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Petersen CL, Byriel MR, Shkurti J, Rafaelsen SR. Large retrorectal spindle cell sarcoma: A case report and brief review of the literature. Radiol Case Rep 2024; 19:2684-2688. [PMID: 38645943 PMCID: PMC11033112 DOI: 10.1016/j.radcr.2024.03.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/16/2024] [Accepted: 03/24/2024] [Indexed: 04/23/2024] Open
Abstract
Large retrorectal tumors are rare and often a diagnostic and surgical challenge due to their anatomical location. We report the case of a 55-year-old patient with weight loss and changed bowel habits, where digital rectal examination revealed a retrorectal mass raising suspicion of a tumor. Magnetic resonance imaging (MRI) and computed tomography (CT) showed a large retrorectal tumor and histopathology after surgical resection showed undifferentiated spindle cell sarcoma. This tumor type has not been previously reported as the etiology of large retrorectal tumors. We discuss the implications of diagnostic imaging, especially MRI, in the approach to diagnosis and surgical treatment of retrorectal tumors with reference to the scientific literature and previously reported cases of retrorectal tumors.
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Affiliation(s)
- Christian Lund Petersen
- Department of Radiology, University Hospital of Southern Denmark, Beriderbakken 4, DK-7100 Vejle, Denmark
| | - Mathias Rosenfeldt Byriel
- Department of Radiology, University Hospital of Southern Denmark, Beriderbakken 4, DK-7100 Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, J.B. Winsløwvej 19, DK-5000 Odense, Denmark
| | - Jona Shkurti
- Department of Diagnostic Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - Søren Rafael Rafaelsen
- Department of Radiology, University Hospital of Southern Denmark, Beriderbakken 4, DK-7100 Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, J.B. Winsløwvej 19, DK-5000 Odense, Denmark
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Matsumoto S, Tsuboyama T, Onishi H, Fukui H, Honda T, Wakayama T, Wang X, Matsui T, Nakamoto A, Ota T, Kiso K, Osawa K, Tomiyama N. Ultra-High-Resolution T2-Weighted PROPELLER MRI of the Rectum With Deep Learning Reconstruction: Assessment of Image Quality and Diagnostic Performance. Invest Radiol 2024; 59:479-488. [PMID: 37975732 DOI: 10.1097/rli.0000000000001047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the impact of ultra-high-resolution acquisition and deep learning reconstruction (DLR) on the image quality and diagnostic performance of T2-weighted periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) imaging of the rectum. MATERIALS AND METHODS This prospective study included 34 patients who underwent magnetic resonance imaging (MRI) for initial staging or restaging of rectal tumors. The following 4 types of oblique axial PROPELLER images perpendicular to the tumor were obtained: a standard 3-mm slice thickness with conventional reconstruction (3-CR) and DLR (3-DLR), and 1.2-mm slice thickness with CR (1.2-CR) and DLR (1.2-DLR). Three radiologists independently evaluated the image quality and tumor extent by using a 5-point scoring system. Diagnostic accuracy was evaluated in 22 patients with rectal cancer who underwent surgery after MRI without additional neoadjuvant therapy (median interval between MRI and surgery, 22 days). The signal-to-noise ratio and tissue contrast were measured on the 4 types of PROPELLER imaging. RESULTS 1.2-DLR imaging showed the best sharpness, overall image quality, and rectal and lesion conspicuity for all readers ( P < 0.01). Of the assigned scores for tumor extent, extramural venous invasion (EMVI) scores showed moderate agreement across the 4 types of PROPELLER sequences in all readers (intraclass correlation coefficient, 0.60-0.71). Compared with 3-CR imaging, the number of cases with MRI-detected extramural tumor spread was significantly higher with 1.2-DLR imaging (19.0 ± 2.9 vs 23.3 ± 0.9, P = 0.03), and the number of cases with MRI-detected EMVI was significantly increased with 1.2-CR, 3-DLR, and 1.2-DLR imaging (8.0 ± 0.0 vs 9.7 ± 0.5, 11.0 ± 2.2, and 12.3 ± 1.7, respectively; P = 0.02). For the diagnosis of histopathologic extramural tumor spread, 3-CR and 1.2-CR had significantly higher specificity than 3-DLR and 1.2-DLR imaging (0.75 and 0.78 vs 0.64 and 0.58, respectively; P = 0.02), and only 1.2-CR had significantly higher accuracy than 3-CR imaging (0.83 vs 0.79, P = 0.01). The accuracy of MRI-detected EMVI with reference to pathological EMVI was significantly lower for 3-CR and 3-DLR compared with 1.2-CR (0.77 and 0.74 vs 0.85, respectively; P < 0.01), and was not significantly different between 1.2-CR and 1.2-DLR (0.85 vs 0.80). Using any pathological venous invasion as the reference standard, the accuracy of MRI-detected EMVI was significantly the highest with 1.2-DLR, followed by 1.2-CR, 3-CR, and 3-DLR (0.71 vs 0.67 vs 0.59 vs 0.56, respectively; P < 0.01). The signal-to-noise ratio was significantly highest with 3-DLR imaging ( P < 0.05). There were no significant differences in tumor-to-muscle contrast between the 4 types of PROPELLER imaging. CONCLUSIONS Ultra-high-resolution PROPELLER T2-weighted imaging of the rectum combined with DLR improved image quality, increased the number of cases with MRI-detected extramural tumor spread and EMVI, but did not improve diagnostic accuracy with respect to pathology in rectal cancer, possibly because of false-positive MRI findings or false-negative pathologic findings.
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Affiliation(s)
- Shohei Matsumoto
- From the Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan (S.M., T.T., H.O., H.F., T.H., A.N., T.O., K.K., K.O., N.T.); MR Collaboration and Development, GE Healthcare, Tokyo, Japan (T.W.); MR Collaboration and Development, GE Healthcare, Austin, TX (X.W.); and Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan (T.M.)
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Wei Q, Chen L, Hou X, Lin Y, Xie R, Yu X, Zhang H, Wen Z, Wu Y, Liu X, Chen W. Multiparametric MRI-based radiomic model for predicting lymph node metastasis after neoadjuvant chemoradiotherapy in locally advanced rectal cancer. Insights Imaging 2024; 15:163. [PMID: 38922456 PMCID: PMC11208366 DOI: 10.1186/s13244-024-01726-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 05/16/2024] [Indexed: 06/27/2024] Open
Abstract
OBJECTIVES To construct and validate multiparametric MR-based radiomic models based on primary tumors for predicting lymph node metastasis (LNM) following neoadjuvant chemoradiotherapy (nCRT) in locally advanced rectal cancer (LARC) patients. METHODS A total of 150 LARC patients from two independent centers were enrolled. The training cohort comprised 100 patients from center A. Fifty patients from center B were included in the external validation cohort. Radiomic features were extracted from the manually segmented volume of interests of the primary tumor before and after nCRT. Feature selection was performed using multivariate logistic regression analysis. The clinical risk factors were selected via the least absolute shrinkage and selection operator method. The radiologist's assessment of LNM was performed. Eight models were constructed using random forest classifiers, including four single-sequence models, three combined-sequence models, and a clinical model. The models' discriminative performance was assessed via receiver operating characteristic curve analysis quantified by the area under the curve (AUC). RESULTS The AUCs of the radiologist's assessment, the clinical model, and the single-sequence models ranged from 0.556 to 0.756 in the external validation cohort. Among the single-sequence models, modelpost_DWI exhibited superior predictive power, with an AUC of 0.756 in the external validation set. In combined-sequence models, modelpre_T2_DWI_post had the best diagnostic performance in predicting LNM after nCRT, with a significantly higher AUC (0.831) than those of the clinical model, modelpre_T2_DWI, and the single-sequence models (all p < 0.05). CONCLUSIONS A multiparametric model that incorporates MR radiomic features before and after nCRT is optimal for predicting LNM after nCRT in LARC. CRITICAL RELEVANCE STATEMENT This study enrolled 150 LARC patients from two independent centers and constructed multiparametric MR-based radiomic models based on primary tumors for predicting LNM following nCRT, which aims to guide therapeutic decisions and predict prognosis for LARC patients. KEY POINTS The biological characteristics of primary tumors and metastatic LNs are similar in rectal cancer. Radiomics features and clinical data before and after nCRT provide complementary tumor information. Preoperative prediction of LN status after nCRT contributes to clinical decision-making.
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Affiliation(s)
- Qiurong Wei
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Ling Chen
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaoyan Hou
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yunying Lin
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Renlong Xie
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiayu Yu
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hanliang Zhang
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhibo Wen
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yuankui Wu
- Department of Medical Imaging, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xian Liu
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Weicui Chen
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
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Xiao T, Chen J, Liu Q. Management of internal iliac and obturator lymph nodes in mid-low rectal cancer. World J Surg Oncol 2024; 22:153. [PMID: 38863003 PMCID: PMC11167753 DOI: 10.1186/s12957-024-03427-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 05/27/2024] [Indexed: 06/13/2024] Open
Abstract
In rectal cancer treatment, the diagnosis and management of lateral pelvic lymph nodes (LLN) are critical for preventing local recurrence. Over time, scholars have reached a consensus: when imaging suggests LLN metastasis, combining neoadjuvant chemoradiotherapy (nCRT) with selective LLN dissection (LLND) can mitigate the risk of recurrence. Selective LLND typically encompasses lymph nodes in the internal iliac and obturator regions. Recent studies emphasize distinctions between internal iliac and obturator lymph nodes regarding prognosis and treatment outcomes, prompting the need for differentiated diagnostic and treatment approaches.
