magnetic resonance imaging (MRI) has shown to be the most reliable tool for this purpose. MRI offers prognostic information about the patients and guides the decision between neoadjuvant treatment and total mesorectal excision alone. Also, not only the initial staging but also restaging by MRI can provide significant information regarding tumor response that is essential when considering alternative approaches.
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Affiliation(s)
- Jemma Bhoday
- Department of Radiology, The Royal Marsden NHS Foundation Trust NIHR BRC and Imperial College London, Sutton, Surrey, United Kingdom
| | - Svetlana Balyasnikova
- Department of Radiology, The Royal Marsden NHS Foundation Trust NIHR BRC and Imperial College London, Sutton, Surrey, United Kingdom
| | - Anita Wale
- Department of Radiology, The Royal Marsden NHS Foundation Trust NIHR BRC and Imperial College London, Sutton, Surrey, United Kingdom
| | - Gina Brown
- Department of Radiology, The Royal Marsden NHS Foundation Trust NIHR BRC and Imperial College London, Sutton, Surrey, United Kingdom
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Heald RJ, Santiago I, Pares O, Carvalho C, Figueiredo N. The Perfect Total Mesorectal Excision Obviates the Need for Anything Else in the Management of Most Rectal Cancers. Clin Colon Rectal Surg 2017; 30:324-332. [PMID: 29184467 DOI: 10.1055/s-0037-1606109] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This article discusses the local control of primary rectal cancer and its locoregional spread in the light of modern advances. In recent years, the use of neoadjuvant chemoradiation has spread widely. However, its true benefit is not always balanced with its morbidities. Often total mesorectal excision (TME) is the best option. We will discuss the indications for immediate surgery for chemoradiation in advance and the importance of a delay in the management plan. To understand this selection, it is mandatory to know the true extent of tissue at risk for tumor dissemination and spread. Considering that TME may be enough for many patients and that most local recurrences are failures of surgical technique we introduce a new concept of total mesorectal irradiation. This exploits the new reality that precise, focused neoadjuvant therapy can offer a better response with fewer complications. Together these important changes in cancer board (multidisciplinary team) planning can also offer selected patients complete control of their cancer with no need for surgery.
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Affiliation(s)
- Richard John Heald
- Digestive Unit, Champalimaud Cancer Center, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Ines Santiago
- Digestive Unit, Champalimaud Cancer Center, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Oriol Pares
- Digestive Unit, Champalimaud Cancer Center, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Carlos Carvalho
- Digestive Unit, Champalimaud Cancer Center, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Nuno Figueiredo
- Digestive Unit, Champalimaud Cancer Center, Champalimaud Centre for the Unknown, Lisbon, Portugal
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Extramural vascular invasion detected by contrast-enhanced multiple-row detectors computed tomography (ceMDCT) as a predictor of synchronous metastases in colon cancer. Oncotarget 2017; 8:94883-94892. [PMID: 29212274 PMCID: PMC5706920 DOI: 10.18632/oncotarget.22034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 08/28/2017] [Indexed: 01/16/2023] Open
Abstract
Background Extramural Vascular Invasion (EMVI) is histologically defined as the presence of tumor cells beyond the muscularis propria in vessels resulting in disease metastases. Objective To determine whether EMVI, detected by contrast-enhanced multiple-row detectors computed tomography (MDCT), has closely association with synchronous metastases in colon cancer. Methods Patients with pathology proven colon cancer were included in this retrospective study. Preoperative imaging status, including Extramural tumor depth, Lymph nodes, tumor location, and ctEMVI status, were defined on MDCT. Postoperative pathological tumor stage, lymph node stage, and tumor differentiation, were defined in accordance with the American Joint Committee on Cancer (AJCC) 7th Edition. Synchronous metastases were detected on follow-up MDCT 3 months after initial diagnosis or by surgery, if available. Associations between ctEMVI and other preoperative and postoperative factors were analyzed using Chi-squared tests. Logistic regression analyses were performed to analyze the preoperative and postoperative factors of synchronous metastases in colon cancer. Results ctEMVI was observed in 96 patients (96/241, 39.8%). The presence of ctEMVI varied significantly depending on ctEMD (χ2 = 66.557, P<0.001), lymph nodes status on MDCT (χ2 =24.533, P=0.001), pathological tumor status (χ2 = 36.267, P <0.001) and pathological lymph nodes status analyses (χ2 =32.103, P <0.001). Synchronous metastases were seen in 36 patients (36/96, 37.5%) with ctEMVI and 11 (11/145, 7.6%) patients without ctEMVI. The incidence of synchronous metastases was significantly higher in the cohort of positive ctEMVI with odds ratio (OR) of 7.309 (95% CI 3.485∼15.330, P<0.001). Positive ctEMVI (Odds ratio 4.654, 95%CI: 1.987∼10.898, P <0.001) and ctEMD larger than 5 mm (Odds ratio 2.654, 95%CI: 1.116∼6.309, P =0.027) were demonstrated to be significant preoperative factors in predicting synchronous metastases. Conclusion MDCT-detected EMVI could be used as a preoperative factor to predict synchronous metastases in colon cancer.
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Lord AC, D'Souza N, Pucher PH, Moran BJ, Abulafi AM, Wotherspoon A, Rasheed S, Brown G. Significance of extranodal tumour deposits in colorectal cancer: A systematic review and meta-analysis. Eur J Cancer 2017. [DOI: 10.1016/j.ejca.2017.05.027] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Lee ES, Kim MJ, Park SC, Hur BY, Hyun JH, Chang HJ, Baek JY, Kim SY, Kim DY, Oh JH. Magnetic Resonance Imaging-Detected Extramural Venous Invasion in Rectal Cancer before and after Preoperative Chemoradiotherapy: Diagnostic Performance and Prognostic Significance. Eur Radiol 2017; 28:496-505. [PMID: 28786006 DOI: 10.1007/s00330-017-4978-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 05/25/2017] [Accepted: 06/29/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVES We evaluated the diagnostic performance of magnetic resonance imaging (MRI) in terms of identifying extramural venous invasion (EMVI) in rectal cancer patients with preoperative chemoradiotherapy (CRT) and its prognostic significance. METHODS During 2008-2010, 200 patients underwent surgery following preoperative CRT for rectal cancer. Two radiologists independently reviewed all pre- and post-CRT MRI retrospectively. We investigated diagnostic performance of pre-CRT MR-EMVI (MR-EMVI) and post-CRT MR-EMVI (yMR-EMVI), based on pathological EMVI as the standard of reference. We assessed correlation between MRI findings and patients' prognosis, such as disease-free survival (DFS) and overall survival (OS). Additionally, subgroup analysis in MR- or yMR-EMVI-positive patients was performed to confirm the significance of the severity of EMVI in MRI on patient's prognosis. RESULTS The sensitivity and specificity of yMR-EMVI were 76.19% and 79.75% (area under the curve: 0.830), respectively. In univariate analysis, yMR-EMVI was the only significant MRI factor in DFS (P = 0.027). The mean DFS for yMR-EMVI (+) patients was significantly less than for yMR-EMVI (-) patients: 57.56 months versus 72.46 months. CONCLUSION yMR-EMVI demonstrated good diagnostic performance. yMR-EMVI was the only significant EMVI-related MRI factor that correlated with patients' DFS in univariate analysis; however, it was not significant in multivariate analysis. KEY POINTS • Diagnostic performance of MRI for EMVI after preoperative chemoradiotherapy is good. • The mean DFS was lower in yMR-EMVI-positive than yMR-EMVI-negative patients. • MRI can facilitate prognosis prediction of rectal cancer patients with preoperative chemoradiotherapy.
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Affiliation(s)
- Eun Sun Lee
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea.,College of Medicine and Graduate School of Medicine, Chung-Ang University, Seoul, Korea.,Department of Radiology, National Cancer Centre, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Korea
| | - Min Ju Kim
- Department of Radiology, National Cancer Centre, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Korea.
| | - Sung Chan Park
- Centre for Colorectal Cancer, National Cancer Centre, Goyang, Gyeonggi-do, Korea
| | - Bo Yun Hur
- Department of Radiology, National Cancer Centre, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Korea
| | - Jong Hee Hyun
- Centre for Colorectal Cancer, National Cancer Centre, Goyang, Gyeonggi-do, Korea
| | - Hee Jin Chang
- Centre for Colorectal Cancer, National Cancer Centre, Goyang, Gyeonggi-do, Korea
| | - Ji Yeon Baek
- Centre for Colorectal Cancer, National Cancer Centre, Goyang, Gyeonggi-do, Korea
| | - Sun Young Kim
- Centre for Colorectal Cancer, National Cancer Centre, Goyang, Gyeonggi-do, Korea.,Department of Oncology, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae Yong Kim
- Centre for Colorectal Cancer, National Cancer Centre, Goyang, Gyeonggi-do, Korea
| | - Jae Hwan Oh
- Centre for Colorectal Cancer, National Cancer Centre, Goyang, Gyeonggi-do, Korea
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85
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Siddiqui MRS, Simillis C, Hunter C, Chand M, Bhoday J, Garant A, Vuong T, Artho G, Rasheed S, Tekkis P, Abulafi AM, Brown G. A meta-analysis comparing the risk of metastases in patients with rectal cancer and MRI-detected extramural vascular invasion (mrEMVI) vs mrEMVI-negative cases. Br J Cancer 2017; 116:1513-1519. [PMID: 28449006 PMCID: PMC5518867 DOI: 10.1038/bjc.2017.99] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 02/22/2017] [Accepted: 03/21/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Pathological extramural vascular invasion (EMVI) is an independent prognostic factor in rectal cancer, but can also be identified on MRI-detected extramural vascular invasion (mrEMVI). We perform a meta-analysis to determine the risk of metastatic disease at presentation and after surgery in mrEMVI-positive patients compared with negative tumours. METHODS Electronic databases were searched from January 1980 to March 2016. Conventional meta-analytical techniques were used to provide a summative outcome. Quality assessment of the studies was performed. RESULTS Six articles reported on mrEMVI in 1262 patients. There were 403 patients in the mrEMVI-positive group and 859 patients in the mrEMVI-negative group. The combined prevalence of mrEMVI-positive tumours was 0.346(range=0.198-0.574). Patients with mrEMVI-positive tumours presented more frequently with metastases compared to mrEMVI-negative tumours (fixed effects model: odds ratio (OR)=5.68, 95% confidence interval (CI) (3.75, 8.61), z=8.21, df=2, P<0.001). Patients who were mrEMVI-positive developed metastases more frequently during follow-up (random effects model: OR=3.91, 95% CI (2.61, 5.86), z=6.63, df=5, P<0.001). CONCLUSIONS MRI-detected extramural vascular invasion is prevalent in one-third of patients with rectal cancer. MRI-detected extramural vascular invasion is a poor prognostic factor as evidenced by the five-fold increased rate of synchronous metastases, and almost four-fold ongoing risk of developing metastases in follow-up after surgery.