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Affiliation(s)
- Tixian Xiao
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jianan Chen
- Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, 68198, Omaha, Nebraska, USA
| | - Qian Liu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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Niu Y, Wen L, Yang Y, Zhang Y, Fu Y, Lu Q, Wang Y, Yu X, Yu X. Diagnostic performance of Node Reporting and Data System (Node-RADS) for assessing mesorectal lymph node in rectal cancer by CT. BMC Cancer 2024; 24:716. [PMID: 38862951 PMCID: PMC11165899 DOI: 10.1186/s12885-024-12487-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 06/07/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND To compare the diagnostic performance of the Node-RADS scoring system and lymph node (LN) size in preoperative LN assessment for rectal cancer (RC), and to investigate whether the selection of size as the primary criterion whereas morphology as the secondary criterion for LNs can be considered the preferred method for clinical assessment. METHODS Preoperative CT data of 146 RC patients treated with radical resection surgery were retrospectively analyzed. The Node-RADS score and short-axis diameter of size-prioritized LNs and the morphology-prioritized LNs were obtained. The correlations of Node-RADS score to the pN stage, LNM number and lymph node ratio (LNR) were investigated. The performances on assessing pathological lymph node metastasis were compared between Node-RADS score and short-axis diameter. A nomogram combined the Node-RADS score and clinical features was also evaluated. RESULTS Node-RADS score showed significant correlation with pN stage, LNM number and LNR (Node-RADS of size-prioritized LN: r = 0.600, 0.592, and 0.606; Node-RADS of morphology-prioritized LN: r = 0.547, 0.538, and 0.527; Node-RADSmax: r = 0.612, 0.604, and 0.610; all p < 0.001). For size-prioritized LN, Node-RADS achieved an AUC of 0.826, significantly superior to short-axis diameter (0.826 vs. 0.743, p = 0.009). For morphology-prioritized LN, Node-RADS exhibited an AUC of 0.758, slightly better than short-axis diameter (0.758 vs. 0.718, p = 0.098). The Node-RADS score of size-prioritized LN was significantly better than that of morphology-prioritized LN (0.826 vs. 0.758, p = 0.038). The nomogram achieved the best diagnostic performance (AUC = 0.861) than all the other assessment methods (p < 0.05). CONCLUSIONS The Node-RADS scoring system outperforms the short-axis diameter in predicting lymph node metastasis in RC. Size-prioritized LN demonstrates superior predictive efficacy compared to morphology-prioritized LN. The nomogram combined the Node-RADS score of size-prioritized LN with clinical features exhibits the best diagnostic performance. Moreover, a clear relationship was demonstrated between the Node-RADS score and the quantity-dependent pathological characteristics of LNM.
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Affiliation(s)
- Yue Niu
- Department of Diagnostic Radiology, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, Hunan, 410013, China
- Department of Diagnostic Radiology, Graduate Collaborative Training Base of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| | - Lu Wen
- Department of Diagnostic Radiology, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, Hunan, 410013, China
| | - Yanhui Yang
- Department of Diagnostic Radiology, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, Hunan, 410013, China
- Department of Diagnostic Radiology, Graduate Collaborative Training Base of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| | - Yi Zhang
- Department of Diagnostic Radiology, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, Hunan, 410013, China
- Department of Diagnostic Radiology, Graduate Collaborative Training Base of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| | - Yi Fu
- Medical department, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, Hunan, 410013, China
| | - Qiang Lu
- Department of Diagnostic Radiology, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, Hunan, 410013, China
| | - Yu Wang
- Clinical and Technical Support, Philips Healthcare, Shanghai, 200072, China
| | - Xiao Yu
- Clinical and Technical Support, Philips Healthcare, Shanghai, 200072, China
| | - Xiaoping Yu
- Department of Diagnostic Radiology, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, Hunan, 410013, China.
- Department of Diagnostic Radiology, Graduate Collaborative Training Base of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China.
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Santos R, Loft MK, Pedersen MRV. Elastography of the Male Pelvic Region-Perspectives on Malignant Lesions. Diagnostics (Basel) 2024; 14:1218. [PMID: 38928634 PMCID: PMC11202996 DOI: 10.3390/diagnostics14121218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 05/31/2024] [Accepted: 06/01/2024] [Indexed: 06/28/2024] Open
Abstract
Ultrasound elastography is widely used to assess tissue stiffness for lesion characterization, including differentiation between benign and malignant lesions. This study focuses on the use of elastography in the male pelvis, including the prostate, testicles, and rectum, by comparing elastography types (shear wave and strain). This article provides a summary of the existing literature on the use of elastography in the male pelvic region and outlines the clinical perspective. Ultrasound elastography is a good technique for evaluating and monitoring lesions in the male pelvic region.
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Affiliation(s)
- Rute Santos
- Medical Imaging and Radiotherapy Department, Coimbra Health School, Polytechnic University of Coimbra, 3045-093 Coimbra, Portugal
- H&TRC—Health & Technology Research Center, Coimbra Health School, Polytechnic University of Coimbra, 3045-093 Coimbra, Portugal
- CIPER-UC, University of Coimbra, 3004-531 Coimbra, Portugal
| | - Martina Kastrup Loft
- Department of Radiology, University Hospital of Southern Denmark, Vejle Hospital, Beriderbakken 4, 7100 Vejle, Denmark; (M.K.L.); (M.R.V.P.)
- Department of Radiology, University Hospital of Southern Denmark, Kolding Hospital, Sygehusvej 24, 6000 Kolding, Denmark
| | - Malene Roland Vils Pedersen
- Department of Radiology, University Hospital of Southern Denmark, Vejle Hospital, Beriderbakken 4, 7100 Vejle, Denmark; (M.K.L.); (M.R.V.P.)
- Department of Radiology, University Hospital of Southern Denmark, Kolding Hospital, Sygehusvej 24, 6000 Kolding, Denmark
- Department of Regional Health, Faculty of Health, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
- Discipline of Medical Imaging & Radiation Therapy, School of Medicine, University College Cork, T12 AK54 Cork, Ireland
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Lee JH, Kim N, Yu JI, Yoo GS, Park HC, Lee WY, Yun SH, Kim HC, Cho YB, Huh JW, Park YA, Shin JK, Park JO, Kim ST, Park YS, Lee J, Kang WK. Clinical outcomes of neoadjuvant chemoradiotherapy followed by total mesorectal excision in locally advanced rectal cancer with mesorectal fascia involvement. Radiat Oncol J 2024; 42:130-138. [PMID: 38946075 PMCID: PMC11215510 DOI: 10.3857/roj.2023.01032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/13/2024] [Accepted: 02/05/2024] [Indexed: 07/02/2024] Open
Abstract
PURPOSE For the treatment of locally advanced rectal cancer (LARC), research on primary lesions with mesorectal fascia (MRF) involvement is lacking. This study analyzed the clinical outcomes and efficacy of dose-escalated neoadjuvant concurrent chemoradiotherapy (NCRT) to patients with LARC involving MRF. MATERIALS AND METHODS We retrospectively reviewed 301 patients who were diagnosed with LARC involving MRF and underwent NCRT followed by total mesorectal excision (TME). Patients who received radiotherapy (RT) doses of ≤50.4 Gy were defined as the non-boost group, while ≥54.0 Gy as the boost group. Pathological tumor response and survival outcomes, including intrapelvic recurrence-free survival (IPRFS), distant metastases-free survival (DMFS) and overall survival (OS), were analyzed. RESULTS A total of 269 patients (89.4%) achieved a negative pathological circumferential resection margin and 104 (34.6%) had good pathological tumor regression grades. With a median follow-up of 32.4 months, IPRFS, DMFS, and OS rates at 5-years were 88.6%, 78.0%, and 91.2%, respectively. In the subgroup analysis by RT dose, the boost group included more advanced clinical stages of patients. For the non-boost group and boost group, 5-year IPRFS rates were 90.3% and 87.0% (p = 0.242), 5-year DMFS rates were 82.0% and 71.3% (p = 0.105), and 5-year OS rates were 93.0% and 80.6% (p = 0.439), respectively. Treatment related toxicity was comparable between the two groups (p = 0.211). CONCLUSION Although this retrospective study failed to confirm the efficacy of dose-escalated NCRT, favorable IPRFS and pathological complete response was achieved with NCRT followed by TME. Further studies combining patient customized RT dose with systemic therapies are needed.
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Affiliation(s)
- Jeong Ha Lee
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Nalee Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeong Il Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gyu Sang Yoo
- Department of Radiation Oncology, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Hee Chul Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Woo-Yong Lee
- Department of General Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seong Hyeon Yun
- Department of General Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Cheol Kim
- Department of General Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong Beom Cho
- Department of General Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung Wook Huh
- Department of General Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yoon Ah Park
- Department of General Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung Kyong Shin
- Department of General Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joon Oh Park
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung Tae Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Suk Park
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeeyun Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won Ki Kang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Custers PA, Beets GL, Bach SP, Blomqvist LK, Figueiredo N, Gollub MJ, Martling A, Melenhorst J, Ortega CD, Perez RO, Smith JJ, Lambregts DMJ, Beets-Tan RGH, Maas M. An International Expert-Based Consensus on the Definition of a Clinical Near-Complete Response After Neoadjuvant (Chemo)radiotherapy for Rectal Cancer. Dis Colon Rectum 2024; 67:782-795. [PMID: 38701503 DOI: 10.1097/dcr.0000000000003209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
BACKGROUND A variety of definitions for a clinical near-complete response after neoadjuvant (chemo) radiotherapy for rectal cancer are currently used. This variety leads to inconsistency in clinical practice, long-term outcome, and trial enrollment. OBJECTIVE The aim of this study was to reach expert-based consensus on the definition of a clinical near-complete response after (chemo) radiotherapy. DESIGN A modified Delphi process, including a systematic review, 3 surveys, and 2 meetings, was performed with an international expert panel consisting of 7 surgeons and 4 radiologists. The surveys consisted of individual features, statements, and feature combinations (endoscopy, T2-weighted MRI, and diffusion-weighted MRI). SETTING The modified Delphi process was performed in an online setting; all 3 surveys were completed online by the expert panel, and both meetings were hosted online. MAIN OUTCOME MEASURES The main outcome was to reach consensus (80% or more agreement). RESULTS The expert panel reached consensus on a 3-tier categorization of the near-complete response category based on the likelihood of the response to evolve into a clinical complete response after a longer waiting interval. The panelists agreed that a near-complete response is a temporary entity only to be used in the first 6 months after (chemo)radiotherapy. Furthermore, consensus was reached that the lymph node status should be considered when deciding on a near-complete response and that biopsies are not always needed when a near-complete response is found. No consensus was reached on whether primary staging characteristics have to be taken into account when deciding on a near-complete response. LIMITATIONS This 3-tier subcategorization is expert-based; therefore, there is no supporting evidence for this subcategorization. Also, it is unclear whether this subcategorization can be generalized into clinical practice. CONCLUSIONS Consensus was reached on the use of a 3-tier categorization of a near-complete response, which can be helpful in daily practice as guidance for treatment and to inform patients with a near-complete response on the likelihood of successful organ preservation. See Video Abstract. UN CONSENSO INTERNACIONAL BASADO EN EXPERTOS ACERCA DE LA DEFINICIN DE UNA RESPUESTA CLNICA CASI COMPLETA DESPUS DE QUIMIORADIOTERAPIA NEOADYUVANTE CONTRA EL CNCER DE RECTO ANTECEDENTES:Actualmente, se utilizan una variedad de definiciones para una respuesta clínica casi completa después de quimioradioterapia neoadyuvante contra el cáncer de recto. Esta variedad resulta en inconsistencia en la práctica clínica, los resultados a largo plazo y la inscripción en ensayos.OBJETIVO:El objetivo de este estudio fue llegar a un consenso de expertos sobre la definición de una respuesta clínica casi completa después de quimioradioterapia.DISEÑO:Se realizó un proceso Delphi modificado que incluyó una revisión sistemática, 3 encuestas y 2 reuniones con un panel internacional de expertos compuesto por siete cirujanos y 4 radiólogos. Las encuestas consistieron en características individuales, declaraciones y combinaciones de características (endoscopía, T2W-MRI y DWI).AJUSTE:El proceso Delphi modificado se realizó en un entorno en línea; el panel de expertos completó las tres encuestas en línea y ambas reuniones se realizaron en línea.PRINCIPALES MEDIDAS DE RESULTADO:El resultado principal fue llegar a un consenso (≥80% de acuerdo).RESULTADOS:El panel de expertos llegó a un consenso sobre una categorización de tres niveles de la categoría de respuesta casi completa basada en la probabilidad de que la respuesta evolucione hacia una respuesta clínica completa después de un intervalo de espera más largo. Los panelistas coincidieron en que una respuesta casi completa es una entidad temporal que sólo debe utilizarse en los primeros 6 meses después de la quimioradioterapia. Además, se llegó a un consenso en que se debe considerar el estado de los nódulos linfáticos al decidir sobre una respuesta casi completa y que no siempre se necesitan biopsias cuando se encuentra una respuesta casi completa. No se llegó a un consenso sobre si se deben tener en cuenta las características primarias de estadificación al decidir una respuesta casi completa.LIMITACIONES:Esta subcategorización de 3 niveles está basada en expertos; por lo tanto, no hay evidencia que respalde esta subcategorización. Además, no está claro si esta subcategorización puede generalizarse a la práctica clínica.CONCLUSIONES:Se alcanzó consenso sobre el uso de una categorización de 3 niveles de una respuesta casi completa que puede ser útil en la práctica diaria como guía para el tratamiento y para informar a los pacientes con una respuesta casi completa sobre la probabilidad de una preservación exitosa del órgano. (Traducción - Dr. Aurian Garcia Gonzalez).
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Affiliation(s)
- Petra A Custers
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
- GROW School for Oncology and Developmental Reproduction, Maastricht University, Maastricht, the Netherlands
| | - Geerard L Beets
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
- GROW School for Oncology and Developmental Reproduction, Maastricht University, Maastricht, the Netherlands
| | - Simon P Bach
- Department of Surgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Lennart K Blomqvist
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Department of Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Nuno Figueiredo
- Department of Surgery, Hospital Lusiadas Lisboa, Lisbon, Portugal
| | - Marc J Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York
| | - Anna Martling
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Department of Pelvic Cancer, Division of Coloproctology, Karolinska University Hospital, Stockholm, Sweden
| | - Jarno Melenhorst
- GROW School for Oncology and Developmental Reproduction, Maastricht University, Maastricht, the Netherlands
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Cinthia D Ortega
- Department of Radiology, University of São Paulo School of Medicine, São Paulo, Brazil
- Department of Radiology and Diagnostic Imaging, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Rodrigo O Perez
- Division of Colorectal Surgery, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - J Joshua Smith
- Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center, New York
| | - Doenja M J Lambregts
- GROW School for Oncology and Developmental Reproduction, Maastricht University, Maastricht, the Netherlands
- Department of Radiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Regina G H Beets-Tan
- GROW School for Oncology and Developmental Reproduction, Maastricht University, Maastricht, the Netherlands
- Department of Radiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Monique Maas
- GROW School for Oncology and Developmental Reproduction, Maastricht University, Maastricht, the Netherlands
- Department of Radiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
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Salmerón-Ruiz A, Luengo Gómez D, Medina Benítez A, Láinez Ramos-Bossini AJ. Primary staging of rectal cancer on MRI: an updated pictorial review with focus on common pitfalls and current controversies. Eur J Radiol 2024; 175:111417. [PMID: 38484688 DOI: 10.1016/j.ejrad.2024.111417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/23/2024] [Accepted: 03/06/2024] [Indexed: 10/04/2024]
Abstract
Magnetic resonance imaging (MRI) plays a pivotal role in primary staging of rectal cancer, enabling the determination of appropriate management strategies and prediction of patient outcomes. However, inconsistencies and pitfalls exist in various aspects, including rectal anatomy, MRI protocols and strategies for artifact resolution, as well as in T- and N-staging, all of which limit the diagnostic value of MRI. This narrative and pictorial review offers a comprehensive overview of factors influencing primary staging of rectal cancer and the role of MRI in assessing them. It highlights the significance of the circumferential resection margin and its relationship with the mesorectal fascia, as well as the prognostic role of extramural venous invasion and tumor deposits. Special attention is given to tumors of the lower rectum due to their complex anatomy and the challenges they pose in MRI staging. The review also addresses current controversies in rectal cancer staging and the need for personalized risk stratification. In summary, this review provides valuable insights into the role of MRI in the primary staging of rectal cancer, emphasizing key aspects for accurate assessment to enhance patient outcomes.
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Affiliation(s)
- A Salmerón-Ruiz
- Abdominal Radiology Section. Department of Radiology, Hospital Universitario Virgen de las Nieves, 18014. Granada, Spain; Advanced Medical Imaging Group (TeCe22), Instituto Biosanitario de Granada (ibs.GRANADA). 18016 Granada, Spain
| | - D Luengo Gómez
- Abdominal Radiology Section. Department of Radiology, Hospital Universitario Virgen de las Nieves, 18014. Granada, Spain; Advanced Medical Imaging Group (TeCe22), Instituto Biosanitario de Granada (ibs.GRANADA). 18016 Granada, Spain
| | - A Medina Benítez
- Abdominal Radiology Section. Department of Radiology, Hospital Universitario Virgen de las Nieves, 18014. Granada, Spain
| | - A J Láinez Ramos-Bossini
- Abdominal Radiology Section. Department of Radiology, Hospital Universitario Virgen de las Nieves, 18014. Granada, Spain; Advanced Medical Imaging Group (TeCe22), Instituto Biosanitario de Granada (ibs.GRANADA). 18016 Granada, Spain.
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Fidan M, Nural MS, Çamlıdağ İ, Yürüker SS, Meydan BC. Evaluation of treatment response by multiparametric MR imaging in locally advanced rectal tumors following neoadjuvant chemotherapy. Abdom Radiol (NY) 2024:10.1007/s00261-024-04389-3. [PMID: 38822855 DOI: 10.1007/s00261-024-04389-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/11/2024] [Accepted: 05/14/2024] [Indexed: 06/03/2024]
Abstract
PURPOSE To investigate the effectiveness of multiparametric MRI examination in determining tumor response after neoadjuvant chemoradiotherapy (CRT) in locally advanced rectal tumors. METHODS 46 patients with locally advanced rectal adenocarcinoma were included and were divided into two groups as complete responders and nonresponders based on Mandard score. On MRI, relative T2w signal intensity and ADC values obtained before and after treatment and tumour volumes in dynamic contrast enhanced images (DCI) were used to determine complete response to treatment. RESULTS There were no significant differences between mean ADC values obtained by single slice ADC and three circular ROI methods. There were significant differences between two groups in terms of Post-CRT ADC value, ΔADC and %ΔADC obtained by whole tumour volume ADC method (p < 0.05). There were significant differences between Pre-CRT and Post-CRT volume values. ΔV DCI and %ΔV DCI, ΔV ADC and T2w volume values were significantly lower in complete responders (p < 0.05). In multivariate analysis, sensitivity and specificity were calculated as 88.9% and 91.9% (AUC = 0.943) when Post-CRT mean ADC value and Post-CRT DCI volume values were used together, and sensitivity and specificity were calculated as 88.9% and 94.6% (AUC = 0.949) when ΔADC and Post-CRT DCI volume values were used together. CONCLUSION Whole tumour volume mean ADC value is the most useful method to determine treatment response. Post-CRT DCI volume measurement stands out as the most useful method in assessing complete response alone. The highest diagnostic values are achieved when the post-CRT DCI volume is combined with the ADC change value of the whole tumor volume.