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Affiliation(s)
- Muhammed R S Siddiqui
- Department of Colorectal Surgery, Croydon University Hospital, Croydon CR77YE, UK
- Department of Radiology, Royal Marsden Hospital, Sutton SM2 5PT, UK
| | | | - Chris Hunter
- Department of Colorectal Surgery, Croydon University Hospital, Croydon CR77YE, UK
- Department of Radiology, Royal Marsden Hospital, Sutton SM2 5PT, UK
| | - Manish Chand
- Department of Colorectal Surgery, Croydon University Hospital, Croydon CR77YE, UK
- Department of Radiology, Royal Marsden Hospital, Sutton SM2 5PT, UK
| | - Jemma Bhoday
- Department of Colorectal Surgery, Croydon University Hospital, Croydon CR77YE, UK
- Department of Radiology, Royal Marsden Hospital, Sutton SM2 5PT, UK
| | - Aurelie Garant
- Department of Radiation Oncology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada
| | - Te Vuong
- Department of Radiation Oncology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada
| | - Giovanni Artho
- Department of Radiation Oncology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada
| | - Shahnawaz Rasheed
- Department of Surgery, Royal Marsden Hospital, Fulham Rd, London SW3 6JJ, UK
| | - Paris Tekkis
- Department of Surgery, Royal Marsden Hospital, Fulham Rd, London SW3 6JJ, UK
| | - Al-Mutaz Abulafi
- Department of Colorectal Surgery, Croydon University Hospital, Croydon CR77YE, UK
| | - Gina Brown
- Department of Radiology, Royal Marsden Hospital, Sutton SM2 5PT, UK
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86
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Kang KA, Jang KM, Kim SH, Kang TW, Cha DI. Risk factor assessment to predict the likelihood of a diagnosis of metastasis for indeterminate hepatic lesions found at computed tomography in patients with rectal cancer. Clin Radiol 2017; 72:473-481. [PMID: 28258741 DOI: 10.1016/j.crad.2017.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 01/12/2017] [Accepted: 01/23/2017] [Indexed: 12/17/2022]
Abstract
AIM To assess the significant factors on rectal magnetic resonance imaging (MRI) to predict the likelihood of a diagnosis of metastasis for indeterminate hepatic lesions found at computed tomography (CT) in patients with rectal cancer. MATERIALS AND METHODS A total of 207 patients with rectal cancer who underwent preoperative contrast-enhanced abdominopelvic CT, and rectal and liver MRI were included. Univariate analysis and multivariate logistic regression were used to evaluate the determining factors for the significance of indeterminate hepatic lesions on CT in patients with rectal cancer. RESULTS Hepatic metastases were diagnosed in 29 (20.9%) of 139 patients who had indeterminate hepatic lesions on preoperative CT obtained for rectal cancer. On univariate analysis, carcinoembryonic antigen level, N stage, mesorectal fascia (MRF) invasion, diameter of superior haemorrhoidal vein, and mesorectal vascular lesion (MVL) grade on rectal MRI (p<0.05) were associated with the possibility of metastasis for indeterminate hepatic lesions on CT. On multivariate analysis, MVL grade and MRF invasion on rectal MRI were independent factors associated with the possibility of metastasis for indeterminate hepatic lesions on CT (p<0.0005 and p=0.0066, respectively). CONCLUSION MVL grade and MRF invasion on rectal MRI are independent factors for estimating hepatic metastasis among indeterminate hepatic lesions on CT in patients with rectal cancer.