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Affiliation(s)
- Murat Fidan
- Department of Radiology, Ordu Fatsa State Hospital, Evkaf, Hastane Yolu No:5, 52400, Fatsa/Ordu, Turkey
| | - Mehmet Selim Nural
- Department of Radiology, Ondokuz Mayıs University, 55210, Kurupelit/Samsun, Turkey
| | - İlkay Çamlıdağ
- Department of Radiology, Ondokuz Mayıs University, 55210, Kurupelit/Samsun, Turkey.
| | - Saim Savaş Yürüker
- Department of Radiology, Ondokuz Mayıs University, 55210, Kurupelit/Samsun, Turkey
| | - Bilge Can Meydan
- Department of Radiology, Ondokuz Mayıs University, 55210, Kurupelit/Samsun, Turkey
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Marjasuo ST, Lehtimäki TE, Koskenvuo LE, Lepistö AH. Impact of mesorectal extranodal tumor deposits in magnetic resonance imaging on outcome of rectal cancer patients. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108337. [PMID: 38657373 DOI: 10.1016/j.ejso.2024.108337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/15/2024] [Accepted: 04/09/2024] [Indexed: 04/26/2024]
Abstract
AIM Mesorectal extranodal tumor deposits (TDs) are identified in many rectal cancers. Their radiological features differ from metastatic lymph nodes, and they can be detected with magnetic resonance imaging (MRI). The purpose of this study was to determine the prevalence of rectal cancer TDs detected with MRI and their impact on overall (OS), cancer-specific (CSS), and disease-free survival (DFS) and the local recurrence rate. METHOD In this retrospective cohort study, we screened all 525 consecutive rectal cancer patients who underwent surgery during 2017-2018 in a tertiary center. Patients with synchronous metastases or who had not undergone MRI were excluded. We analyzed the OS, CSS, and DFS as well as local recurrences. RESULTS Of the 480 included patients, TDs were detected in the images of 81 (16.9 %). Extramural venous invasion (EMVI) and TDs were frequently found together (n = 50, 61.7 % of all cases with TDs). The presence of TDs alone [hazard ratio (HR) 1.66 (1.03-2.68)] or TDs and/or EMVI [HR 1.63 (1.01-2.62)] were risk factors for adverse DFS in multivariate Cox regression analysis. The OS and CSS rates were poorer among patients with TDs compared to those without, p = 0.009 and p < 0.001, respectively. TDs were also a risk factor for local recurrence in the univariate analysis. CONCLUSIONS TDs detected with imaging are a risk factor for impaired DFS and associated with impaired CSS and OS of rectal cancer patients and should be taken into consideration in clinical decision-making.
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Affiliation(s)
- Suvi T Marjasuo
- Imaging Services, Tays Central Hospital, Tampere, Finland; University of Helsinki, Helsinki, Finland.
| | | | - Laura E Koskenvuo
- Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Anna H Lepistö
- Department of Surgery, Helsinki University Hospital and University of Helsinki, Finland; Applied Tumor Genomics, Research Programs Unit Organization, University of Helsinki, Helsinki, Finland
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Torri GB, Wiethan CP, Langer FW, de Oliveira GS, Meirelles AVB, Horvat N, Tse JR, Dias AB, Altmayer S. Split scar sign to predict complete response in rectal cancer after neoadjuvant chemoradiotherapy: systematic review and meta-analysis. Eur Radiol 2024; 34:3874-3881. [PMID: 37979009 PMCID: PMC11166750 DOI: 10.1007/s00330-023-10447-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/23/2023] [Accepted: 10/29/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES Magnetic resonance imaging (MRI) is the modality of choice for rectal cancer initial staging and restaging after neoadjuvant chemoradiation. Our objective was to perform a meta-analysis of the diagnostic performance of the split scar sign (SSS) on rectal MRI in predicting complete response after neoadjuvant therapy. METHODS MEDLINE, EMBASE, and Cochrane databases were searched for relevant published studies through June 2023. Primary studies met eligibility criteria if they evaluated the diagnostic performance of the SSS to predict complete response on pathology or clinical follow-up in patients undergoing neoadjuvant chemoradiation. A meta-analysis with a random-effects model was used to estimate pooled sensitivity and specificity, area under the curve (AUC), and diagnostic odds ratio (DOR) of the SSS. RESULTS A total of 4 studies comprising 377 patients met the inclusion criteria. The prevalence of complete response in the studies was 21.7-52.5%. The pooled sensitivity and specificity of the SSS to predict complete response were 62.0% (95% CI, 43.5-78.5%) and 91.9% (95% CI, 78.9-97.2%), respectively. The estimated AUC for SSS was 0.83 (95% CI, 0.56-0.94) with a DOR of 18.8 (95% CI, 3.65-96.5). CONCLUSION The presence of SSS on rectal MRI demonstrated high specificity for complete response in patients with rectal cancer after neoadjuvant chemoradiation. This imaging pattern can be a valuable tool to identify potential candidates for organ-sparing treatment and surveillance. CLINICAL RELEVANCE STATEMENT SSS presents high specificity for complete response post-neoadjuvant. This MRI finding enhances rectal cancer treatment assessment and aids clinicians and patients in choosing watch-and-wait over immediate surgery, which can potentially reduce costs and associated morbidity. KEY POINTS •Fifteen to 50% of rectal cancer patients achieve complete response after neoadjuvant chemoradiation and may be eligible for a watch-and-wait strategy. •The split scar sign has high specificity for a complete response. •This imaging finding is valuable to select candidates for organ-sparing management.
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Affiliation(s)
- Giovanni Brondani Torri
- Department of Radiology and Diagnostic Imaging, University Hospital of Santa Maria, Federal University of Santa Maria, Santa Maria, Rio Grande Do Sul, 97105-900, Brazil
| | - Camila Piovesan Wiethan
- Department of Radiology and Diagnostic Imaging, University Hospital of Santa Maria, Federal University of Santa Maria, Santa Maria, Rio Grande Do Sul, 97105-900, Brazil
| | - Felipe Welter Langer
- Department of Radiology and Diagnostic Imaging, University Hospital of Santa Maria, Federal University of Santa Maria, Santa Maria, Rio Grande Do Sul, 97105-900, Brazil
| | | | - Alice Villa Bella Meirelles
- Clinics Hospital, Federal University of Minas Gerais, Av. Prof. Alfredo Balena, 110 - Santa Efigênia, Belo Horizonte, 30130-100, Brazil
| | - Natally Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Justin Ruey Tse
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305-5105, USA
| | - Adriano Basso Dias
- Department of Medical Imaging, University of Toronto, 263 McCaul Street, 4Th Floor, Toronto, ON, M5T 1W7, Canada
| | - Stephan Altmayer
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305-5105, USA.
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El Homsi M, Bercz A, Chahwan S, Fernandes MC, Javed-Tayyab S, Golia Pernicka JS, Nincevic J, Paroder V, Ruby L, Smith JJ, Petkovska I. Watch & wait - Post neoadjuvant imaging for rectal cancer. Clin Imaging 2024; 110:110166. [PMID: 38669916 PMCID: PMC11090716 DOI: 10.1016/j.clinimag.2024.110166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/15/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024]
Abstract
Rectal cancer management has evolved over the past decade with the emergence of total neoadjuvant therapy (TNT). For select patients who achieve a clinical complete response following TNT, organ preservation by means of the watch-and-wait (WW) strategy is an increasingly adopted alternative that preserves rectal function and quality of life without compromising oncologic outcomes. Recently, published 5-year results from the OPRA trial demonstrated that organ preservation can be achieved in approximately half of patients managed with the WW strategy, with most local regrowth events occurring within two years. Considering the potential for local regrowth, the implementation of the WW strategy mandates rigorous clinical and radiographic surveillance. Magnetic resonance imaging (MRI) serves as the conventional imaging modality for local staging and surveillance of rectal cancer given its excellent soft-tissue resolution. This review will discuss the current evidence for the WW strategy and the role of restaging rectal MRI in determining patient eligibility for this strategy. Restaging rectal MRI acquisition parameters and treatment response assessment, including important factors to assess, pitfalls, and classification systems, will be discussed in the context of the WW strategy.
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Affiliation(s)
- Maria El Homsi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Aron Bercz
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Stephanie Chahwan
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Maria Clara Fernandes
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Sidra Javed-Tayyab
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Jennifer S Golia Pernicka
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Josip Nincevic
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Viktoriya Paroder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Lisa Ruby
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - J Joshua Smith
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Iva Petkovska
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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Geffen EGMV, Nederend J, Sluckin TC, Hazen SMJA, Horsthuis K, Beets-Tan RGH, Marijnen CAM, Tanis PJ, Kusters M. Prognostic significance of MRI-detected extramural venous invasion according to grade and response to neo-adjuvant treatment in locally advanced rectal cancer A national cohort study after radiologic training and reassessment. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108307. [PMID: 38581757 DOI: 10.1016/j.ejso.2024.108307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/20/2024] [Accepted: 03/23/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Detection of grade 3-4 extra mural venous invasion (mrEMVI) on magnetic resonance imaging (MRI) is associated with an increased distant metastases (DM)-rate. This study aimed to determine the impact of different grades of mrEMVI and their disappearance after neoadjuvant therapy. METHODS A Dutch national retrospective cross-sectional study was conducted, including patients who underwent resection for rectal cancer in 2016 from 60/69 hospitals performing rectal surgery. Patients with a cT3-4 tumour ≤8 cm from the anorectal junction were selected and their MRI-scans were reassessed by trained abdominal radiologists. Positive mrEMVI grades (3 and 4) were analyzed in regard to 4-year local recurrence (LR), DM, disease-free survival (DFS) and overall survival (OS). RESULTS The 1213 included patients had a median follow-up of 48 months (IQR 30-54). Positive mrEMVI was present in 324 patients (27%); 161 had grade 3 and 163 had grade 4. A higher mrEMVI stage (grade 4 vs grade 3 vs no mrEMVI) increased LR-risk (21% vs 18% vs 7%, <0.001) and DM-risk (49% vs 30% vs 21%, p < 0.001) and decreased DFS (42% vs 55% vs 69%, p < 0.001) and OS (62% vs 76% vs 81%, p < 0.001), which remained independently associated in multivariable analysis. When mrEMVI had disappeared on restaging MRI, DM-rate was comparable to initial absence of mrEMVI (both 26%), whereas LR-rate remained high (22% vs 9%, p = 0.006). CONCLUSION The negative oncological impact of mrEMVI on recurrence and survival rates was dependent on grading. Disappearance of mrEMVI on restaging MRI decreased the risk of DM, but not of LR.
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Affiliation(s)
- Eline G M van Geffen
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Surgery, De Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam, Treatment and Quality of Life and Imaging and Biomarkers, Amsterdam, the Netherlands
| | - Joost Nederend
- Catharina Hospital, Department of Radiology, Michelangelolaan 2, Eindhoven, the Netherlands
| | - Tania C Sluckin
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Surgery, De Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam, Treatment and Quality of Life and Imaging and Biomarkers, Amsterdam, the Netherlands
| | - Sanne-Marije J A Hazen
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Surgery, De Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam, Treatment and Quality of Life and Imaging and Biomarkers, Amsterdam, the Netherlands
| | - Karin Horsthuis
- Cancer Center Amsterdam, Treatment and Quality of Life and Imaging and Biomarkers, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Radiology and Nuclear Medicine, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Regina G H Beets-Tan
- The Netherlands Cancer Institute, Department of Radiology, Plesmanlaan 121, Amsterdam, the Netherlands; GROW School for Oncology and Developmental Biology, University of Maastricht, Universiteitssingel 40, Maastricht, the Netherlands; Department of Radiology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Campusvej 55, DK-5230, Odense, Denmark
| | - Corrie A M Marijnen
- LUMC, Department of Radiation Oncology, Albinusdreef 2, Leiden, the Netherlands; The Netherlands Cancer Institute, Department of Radiation Oncology, Plesmanlaan 121, Amsterdam, the Netherlands
| | - Pieter J Tanis
- Cancer Center Amsterdam, Treatment and Quality of Life and Imaging and Biomarkers, Amsterdam, the Netherlands; Amsterdam UMC Location University of Amsterdam, Department of Surgery, Meibergdreef 9, Amsterdam, the Netherlands; Erasmus MC, Department of Surgical Oncology and Gastrointestinal Surgery, Rotterdam, the Netherlands
| | - Miranda Kusters
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Surgery, De Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam, Treatment and Quality of Life and Imaging and Biomarkers, Amsterdam, the Netherlands.
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Akgül Ö, Martlı HF, Göktaş A, Pak MA, Tez M. Comparison of preoperative magnetic resonance imaging with postoperative pathology results in rectal cancer patients undergoing neoadjuvant therapy. ANZ J Surg 2024; 94:1133-1137. [PMID: 38345184 DOI: 10.1111/ans.18890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/13/2024] [Accepted: 01/18/2024] [Indexed: 06/19/2024]
Abstract
BACKGROUND Locally advanced rectal cancer often requires neoadjuvant treatment (NAT) before surgical intervention. This study aimed to assess the concordance between preoperative magnetic resonance imaging (MRI) findings and postoperative pathology results after NAT in rectal cancer patients. METHOD A retrospective analysis of 52 patients who underwent NAT and subsequent surgery at Ankara Bilkent City Hospital between May 2019 and May 2023 was conducted. Demographics, preoperative MRIs, time intervals between NAT, MRI, and surgery, and postoperative pathology were assessed. RESULTS The median age of the cohort was 59 years, with a male predominance (76.9%). Tumour T stage (κ = 0.157), lymph node stage (κ = 0.138), and circumferential resection margin (κ = 0.138) concordance showed poor agreement between post-neoadjuvant treatment (PNT) MRI and pathology. PNT MRI demonstrated a limited correlation with postoperative pathology. CONCLUSIONS While preoperative MRI is commonly used for restaging after NAT in rectal cancer, our study highlights its limited concordance with postoperative pathology. The sensitivity and specificity metrics, although reported in the literature, should be interpreted alongside concordance assessments for a comprehensive evaluation.
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Affiliation(s)
- Özgür Akgül
- Department of Surgery, University of Health Sciences, Ankara City Hospital, Çankaya, Ankara, Turkey
| | - Hüseyin Fahri Martlı
- Department of Surgery, University of Health Sciences, Ankara City Hospital, Çankaya, Ankara, Turkey
| | - Abidin Göktaş
- Department of Surgery, University of Health Sciences, Ankara City Hospital, Çankaya, Ankara, Turkey
| | - Mehmet Ali Pak
- Department of Surgery, University of Health Sciences, Ankara City Hospital, Çankaya, Ankara, Turkey
| | - Mesut Tez
- Department of Surgery, University of Health Sciences, Ankara City Hospital, Çankaya, Ankara, Turkey
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Shao Z, Xu Y, Zhang X, Zou C, Xie R. Changes in serum uric acid, serum uric acid/serum creatinine ratio, and gamma-glutamyltransferase might predict the efficacy of neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer. Strahlenther Onkol 2024; 200:523-534. [PMID: 37286741 DOI: 10.1007/s00066-023-02096-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 04/23/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE The purpose of this study was to investigate the predictive value of changes in serum uric acid (SUA), the ratio of serum uric acid to serum creatinine (SUA/SCr), and serum gamma-glutamyltransferase (GGT) from before to after therapy in patients with locally advanced rectal cancer (LARC). METHODS Data from 114 LARC patients from January 2016 to December 2021 were included in this retrospective study. All patients received neoadjuvant chemoradiotherapy (nCRT) and total mesorectal excision (TME). The change in SUA was calculated as a ratio: (SUA level after nCRT-SUA level before nCRT)/SUA level before nCRT. The change ratios of SUA/SCr and GGT were calculated in the same way. The efficacy of nCRT was evaluated by magnetic resonance (MR) and postoperative pathological response. A nonlinear model was used to evaluate whether the change ratios of SUA, SUA/SCr, and GGT were associated with the efficacy of nCRT. The predictive power of the change ratios of SUA, SUA/SCr, and GGT was assessed by receiver operating characteristic (ROC) curves. Univariate and multivariate Cox regression analyses were employed to measure the associations between disease-free survival (DFS) and other predictive indicators. The Kaplan-Meier method was used to further compare DFS between groups. RESULTS The nonlinear model indicated that the change ratios of SUA, SUA/SCr, and GGT were associated with the efficacy of nCRT. The change ratios of SUA, SUA/SCr, and GGT were used to predict the area under the ROC curve of efficacy for nCRT (0.95, 0.91-0.99), which was better than the prediction by the change ratio of SUA (0.94, 0.89-0.99), SUA/SCr (0.90, 0.84-0.96), or GGT alone (0.86, 0.79-0.93; p < 0.05). The optimal cut-off values of SUA, SUA/SCr, and GGT change were 0.02, 0.01, and 0.04, respectively. The Kaplan-Meier method indicated that patients with SUA, SUA/SCr, or GGT changes greater than the cut-off values had shorter DFS (p < 0.05). CONCLUSION Change ratios of SUA, SUA/SCr, or GGT greater than the cut-off values implied a risk of poor pathological response after nCRT and shorter DFS in LARC patients.
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Affiliation(s)
- Zhenyong Shao
- Department of Radiotherapy, The First Affiliated Hospital of Wenzhou Medical University, 325000, Wenzhou, China
| | - Yuyan Xu
- Department of Radiotherapy, The First Affiliated Hospital of Wenzhou Medical University, 325000, Wenzhou, China
| | - Xuebang Zhang
- Department of Radiotherapy, The First Affiliated Hospital of Wenzhou Medical University, 325000, Wenzhou, China
| | - Changlin Zou
- Department of Radiotherapy, The First Affiliated Hospital of Wenzhou Medical University, 325000, Wenzhou, China.
| | - Raoying Xie
- Department of Radiotherapy, The First Affiliated Hospital of Wenzhou Medical University, 325000, Wenzhou, China.
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Peng L, Wang D, Zhuang Z, Chen X, Xue J, Zhu H, Zhang L. Preoperative Noninvasive Evaluation of Tumor Budding in Rectal Cancer Using Multiparameter MRI Radiomics. Acad Radiol 2024; 31:2334-2345. [PMID: 38135624 DOI: 10.1016/j.acra.2023.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 12/24/2023]
Abstract
RATIONALE AND OBJECTIVES To assess the value of a multiparametric magnetic resonance imaging (MRI)-based model integrating radiomics features with clinical and MRI semantic features for preoperative evaluation of tumor budding (TB) in rectal cancer. MATERIALS AND METHODS A total of 120 patients with pathologically confirmed rectal cancer were retrospectively analyzed. The patients were randomized into training and validation cohorts in a 6:4 ratio. Radiomics features were extracted and selected from preoperative T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and contrast-enhanced T1-weighted imaging (T1CE) sequences, after which the corresponding radiomics score (RS) was calculated, and the radiomics models (T2WI model, DWI model, and T1CE model) were constructed. Logistic regression analysis was selected to develop a combined model integrated RST2WI, RSDWI, RST1CE, and clinical and MRI semantic features. The efficacy of each model in diagnosing TB grade was observed by the receiver operating characteristic (ROC) curve. Decision curve analysis (DCA) was used to assess the clinical benefits of the models. RESULTS Seven features were extracted and selected from each T2WI, DWI, and T1CE sequence to calculate the corresponding RS and construct the corresponding radiomics model. MRI reported N stage was an independent risk factor for TB. The area under the ROC curve of the combined model was 0.961 and 0.891 in the training and validation cohorts, respectively. The combined model showed better performance than the other models. DCA showed that the net benefit of the combined model was better than that of the other models in the vast majority of threshold probabilities. CONCLUSION A combined model integrating radiomics features and MRI semantic features allows for noninvasive preoperative evaluation of TB grading in patients with rectal cancer.