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Affiliation(s)
- K A Kang
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - K M Jang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Republic of Korea.
| | - S H Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Republic of Korea
| | - T W Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Republic of Korea
| | - D I Cha
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Republic of Korea
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87
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Cho SH, Choi GS, Kim GC, Seo AN, Kim HJ, Kim WH, Shin KM, Lee SM, Ryeom H, Kim SH. Long-term outcomes of surgery alone versus surgery following preoperative chemoradiotherapy for early T3 rectal cancer: A propensity score analysis. Medicine (Baltimore) 2017; 96:e6362. [PMID: 28328820 PMCID: PMC5371457 DOI: 10.1097/md.0000000000006362] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Recently, a few studies have raised the question of whether preoperative chemoradiotherapy (PCRT) is essential for all T3 rectal cancers. This case-matched study aimed to compare the long-term outcomes of surgery alone with those of PCRT + surgery for magnetic resonance imaging (MRI)-assessed T3ab (extramural depth of invasion ≤5 mm) and absent mesorectal fascia invasion (clear MRF) in mid/lower rectal cancer patients.From January 2006 to November 2012, 203 patients who underwent curative surgery alone (n = 118) or PCRT + surgery (n = 85) were enrolled in this retrospective study. A 1:1 propensity score-matched analysis was performed to eliminate the inherent bias. Case-matching covariates included age, sex, body mass index, histologic grade, carcinoembryonic antigen, operation method, follow-up period, tumor height, and status of lymph node metastasis. The end-points were the 5-year local recurrence (LR) rate and disease-free-survival (DFS).After propensity score matching, 140 patients in 70 pairs were included. Neither the 5-year LR rate nor the DFS was significantly different between the 2 groups (the 5-year LR rate, P = 0.93; the 5-year DFS, P = 0.94). The 5-year LR rate of the surgery alone was 2% (95% confidence interval [CI] 0.2%-10.9%) versus 2% (95% CI 0.2%-10.1%) in the PCRT + surgery group. The 5-year DFS of the surgery alone was 87% (95% CI 74.6%-93.7%) versus 88% (95% CI 77.8%-93.9%) in the PCRT + surgery group.In patients with MRI-assessed T3ab and clear MRF mid/lower rectal cancer, the long-term outcomes of surgery alone were comparable with those of the PCRT + surgery. The suggested MRI-assessed T3ab and clear MRF can be used as a highly selective indication of surgery alone in mid/lower T3 rectal cancer. Additionally, in those patients, surgery alone can be tailored to the clinical situation.
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Affiliation(s)
| | | | | | - An Na Seo
- Department of Pathology, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University
| | | | | | | | | | | | - See Hyung Kim
- Department of Radiology, Dongsan Hospital, College of Medicine, Keimyung University, Daegu, Republic of Korea
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88
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Essential Items for Structured Reporting of Rectal Cancer MRI: 2016 Consensus Recommendation from the Korean Society of Abdominal Radiology. Korean J Radiol 2017; 18:132-151. [PMID: 28096724 PMCID: PMC5240498 DOI: 10.3348/kjr.2017.18.1.132] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 07/21/2016] [Indexed: 12/30/2022] Open
Abstract
High-resolution rectal MRI plays a crucial role in evaluating rectal cancer by providing multiple prognostic findings and imaging features that guide proper patient management. Quality reporting is critical for accurate effective communication of the information among multiple disciplines, for which a systematic structured approach is beneficial. Existing guides on reporting of rectal MRI are divergent on some issues, largely reflecting the differences in overall management of rectal cancer patients between the United States and Europe. The Korean Society of Abdominal Radiology (KSAR) study group for rectal cancer has developed an expert consensus recommendation regarding essential items for structured reporting of rectal cancer MRI using a modified Delphi method. This recommendation aims at presenting an up-to-date, evidence-based, practical, structured reporting template that can be readily adopted in daily clinical practice. In addition, a thorough explanation of the clinical and scientific rationale underlying the reporting items and their formats is provided. This KSAR recommendation may serve as a useful tool to help achieve more standardized optimal care for rectal cancer patients using rectal MRI.
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89
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Tripathi P, Rao SX, Zeng MS. Clinical value of MRI-detected extramural venous invasion in rectal cancer. J Dig Dis 2017; 18:2-12. [PMID: 28009094 DOI: 10.1111/1751-2980.12439] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 12/10/2016] [Accepted: 12/19/2016] [Indexed: 12/11/2022]
Abstract
Extramural venous invasion (EMVI) is associated with a poor prognosis and a poor overall survival rate in rectal cancer. It can independently predict local and distant tumor recurrences. Preoperative EMVI detection in rectal cancer is useful for determining the treatment strategy. EMVI status is beneficial for the post-treatment evaluation and analysis of rectal cancer. Magnetic resonance imaging (MRI) is a non-invasive diagnostic modality with no radiation effects. High-resolution MRI can detect EMVI with high accuracy. In addition, MRI results are equal to or even better than pathological results in the detection of medium to large EMVI in rectal cancer. MRI-detected EMVI (mrEMVI) can be used as a potential biomarker that facilitates treatment methods. This review highlights the importance of MRI before and after rectal cancer treatment. In addition, we analyze the prognostic correlation between mrEMVI and circulating tumor cells (CTC) in rectal cancer. This article may help shed light on the significance of mrEMVI.