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Affiliation(s)
- Lin Peng
- Department of Medical Imaging, The Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, China (L.P., D.W., Z.Z., H.Z., L.Z.)
| | - Dongqing Wang
- Department of Medical Imaging, The Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, China (L.P., D.W., Z.Z., H.Z., L.Z.); School of Medicine, Jiangsu University, Zhenjiang, 212001, China (D.W., X.C., J.X.)
| | - Zijian Zhuang
- Department of Medical Imaging, The Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, China (L.P., D.W., Z.Z., H.Z., L.Z.)
| | - Xingchi Chen
- School of Medicine, Jiangsu University, Zhenjiang, 212001, China (D.W., X.C., J.X.)
| | - Jing Xue
- School of Medicine, Jiangsu University, Zhenjiang, 212001, China (D.W., X.C., J.X.)
| | - Haitao Zhu
- Department of Medical Imaging, The Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, China (L.P., D.W., Z.Z., H.Z., L.Z.)
| | - Lirong Zhang
- Department of Medical Imaging, The Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, China (L.P., D.W., Z.Z., H.Z., L.Z.).
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Zhuang Z, Zhang Y, Yang X, Deng X, Wang Z. T2WI-based texture analysis predicts preoperative lymph node metastasis of rectal cancer. Abdom Radiol (NY) 2024; 49:2008-2016. [PMID: 38411692 DOI: 10.1007/s00261-024-04209-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/31/2023] [Accepted: 01/07/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND To prospectively develop and validate the T2WI texture analysis model based on a node-by-node comparison for improving the diagnostic accuracy of lymph node metastasis (LNM) in rectal cancer. METHODS A total of 381 histopathologically confirmed lymph nodes (LNs) were collected. LNs texture features were extracted from MRI-T2WI. Spearman's rank correlation coefficient and the least absolute shrinkage and selection operator were used for feature selection to construct the LN rad-score. Then the clinical risk factors and LN texture features were combined to establish combined predictive model. Model performance was assessed by the area under the receiver operating characteristic (ROC) curve (AUC). Decision curve analysis (DCA) and nomogram were used to evaluate the clinical application of the model. RESULTS A total of 107 texture features were extracted from LN-MRI images. After selection and dimensionality reduction, the radiomics prediction model consisting of 8 texture features showed well-predictive performance in the training and validation cohorts (AUC, 0.676; 95% CI 0.582-0.771) (AUC, 0.774; 95% CI 0.648-0.899). A clinical-radiomics prediction model with the best performance was created by combining clinical and radiomics features, 0.818 (95% CI 0.742-0.893) for the training and 0.922 (95% CI 0.863-0.980) for the validation cohort. The LN Rad-score in clinical-radiomics nomogram obtained the highest classification contribution and was well calibrated. DCA demonstrated the superiority of the clinical-radiomics model. CONCLUSION The lymph node T2WI-based texture features can help to improve the preoperative prediction of LNM.
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Affiliation(s)
- Zixuan Zhuang
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan Province, China.
| | - Yang Zhang
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan Province, China
| | - Xuyang Yang
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan Province, China
| | - Xiangbing Deng
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan Province, China
| | - Ziqiang Wang
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan Province, China
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Li Q, Hong R, Zhang P, Hou L, Bao H, Bai L, Zhao J. A clinical-radiomics nomogram based on spectral CT multi-parameter images for preoperative prediction of lymph node metastasis in colorectal cancer. Clin Exp Metastasis 2024:10.1007/s10585-024-10293-3. [PMID: 38767757 DOI: 10.1007/s10585-024-10293-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 05/06/2024] [Indexed: 05/22/2024]
Abstract
To develop a clinical-radiomics nomogram based on spectral CT multi-parameter images for predicting lymph node metastasis in colorectal cancer. A total of 76 patients with colorectal cancer and 156 lymph nodes were included. The clinical data of the patients were collected, including gender, age, tumor location and size, preoperative tumor markers, etc. Three sets of conventional images in the arterial, venous, and delayed phases were obtained, and six sets of spectral images were reconstructed using the arterial phase spectral data, including virtual monoenergetic images (40 keV, 70 keV, 100 keV), iodine density maps, iodine no water maps, and virtual non-contrast images. Radiomics features of lymph nodes were extracted from the above images, respectively. Univariate analysis and least absolute shrinkage and selection operator (LASSO) regression were used to select features. A clinical model was constructed based on age and carcinoembryonic antigen (CEA) levels. The radiomics features selected were used to generate a composed radiomics signature (Com-RS). A nomogram was developed using age, CEA, and the Com-RS. The models' prediction efficiency, calibration, and clinical application value were evaluated by the area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis, respectively. The nomogram outperforms the clinical model and the Com-RS (AUC = 0.879, 0.824). It is well calibrated and has great clinical application value. This study developed a clinical-radiomics nomogram based on spectral CT multi-parameter images, which can be used as an effective tool for preoperative personalized prediction of lymph node metastasis in colorectal cancer.
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Affiliation(s)
- Qian Li
- Department of Radiology, The Third Hospital of Hebei Medical University, Ziqiang Road, Shijiazhuang, 050000, Hebei, China
| | - Rui Hong
- Department of Radiology, The Third Hospital of Hebei Medical University, Ziqiang Road, Shijiazhuang, 050000, Hebei, China
| | - Ping Zhang
- Department of Radiology, The Third Hospital of Hebei Medical University, Ziqiang Road, Shijiazhuang, 050000, Hebei, China
| | - Liting Hou
- Department of Radiology, The Third Hospital of Hebei Medical University, Ziqiang Road, Shijiazhuang, 050000, Hebei, China
| | - Hailun Bao
- Department of Radiology, The Third Hospital of Hebei Medical University, Ziqiang Road, Shijiazhuang, 050000, Hebei, China
| | - Lin Bai
- Department of Radiology, The Third Hospital of Hebei Medical University, Ziqiang Road, Shijiazhuang, 050000, Hebei, China.
| | - Jian Zhao
- Department of Radiology, The Third Hospital of Hebei Medical University, Ziqiang Road, Shijiazhuang, 050000, Hebei, China.
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Ye YX, Yang L, Kang Z, Wang MQ, Xie XD, Lou KX, Bao J, Du M, Li ZX. Magnetic resonance imaging-based lymph node radiomics for predicting the metastasis of evaluable lymph nodes in rectal cancer. World J Gastrointest Oncol 2024; 16:1849-1860. [PMID: 38764830 PMCID: PMC11099437 DOI: 10.4251/wjgo.v16.i5.1849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/23/2024] [Accepted: 03/04/2024] [Indexed: 05/09/2024] Open
Abstract
BACKGROUND Lymph node (LN) staging in rectal cancer (RC) affects treatment decisions and patient prognosis. For radiologists, the traditional preoperative assessment of LN metastasis (LNM) using magnetic resonance imaging (MRI) poses a challenge. AIM To explore the value of a nomogram model that combines Conventional MRI and radiomics features from the LNs of RC in assessing the preoperative metastasis of evaluable LNs. METHODS In this retrospective study, 270 LNs (158 nonmetastatic, 112 metastatic) were randomly split into training (n = 189) and validation sets (n = 81). LNs were classified based on pathology-MRI matching. Conventional MRI features [size, shape, margin, T2-weighted imaging (T2WI) appearance, and CE-T1-weighted imaging (T1WI) enhancement] were evaluated. Three radiomics models used 3D features from T1WI and T2WI images. Additionally, a nomogram model combining conventional MRI and radiomics features was developed. The model used univariate analysis and multivariable logistic regression. Evaluation employed the receiver operating characteristic curve, with DeLong test for comparing diagnostic performance. Nomogram performance was assessed using calibration and decision curve analysis. RESULTS The nomogram model outperformed conventional MRI and single radiomics models in evaluating LNM. In the training set, the nomogram model achieved an area under the curve (AUC) of 0.92, which was significantly higher than the AUCs of 0.82 (P < 0.001) and 0.89 (P < 0.001) of the conventional MRI and radiomics models, respectively. In the validation set, the nomogram model achieved an AUC of 0.91, significantly surpassing 0.80 (P < 0.001) and 0.86 (P < 0.001), respectively. CONCLUSION The nomogram model showed the best performance in predicting metastasis of evaluable LNs.
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Affiliation(s)
- Yong-Xia Ye
- Department of Radiology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing 210011, Jiangsu Province, China
| | - Liu Yang
- Department of Colorectal Surgery, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research and The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210000, Jiangsu Province, China
| | - Zheng Kang
- Department of Radiology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing 210011, Jiangsu Province, China
| | - Mei-Qin Wang
- Department of Radiology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing 210011, Jiangsu Province, China
| | - Xiao-Dong Xie
- Department of Radiology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing 210011, Jiangsu Province, China
| | - Ke-Xin Lou
- Department of Pathology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing 210011, Jiangsu Province, China
| | - Jun Bao
- Colorectal Center, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing 210011, Jiangsu Province, China
| | - Mei Du
- Department of Radiology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing 210011, Jiangsu Province, China
| | - Zhe-Xuan Li
- Department of Radiology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing 210011, Jiangsu Province, China
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Smith HG, Nilsson PJ, Shogan BD, Harji D, Gambacorta MA, Romano A, Brandl A, Qvortrup C. Neoadjuvant treatment of colorectal cancer: comprehensive review. BJS Open 2024; 8:zrae038. [PMID: 38747103 PMCID: PMC11094476 DOI: 10.1093/bjsopen/zrae038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/12/2024] [Accepted: 03/21/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Neoadjuvant therapy has an established role in the treatment of patients with colorectal cancer. However, its role continues to evolve due to both advances in the available treatment modalities, and refinements in the indications for neoadjuvant treatment and subsequent surgery. METHODS A narrative review of the most recent relevant literature was conducted. RESULTS Short-course radiotherapy and long-course chemoradiotherapy have an established role in improving local but not systemic disease control in patients with rectal cancer. Total neoadjuvant therapy offers advantages over short-course radiotherapy and long-course chemoradiotherapy, not only in terms of increased local response but also in reducing the risk of systemic relapses. Non-operative management is increasingly preferred to surgery in patients with rectal cancer and clinical complete responses but is still associated with some negative impacts on functional outcomes. Neoadjuvant chemotherapy may be of some benefit in patients with locally advanced colon cancer with proficient mismatch repair, although patient selection is a major challenge. Neoadjuvant immunotherapy in patients with deficient mismatch repair cancers in the colon or rectum is altering the treatment paradigm for these patients. CONCLUSION Neoadjuvant treatments for patients with colon or rectal cancers continue to evolve, increasing the complexity of decision-making for patients and clinicians alike. This review describes the current guidance and most recent developments.
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Affiliation(s)
- Henry G Smith
- Abdominalcenter K, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Per J Nilsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Dept. of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Benjamin D Shogan
- Department of Surgery, The University of Chicago Medicine, Chicago, Illinois, USA
| | - Deena Harji
- Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Maria Antonietta Gambacorta
- Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
- Dipartimento di Scienze Radiologiche ed Ematologiche, Universita Cattolica del Sacro Cuore, Rome, Italy
| | - Angela Romano
- Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - Andreas Brandl
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Camilla Qvortrup
- Department of Oncology, Rigshospital, University of Copenhagen, Copenhagen, Denmark
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Rutgers ML, Burghgraef TA, Hol JC, Crolla RM, van Geloven NA, Leijtens JW, Polat F, Pronk A, Smits AB, Tuyman JB, Verdaasdonk EG, Sietses C, Consten EC, Hompes R. Total mesorectal excision in MRI-defined low rectal cancer: multicentre study comparing oncological outcomes of robotic, laparoscopic and transanal total mesorectal excision in high-volume centres. BJS Open 2024; 8:zrae029. [PMID: 38788679 PMCID: PMC11126316 DOI: 10.1093/bjsopen/zrae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND The routine use of MRI in rectal cancer treatment allows the use of a strict definition for low rectal cancer. This study aimed to compare minimally invasive total mesorectal excision in MRI-defined low rectal cancer in expert laparoscopic, transanal and robotic high-volume centres. METHODS All MRI-defined low rectal cancer operated on between 2015 and 2017 in 11 Dutch centres were included. Primary outcomes were: R1 rate, total mesorectal excision quality and 3-year local recurrence and survivals (overall and disease free). Secondary outcomes included conversion rate, complications and whether there was a perioperative change in the preoperative treatment plan. RESULTS Of 1071 eligible rectal cancers, 633 patients with low rectal cancer were identified. Quality of the total mesorectal excision specimen (P = 0.337), R1 rate (P = 0.107), conversion (P = 0.344), anastomotic leakage rate (P = 0.942), local recurrence (P = 0.809), overall survival (P = 0.436) and disease-free survival (P = 0.347) were comparable among the centres. The laparoscopic centre group had the highest rate of perioperative change in the preoperative treatment plan (10.4%), compared with robotic expert centres (5.2%) and transanal centres (2.1%), P = 0.004. The main reason for this change was stapling difficulty (43%), followed by low tumour location (29%). Multivariable analysis showed that laparoscopic surgery was the only independent risk factor for a change in the preoperative planned procedure, P = 0.024. CONCLUSION Centres with expertise in all three minimally invasive total mesorectal excision techniques can achieve good oncological resection in the treatment of MRI-defined low rectal cancer. However, compared with robotic expert centres and transanal centres, patients treated in laparoscopic centres have an increased risk of a change in the preoperative intended procedure due to technical limitations.
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Affiliation(s)
- Marieke L Rutgers
- Department of Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Thijs A Burghgraef
- Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands
- Department of Surgery, University Medical Centre, Groningen, The Netherlands
| | - Jeroen C Hol
- Department of Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
- Department of Surgery, Hospital Gelderse Vallei, Ede, The Netherlands
| | - Rogier M Crolla
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
| | | | - Jeroen W Leijtens
- Department of Surgery, Laurentius Hospital, Roermond, The Netherlands
| | - Fatih Polat
- Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Apollo Pronk
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - Anke B Smits
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Jurriaan B Tuyman
- Department of Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | | | - Colin Sietses
- Department of Surgery, Hospital Gelderse Vallei, Ede, The Netherlands
| | - Esther C Consten
- Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands
- Department of Surgery, University Medical Centre, Groningen, The Netherlands
| | - Roel Hompes
- Department of Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
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Viktil E, Hanekamp BA, Nesbakken A, Løberg EM, Sjo OH, Negård A, Dormagen JB, Schulz A. Early rectal cancer: The diagnostic performance of MRI supplemented with a rectal micro-enema and a modified staging system to identify tumors eligible for local excision. Acta Radiol Open 2024; 13:20584601241241523. [PMID: 38645439 PMCID: PMC11027598 DOI: 10.1177/20584601241241523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2024] [Accepted: 03/08/2024] [Indexed: 04/23/2024] Open
Abstract
Background In staging early rectal cancers (ERC), submucosal tumor depth is one of the most important features determining the possibility of local excision (LE). The micro-enema (Bisacodyl) induces submucosal edema and may hypothetically improve the visualization of tumor depth. Purpose To test the diagnostic performance of MRI to identify ERC suitable for LE when adding a pre-procedural micro-enema and concurrent use of a modified classification system. Material and Methods In this prospective study, we consecutively included 73 patients with newly diagnosed rectal tumors. Two experienced radiologists independently interpreted the MRI examinations, and diagnostic performance was calculated for local tumors eligible for LE (Tis-T1sm2, n = 43) and non-local tumors too advanced for LE (T1sm3-T3b, n = 30). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were registered for each reader. Inter- and intra-reader agreements were assessed by kappa statistics. Lymph node status was derived from the clinical MRI reports. Results Reader1/reader2 achieved sensitivities of 93%/86%, specificities of 90%/83%, PPV of 93%/88%, and NPV of 90%/81%, respectively, for identifying tumors eligible for LE. Rates of overstaging of local tumors were 7% and 14% for the two readers, and kappa values for the inter- and intra-reader agreement were 0.69 and 0.80, respectively. For tumors ≤T2, all metastatic lymph nodes were smaller than 3 mm on histopathology. Conclusion MRI after a rectal micro-enema and concurrent use of a modified staging system achieved good diagnostic performance to identify tumors suitable for LE. The rate of overstaging of local tumors was comparable to results reported in previous endorectal ultrasound (ERUS) studies.
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Affiliation(s)
- Ellen Viktil
- Department of Radiology and Nuclear Medicine, Oslo University Hospital – Ullevål Hospital, Oslo, Norway
- Institution of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bettina Andrea Hanekamp
- Department of Radiology and Nuclear Medicine, Oslo University Hospital – Ullevål Hospital, Oslo, Norway
- Institution of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Arild Nesbakken
- Institution of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Gastrointestinal Surgery, Oslo University Hospital – Ullevål Hospital, Oslo, Norway
| | - Else Marit Løberg
- Institution of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Pathology, Oslo University Hospital – Ullevål Hospital, Oslo, Norway
| | - Ole Helmer Sjo
- Department of Gastrointestinal Surgery, Oslo University Hospital – Ullevål Hospital, Oslo, Norway
| | - Anne Negård
- Institution of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Radiology, Akershus University Hospital, Lørenskog, Norway
| | - Johann Baptist Dormagen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital – Ullevål Hospital, Oslo, Norway
| | - Anselm Schulz
- Department of Radiology and Nuclear Medicine, Oslo University Hospital – Ullevål Hospital, Oslo, Norway
- Institution of Clinical Medicine, University of Oslo, Oslo, Norway
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Huang H, Han L, Guo J, Zhang Y, Lin S, Chen S, Lin X, Cheng C, Guo Z, Qiu Y. Pretreatment MRI-Based Radiomics for Prediction of Rectal Cancer Outcome: A Discovery and Validation Study. Acad Radiol 2024; 31:1878-1888. [PMID: 37996362 DOI: 10.1016/j.acra.2023.10.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/22/2023] [Accepted: 10/29/2023] [Indexed: 11/25/2023]
Abstract
RATIONALE AND OBJECTIVES Accurate prediction of local recurrence or distant metastasis is critical for developing individualized therapies for locally advanced rectal cancer (LARC) patients after standard therapy. This study aims to develop and validate a multiparameter MRI-based radiomics signature (RS) for prognostic prediction in LARC patients receiving neoadjuvant chemoradiotherapy (nCRT) and total mesorectal excision (TME) and to explore the ability of RS for personalized survival risk stratification. MATERIALS AND METHODS In this multi-center study, 454 patients who received nCRT and TME and completed 3 years of follow-up participated. RS was constructed for prognostic prediction based on features extracted from pretreatment multiparameter MRI in a training cohort (TC; n = 298), which was tested in an internal validation cohort (IVC; n = 75) and further validated in an independent external validation cohort (EVC; n = 81). Furthermore, the ability of RS for personalized survival risk stratification was explored using the Kaplan-Meier survival curves. RESULTS The RS model showed satisfactory accuracy for prognostic prediction with AUCs of 0.83, 0.81 and 0.82 in the TC, IVC and EVC, respectively. In addition, RS helped to refine risk stratification for LARC patients on the basis of significantly different 3-year disease-free survival rates, independent of their pathological stage, pre-surgery CEA, and even treatment modality. CONCLUSIONS The proposed RS can be used not only to predict local recurrence or distant metastasis but also to serve as an effective postoperative survival risk stratification tool for clinicians to facilitate decision-making for LARC patients receiving standard treatment.
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Affiliation(s)
- Hongyan Huang
- Department of Radiology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen 518000, P.R. China
| | - Lujun Han
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, P.R. China
| | - Jianbo Guo
- Department of Radiology, Meizhou People's Hospital, No. 63 Huangtang Road, Meizhou 514000 P.R. China
| | - Yanyu Zhang
- Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Duobao AVE 56, Liwan district, Guangzhou, P.R. China
| | - Shiwei Lin
- Department of Radiology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen 518000, P.R. China
| | - Shengli Chen
- Department of Radiology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen 518000, P.R. China
| | - Xiaoshan Lin
- Department of Radiology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen 518000, P.R. China
| | - Caixue Cheng
- Department of Radiology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen 518000, P.R. China
| | - Zheng Guo
- Department of Hematology and Oncology, International Cancer Center, Shenzhen Key Laboratory of Precision Medicine for Hematological Malignancies, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Shenzhen University Health Science Center, Xueyuan AVE 1098, Nanshan District, Shenzhen, Guangdong 518000, P.R. China
| | - Yingwei Qiu
- Department of Radiology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen 518000, P.R. China.