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Affiliation(s)
- Pratik Tripathi
- Department of Radiology, Zhongshan Hospital and Department of Medical Imaging, Shanghai Medical College, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Sheng Xiang Rao
- Department of Radiology, Zhongshan Hospital and Department of Medical Imaging, Shanghai Medical College, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Meng Su Zeng
- Department of Radiology, Zhongshan Hospital and Department of Medical Imaging, Shanghai Medical College, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China
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90
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Prognostic Value of Computed Tomography–Detected Extramural Venous Invasion to Predict Disease-Free Survival in Patients With Gastric Cancer. J Comput Assist Tomogr 2017; 41:430-436. [DOI: 10.1097/rct.0000000000000543] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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91
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Li XF, Jiang Z, Gao Y, Li CX, Shen BZ. Combination of three-gene immunohistochemical panel and magnetic resonance imaging-detected extramural vascular invasion to assess prognosis in non-advanced rectal cancer patients. World J Gastroenterol 2016; 22:8576-8583. [PMID: 27784970 PMCID: PMC5064039 DOI: 10.3748/wjg.v22.i38.8576] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 08/24/2016] [Accepted: 09/14/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To identify a small, clinically applicable immunohistochemistry (IHC) panel that could be combined with magnetic resonance imaging (MRI)-detected extramural vascular invasion (EMVI) for assessment of prognosis concerning the non-advanced rectal cancer patients prior to operation.
METHODS About 329 patients with pathologically confirmed rectal carcinoma (RC) were screened in this research, all of whom had been examined via an MRI and were treatment-naïve from July 2011 to July 2014. The candidate proteins that were reported to be altered by RC were examined in tissues by IHC. All chosen samples were adopted from the fundamental cores of histopathologically confirmed carcinomas during the initial surgeries.
RESULTS Of the three proteins that were tested, c-MYC, PCNA and TIMP1 were detected with relatively significant expression in tumors, 35.9%, 23.7% and 58.7% respectively. The expression of the three proteins were closely connected with prognosis (P = 0.032, 0.003, 0.021). The patients could be classified into different outcome groups according to an IHC panel (P < 0.01) via these three proteins. Taking into consideration known survival covariates, especially EMVI, the IHC panel served as an independent prognostic factor. The EMVI combined with the IHC panel could categorize patients into different prognostic groups with distinction (P < 0.01).
CONCLUSION These studies argue that this three-protein panel of c-MYC, PCNA, coupled with TIMP1 combined with MRI-detected EMVI could offer extra prognostic details for preoperative treatment of RC.
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92
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Yu J, Xu Q, Huang DY, Song JC, Li Y, Xu LL, Shi HB. Prognostic aspects of dynamic contrast-enhanced magnetic resonance imaging in synchronous distant metastatic rectal cancer. Eur Radiol 2016; 27:1840-1847. [PMID: 27595835 DOI: 10.1007/s00330-016-4532-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 07/20/2016] [Accepted: 07/25/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To explore the correlations between DCE-MRI quantitative parameters and synchronous distant metastasis and the clinicopathological factors in rectal cancers. METHODS Sixty-three patients with rectal cancer (synchronous distant metastasis, n = 31; non-metastasis, n = 32) were enrolled in this study. Student's t test and ANOVA were used to compare DCE-MRI parameters (K trans , K ep and V e ). The receiver operating characteristic (ROC) analysis was used to find the reasonable threshold of DCE-MRI parameters to differentiate lesions with synchronous distant metastasis from those without metastasis. RESULTS The K trans , K ep , and V e value were significantly higher in the lesions with distant metastasis than in the lesions without distant metastasis (0.536 ± 0.242 vs. 0.299 ± 0.118 min-1, p < 0.001; 1.598 ± 0.477 vs. 1.341 ± 0.390 min-1, p = 0.022; and 0.324 ± 0.173 vs. 0.249 ± 0.091, p = 0.034; respectively). The K trans showed the highest AUCs of 0.788 (p < 0.001), with sensitivity of 61.29 % and specificity of 87.5 %, respectively. CONCLUSIONS DCE-MRI parameters may represent a prognostic indicator for synchronous distant metastases in patients with rectal cancer. KEY POINTS • The K trans , K ep and V e values correlated with synchronous distant metastasis. • Higher K trans , K ep and V e values were noted among patients with metastasis. • DCE-MRI parameters might represent a prognostic indicator for synchronous distant metastases.
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Affiliation(s)
- Jing Yu
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China
| | - Qing Xu
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China
| | - Dong-Ya Huang
- Department of General Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jia-Cheng Song
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China
| | - Yan Li
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China
| | - Lu-Lu Xu
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China
| | - Hai-Bin Shi
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China.
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Abstract
INTRODUCTION The treatment of rectal cancer has diversified in recent years, presenting the clinician and patient with increasingly challenging management decisions. At the heart of this decision-making process are two competing interests; more radical but more morbid treatments which optimize oncological outcome, and less radical treatments which preserve organs and function but may pose a greater risk of disease recurrence. AREAS COVERED Imaging plays a vital role informing this decision-making process, both by providing prognostic details about the cancer before the start of treatment and by updating this picture as the cancer responds or fails to respond to treatment. There is a range of available imaging modalities, each with its strengths and weaknesses. Optimizing rectal cancer treatment requires a clear understanding of the important questions that imaging needs to answer and the optimum imaging strategy. Expert Commentary: This article provides an evidence-based review of the available imaging techniques and an expert commentary on the best imaging strategy.
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Affiliation(s)
- Chris Hunter
- a Department of Colorectal Surgery , Hull and East Yorkshire NHS Trust , Hull , UK.,b Department of Surgery and Cancer , Imperial College London , London , UK
| | - Gina Brown
- b Department of Surgery and Cancer , Imperial College London , London , UK.,c Department of Academic Radiology , The Royal Marsden Hospital , Sutton , UK
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Liu L, Yang L, Jin E, Wang Z, Yang Z. Effect of gadolinium contrast-enhanced T1-weighted magnetic resonance imaging for detecting extramural venous invasion in rectal cancer. Abdom Radiol (NY) 2016; 41:1736-43. [PMID: 27125200 DOI: 10.1007/s00261-016-0740-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To evaluate the performance of gadolinium contrast-enhanced T1-weighted magnetic resonance imaging (CET1WI) in addition to high-resolution T2-weighted imaging (HRT2WI) for preoperative detection of extramural venous invasion (EMVI) in rectal cancer. METHODS Fifty-nine patients with rectal cancer who underwent preoperative MRI were included in this study. The likelihood of EMVI was retrospectively scored by two readers on CET1WI, HRT2WI, and HRT2WI + CET1WI, using a subjective five-point scale ranging from 0 to 4. The pathological status of EMVI was used as a standard reference. Diagnostic parameters, including area under the receiver operating curve (AUC), sensitivity, and specificity, were calculated, and the diagnostic performances of HRT2WI and HRT2WI + CET1WI were compared. Interobserver variance was also evaluated. RESULTS Eighteen (30.5%) patients showed pathological EMVI. During EMVI detection, reader A obtained an AUC of 0.768, sensitivity of 72.5%, and specificity of 73.2% from HRT2WI alone; after combination with CET1WI, these values improved to 0.864, 83.3%, and 75.6%, respectively. Differences in AUC between these techniques were not significant (p = 0.056). Reader B obtained an AUC of 0.833, sensitivity of 77.8%, and specificity of 73.2% from HRT2WI alone; after combination with CET1W1, these figures were adjusted to 0.720, 50%, and 78%; differences in AUC between techniques were significant (p = 0.027). Interobserver agreement during EMVI scoring was good for HRT2WI (κ = 0.603) and moderate for HRT2WI + CET1WI (κ = 0.413). CONCLUSIONS Although interobserver agreement decreased, combination of CET1WI with HRT2WI could improve EMVI detection.
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Affiliation(s)
- Liheng Liu
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Yong'an Road 95, Beijing, 100050, People's Republic of China
- Department of Radiology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, People's Republic of China
| | - Linke Yang
- Department of Pathology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, People's Republic of China
| | - Erhu Jin
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Yong'an Road 95, Beijing, 100050, People's Republic of China.
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Yong'an Road 95, Beijing, 100050, People's Republic of China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Yong'an Road 95, Beijing, 100050, People's Republic of China
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95
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Moon SJ, Cho SH, Kim GC, Kim WH, Kim HJ, Shin KM, Lee SM, Park JS, Choi GS, Kim SH. Complementary value of pre-treatment apparent diffusion coefficient in rectal cancer for predicting tumor recurrence. Abdom Radiol (NY) 2016; 41:1237-44. [PMID: 26830420 DOI: 10.1007/s00261-016-0648-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To assess the complementary prognostic value of pre-treatment tumor apparent diffusion coefficient (ADC) for the prediction of tumor recurrence in patients with rectal cancer. METHODS From March 2012 to March 2013, a total of 128 patients with mid/lower rectal cancer who underwent pre-treatment rectal MRI were enrolled in this retrospective study. Two radiologists in consensus evaluated conventional imaging features (Cimg) in pre-treatment rectal MRI: tumor height from anal verge (≤5 cm vs. >5 cm), T stage (high vs. low), the presence or absence of lymph node metastasis, mesorectal fascia invasion, and extramural venous invasion. The mean tumor ADC values (TumorADC) based on high b-value (0, 1000 × 10(-3) mm(2)/s) diffusion weight images were extracted. A multivariate Cox proportional hazard (CPH) regression was performed to evaluate the association of Cimg and TumorADC with the 3-year local recurrence (LR) rate. Predictive performance of two multivariate CPH models (Cimg only vs. Cimg + TumorADC) was compared using Harrell's c index (HCI). RESULTS TumorADC (Adjusted HR, 7.830; 95% CI 3.937-15.571) and high T stage (Adjusted HR, 8.039; 95% CI 2.405-26.874) were independently associated with the 3-year LR rate. The CPH model generated with T stage + TumorADC (HCI, 0.820; 95% CI 0.708-0.932) showed significantly higher HCI than that with T stage only (HCI, 0.742; 95% CI 0.594-0.889) (P = 0.009). CONCLUSIONS In patients with mid/lower rectal cancer, integrating TumorADC to Cimg increases predictive performance of the CPH model than that with Cimg alone for the prediction of LR within 3 years after surgery.
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Affiliation(s)
- Sung Jun Moon
- Department of Radiology, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, 807 Hoguk-ro, Buk-gu, Daegu, 702-210, Republic of Korea
| | - Seung Hyun Cho
- Department of Radiology, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, 807 Hoguk-ro, Buk-gu, Daegu, 702-210, Republic of Korea.
| | - Gab Chul Kim
- Department of Radiology, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, 807 Hoguk-ro, Buk-gu, Daegu, 702-210, Republic of Korea
| | - Won Hwa Kim
- Department of Radiology, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, 807 Hoguk-ro, Buk-gu, Daegu, 702-210, Republic of Korea
| | - Hye Jung Kim
- Department of Radiology, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, 807 Hoguk-ro, Buk-gu, Daegu, 702-210, Republic of Korea
| | - Kyung-Min Shin
- Department of Radiology, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, 807 Hoguk-ro, Buk-gu, Daegu, 702-210, Republic of Korea
| | - So Mi Lee
- Department of Radiology, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, 807 Hoguk-ro, Buk-gu, Daegu, 702-210, Republic of Korea
| | - Jun Seok Park
- Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, 807 Hoguk-ro, Buk-gu, Daegu, 702-210, Republic of Korea
| | - Gyu-Seog Choi
- Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, 807 Hoguk-ro, Buk-gu, Daegu, 702-210, Republic of Korea
| | - See Hyung Kim
- Department of Radiology, Dongsan Hospital, College of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu, 700-712, Republic of Korea
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Sclafani F, Brown G. Extramural Venous Invasion (EMVI) and Tumour Regression Grading (TRG) as Potential Prognostic Factors for Risk Stratification and Treatment Decision in Rectal Cancer. CURRENT COLORECTAL CANCER REPORTS 2016. [DOI: 10.1007/s11888-016-0319-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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MRI Detection of Extramural Venous Invasion in Rectal Cancer: Correlation With Histopathology Using Elastin Stain. AJR Am J Roentgenol 2016; 206:747-55. [PMID: 26933769 DOI: 10.2214/ajr.15.15568] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The purpose of this article is to evaluate the diagnostic performance of MRI for detection of extramural venous invasion (EMVI) compared with histopathologic analysis using elastin stain. MATERIALS AND METHODS Forty-nine patients with rectal cancer who had undergone surgical resection with preoperative MRI were identified. Thirty-seven patients had received preoperative chemoradiation therapy (CRT). Sixty-nine MRI studies were independently reviewed by two blinded radiologists for EMVI using a score of 0-4. Comparison was made with histopathologic results obtained by two pathologists reviewing the elastin-stained slides in consensus. EMVI status was also correlated with other tumoral and prognostic features on imaging and pathologic analysis. Statistical analysis was performed using Fisher exact and McNemar tests. RESULTS EMVI was present in 31% of the pathology specimens. An MRI EMVI score of 3-4 was 54% sensitive and 96% specific in detecting EMVI in veins 3 mm in diameter or larger. Inclusion of a score of 2 as positive for EMVI increased the sensitivity to 79% but decreased the specificity to 74%, with poor positive predictive value. Preoperative CRT had no significant effect on the diagnostic performance of MRI. Contrast-enhanced MRI increased reader confidence for diagnosis or exclusion of EMVI compared with T2-weighted imaging. EMVI status correlated with depth of extramural invasion and proximity to mesorectal fascia. CONCLUSION Despite an anticipated increase in sensitivity for EMVI detection by histopathologic analysis using elastin compared with H and E staining, MRI maintains a high specificity and moderate sensitivity for the detection of EMVI.
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Kim H, Myoung S, Koom WS, Kim NK, Kim MJ, Ahn JB, Hur H, Lim JS. MRI Risk Stratification for Tumor Relapse in Rectal Cancer Achieving Pathological Complete Remission after Neoadjuvant Chemoradiation Therapy and Curative Resection. PLoS One 2016; 11:e0146235. [PMID: 26730717 PMCID: PMC4701470 DOI: 10.1371/journal.pone.0146235] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 12/15/2015] [Indexed: 12/27/2022] Open
Abstract
Purpose Rectal cancer patients achieving pCR are known to have an excellent prognosis, yet no widely accepted consensus on risk stratification and post-operative management (e.g., adjuvant therapy) has been established. This study aimed to identify magnetic resonance imaging (MRI) high-risk factors for tumor relapse in pathological complete remission (pCR) achieved by rectal cancer patients who have undergone neoadjuvant concurrent chemoradiation therapy (CRT) and curative resection. Materials and Methods We analyzed 88 (male/female = 55/33, median age, 59.5 years [range 34–78]) pCR-proven rectal cancer patients who had undergone pre-CRT MRI, CRT, post-CRT MRI and curative surgery between July 2005 and December 2012. Patients were observed for post-operative tumor relapse. We analyzed the pre/post-CRT MRIs for parameters including mrT stage, mesorectal fascia (mrMRF) status, tumor volume, tumor regression grade (mrTRG), nodal status (mrN), and extramural vessel invasion (mrEMVI). We performed univariate analysis and Kaplan-Meier survival analysis. Results Post-operative tumor relapse occurred in seven patients (8.0%, n = 7/88) between 5.7 and 50.7 (median 16.8) months. No significant relevance was observed between tumor volume, volume reduction rate, mrTRG, mrT, or mrN status. Meanwhile, positive mrMRF (Ppre-CRT = 0.018, Ppre/post-CRT = 0.006) and mrEMVI (Ppre-CRT = 0.026, Ppre-/post-CRT = 0.008) were associated with higher incidence of post-operative tumor relapse. Kaplan-Meier survival analysis revealed a higher risk of tumor relapse in patients with positive mrMRF (Ppre-CRT = 0.029, Ppre-/post-CRT = 0.009) or mrEMVI (Ppre-CRT = 0.024, Ppre-/post-CRT = 0.003). Conclusion Positive mrMRF and mrEMVI status was associated with a higher risk of post-operative tumor relapse of pCR achieved by rectal cancer patients, and therefore, can be applied for risk stratification and to individualize treatment plans.
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Affiliation(s)
- Honsoul Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, 120–752, Republic of Korea
| | - Sungmin Myoung
- Department of Medical Information, Jungwon University, Goesan, 367–805, Republic of Korea
| | - Woong Sub Koom
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, 120–752, Republic of Korea
| | - Nam Kyu Kim
- Department of Surgery, Division of Colon and Rectal Surgery, Yonsei University College of Medicine, Seoul, 120–752, Republic of Korea
| | - Myeong-Jin Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, 120–752, Republic of Korea
| | - Joong Bae Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, 120–752, Republic of Korea
| | - Hyuk Hur
- Department of Surgery, Division of Colon and Rectal Surgery, Yonsei University College of Medicine, Seoul, 120–752, Republic of Korea
- * E-mail: (HH); (JSL)
| | - Joon Seok Lim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, 120–752, Republic of Korea
- * E-mail: (HH); (JSL)
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Correlation Between Magnetic Resonance Imaging–Based Evaluation of Extramural Vascular Invasion and Prognostic Parameters of T3 Stage Rectal Cancer. J Comput Assist Tomogr 2016; 40:537-42. [DOI: 10.1097/rct.0000000000000397] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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100
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Yu J, Huang DY, Li Y, Dai X, Shi HB. Correlation of standard diffusion-weighted imaging and diffusion kurtosis imaging with distant metastases of rectal carcinoma. J Magn Reson Imaging 2015; 44:221-9. [PMID: 26715111 DOI: 10.1002/jmri.25137] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 12/08/2015] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To investigate the correlation of standard diffusion-weighted imaging (DWI) and diffusion kurtosis imaging (DKI) with distant metastases of rectal carcinoma. MATERIALS AND METHODS Fifty-eight patients with rectal carcinoma (27 with distant metastasis and 31 with no metastasis) were included in this study. The apparent diffusion coefficient (ADC) value from standard DWI (b values of 0 and 1000 sec/mm(2) ), Dapp , and Kapp from DKI (b values of 0, 700, 1400, and 2000 sec/mm(2) ) were acquired with a 3.0T magnetic resonance imaging (MRI) scanner. These quantitative parameters were calculated from the entire tumors. Receiver operating characteristic curve analyses were conducted to assess the utility for discrimination of tumor with distant metastasis and those without metastasis. Parameters were compared using the independent-samples t-test. RESULTS The histogram metrics 10th percentile of Dapp (Dapp-10th ) and ADC values (ADC10th ) were significantly lower in the distant metastasis group than those without metastasis (972.5 ± 118.8 vs. 1121.3 ± 133.8 × 10(-6) mm(2) /s, P = 0.03; 809.2 ± 67.1 vs. 856.2 ± 72.1 × 10(-6) mm(2) /s, P = 0.03). Dapp-10th showed relatively higher area under the curve (AUC) (0.856 vs. 0.669, P = 0.024), and higher specificity (100% vs. 68%) than ADC10th did for differentiation of lesions with distant metastasis from those without metastasis. CONCLUSION DKI was relatively better than standard DWI in discriminating rectal carcinoma with distant metastasis from those without metastasis. J. Magn. Reson. Imaging 2016;44:221-229.
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Affiliation(s)
- Jing Yu
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Dong-Ya Huang
- Department of General Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yan Li
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xin Dai
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hai-Bin Shi
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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