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Crimì F, Cabrelle G, Campi C, Schillaci A, Bao QR, Pepe A, Spolverato G, Pucciarelli S, Vernuccio F, Quaia E. Nodal staging with MRI after neoadjuvant chemo-radiotherapy for locally advanced rectal cancer: a fast and reliable method. Eur Radiol 2024; 34:3205-3214. [PMID: 37930408 DOI: 10.1007/s00330-023-10265-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/02/2023] [Accepted: 08/09/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES In patients with locally advanced rectal carcinoma (LARC), negative nodal status after neoadjuvant chemoradiotherapy (nCRT) may allow for rectum-sparing protocols rather than total mesorectal excision; however, current MRI criteria for nodal staging have suboptimal accuracy. The aim of this study was to compare the diagnostic accuracy of different MRI dimensional criteria for nodal staging after nCRT in patients with LARC. MATERIALS AND METHODS Patients who underwent MRI after nCRT for LARC followed by surgery were retrospectively included and divided into a training and a validation cohort of 100 and 39 patients, respectively. Short-, long-, and cranial-caudal axes and volume of the largest mesorectal node and nodal status based on European Society of Gastrointestinal Radiology consensus guidelines (i.e., ESGAR method) were assessed by two radiologists independently. Inter-reader agreement was assessed in the training cohort. Histopathology was the reference standard. ROC curves and the best cut-off were calculated, and accuracies compared with the McNemar test. RESULTS The study population included 139 patients (median age 62 years [IQR 55-72], 94 men). Inter-reader agreement was high for long axis (κ = 0.81), volume (κ = 0.85), and ESGAR method (κ = 0.88) and low for short axis (κ = 0.11). Accuracy was similar (p > 0.05) for long axis, volume, and ESGAR method both in the training (71%, 74%, and 65%, respectively) and in the validation (83%, 78%, and 75%, respectively) cohorts. CONCLUSION Accuracy of the measurement of long axis and volume of the largest lymph node is not inferior to the ESGAR method for nodal staging after nCRT in LARC. CLINICAL RELEVANCE STATEMENT In MRI restaging of rectal cancer, measurement of the long axis or volume of largest mesorectal lymph node after preoperative chemoradiotherapy is a faster and reliable alternative to ESGAR criteria for nodal staging. KEY POINTS • Current MRI criteria for nodal staging in locally advanced rectal cancer after chemo-radiotherapy have suboptimal accuracy and are time-consuming. • Measurement of long axis or volume of the largest mesorectal lymph node on MRI showed good accuracy for assessment of loco-regional nodal status in locally advanced rectal cancer. • MRI measurement of the long axis and volume of largest mesorectal lymph node after chemo-radiotherapy could be a faster and reliable alternative to ESGAR criteria for nodal staging.
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Affiliation(s)
- Filippo Crimì
- Institute of Radiology, Department of Medicine-DIMED, University of Padova, Padua, Italy
| | - Giulio Cabrelle
- Department of Radiology, University Hospital of Padova, Via Niccolò Giustiniani N.2, 35128, Padua, Italy
| | - Cristina Campi
- Department of Mathematics, University of Genova, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessio Schillaci
- Institute of Radiology, Department of Medicine-DIMED, University of Padova, Padua, Italy
| | - Quoc Riccardo Bao
- General Surgery 3, Department of Surgical, Oncological, and Gastroenterological Sciences (DiSCOG), University of Padova, Padua, Italy
| | - Alessia Pepe
- Institute of Radiology, Department of Medicine-DIMED, University of Padova, Padua, Italy
| | - Gaya Spolverato
- General Surgery 3, Department of Surgical, Oncological, and Gastroenterological Sciences (DiSCOG), University of Padova, Padua, Italy
| | - Salvatore Pucciarelli
- General Surgery 3, Department of Surgical, Oncological, and Gastroenterological Sciences (DiSCOG), University of Padova, Padua, Italy
| | - Federica Vernuccio
- Department of Radiology, University Hospital of Padova, Via Niccolò Giustiniani N.2, 35128, Padua, Italy.
| | - Emilio Quaia
- Institute of Radiology, Department of Medicine-DIMED, University of Padova, Padua, Italy
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Horvat N, Jayaprakasam VS, Crane CH, Zheng J, Gangai N, Romesser PB, Golia Pernicka JS, Capanu M, Gollub MJ. Comparison between pelvic MRI, CT, and PET/CT in baseline staging and radiation planning of anal squamous cell carcinoma. Abdom Radiol (NY) 2024; 49:1351-1362. [PMID: 38456896 DOI: 10.1007/s00261-024-04213-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/12/2024] [Accepted: 01/17/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE To investigate the differences in baseline staging of anal squamous cell carcinoma based on CT, MRI, and PET/CT, and the resultant impact on the radiation plan. METHODS This retrospective study included consecutive patients with anal squamous cell carcinoma who underwent baseline pelvic MRI, CT, and PET/CT (all examinations within 3 weeks of each other) from January 2010 to April 2020. CTs, MRIs, and PET/CTs were re-interpreted by three separate radiologists. Several imaging features were assessed; tumor stage was determined based on the eight edition of the American Joint Committee on Cancer (AJCC) staging manual; and T (tumor), N (node), and M (metastasis) categories were determined based on National Comprehensive Cancer Network (NCCN) guidelines. Radiologist assessments were then randomly presented to a radiation oncologist who formulated the radiation plan in a blinded fashion. RESULTS Across 28 patients (median age, 62 years [range, 31-78], T-category classification was significantly different on PET/CT compared to MRI and CT (p = 0.037 and 0.031, respectively). PET/CT staged a higher proportion of patients with T1/T2 disease (16/28, 57%) compared to MRI (11/28, 39%) and CT (10/28, 36%). MRI staged a higher proportion of patients with T3/T4 disease (14/28, 50%) compared to CT (12/28, 43%) and PET/CT (11/28, 39%). However, there was no significant difference between the three imaging modalities in terms of either N-category, AJCC staging, or NCCN TNM group classification, or in treatment planning. CONCLUSION Our exploratory study showed that MRI demonstrated a higher proportion of T3/T4 tumors, while PET/CT demonstrated more T1/T2 tumors; however, MRI, CT, and PET/CT did not show any significant differences in AJCC and TNM group categories, nor was there any significant difference in treatment doses between them when assessed independently by an experienced radiation oncologist.
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Affiliation(s)
- Natally Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Vetri Sudar Jayaprakasam
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Christopher H Crane
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Junting Zheng
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Natalie Gangai
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Paul B Romesser
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jennifer S Golia Pernicka
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Marinela Capanu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marc J Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
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Valentini V, Alfieri S, Coco C, D'Ugo D, Crucitti A, Pacelli F, Persiani R, Sofo L, Picciocchi A, Doglietto GB, Barbaro B, Vecchio FM, Ricci R, Damiani A, Savino MC, Boldrini L, Cellini F, Meldolesi E, Romano A, Chiloiro G, Gambacorta MA. Four steps in the evolution of rectal cancer managements through 40 years of clinical practice: Pioneering, standardization, challenges and personalization. Radiother Oncol 2024; 194:110190. [PMID: 38438019 DOI: 10.1016/j.radonc.2024.110190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/26/2024] [Indexed: 03/06/2024]
Affiliation(s)
- Vincenzo Valentini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Sergio Alfieri
- Chirurgia Digestiva, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Claudio Coco
- U.O.C. Chirurgia Generale 2, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Domenico D'Ugo
- Unità di chirurgia generale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Fabio Pacelli
- Unità chirurgica del peritoneo e del retroperitoneo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Roberto Persiani
- Unità di chirurgia generale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luigi Sofo
- Divisione di Chirurgia Addominale, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Aurelio Picciocchi
- Dipartimento di Chirurgia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Battista Doglietto
- Chirurgia Digestiva, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Brunella Barbaro
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Fabio Maria Vecchio
- Dipartimento di Patologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Riccardo Ricci
- Dipartimento di Patologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Andrea Damiani
- Gemelli Generator Real World Data Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Chiara Savino
- Gemelli Generator Real World Data Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luca Boldrini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Cellini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Elisa Meldolesi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Angela Romano
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giuditta Chiloiro
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
| | - Maria Antonietta Gambacorta
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Cicalini I, Chiarelli AM, Chiacchiaretta P, Perpetuini D, Rosa C, Mastrodicasa D, d'Annibale M, Trebeschi S, Serafini FL, Cocco G, Narciso M, Corvino A, Cinalli S, Genovesi D, Lanuti P, Valentinuzzi S, Pieragostino D, Brocco D, Beets-Tan RGH, Tinari N, Sensi SL, Stuppia L, Del Boccio P, Caulo M, Delli Pizzi A. Multi-omics staging of locally advanced rectal cancer predicts treatment response: a pilot study. LA RADIOLOGIA MEDICA 2024; 129:712-726. [PMID: 38538828 PMCID: PMC11088547 DOI: 10.1007/s11547-024-01811-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 03/13/2024] [Indexed: 05/12/2024]
Abstract
Treatment response assessment of rectal cancer patients is a critical component of personalized cancer care and it allows to identify suitable candidates for organ-preserving strategies. This pilot study employed a novel multi-omics approach combining MRI-based radiomic features and untargeted metabolomics to infer treatment response at staging. The metabolic signature highlighted how tumor cell viability is predictively down-regulated, while the response to oxidative stress was up-regulated in responder patients, showing significantly reduced oxoproline values at baseline compared to non-responder patients (p-value < 10-4). Tumors with a high degree of texture homogeneity, as assessed by radiomics, were more likely to achieve a major pathological response (p-value < 10-3). A machine learning classifier was implemented to summarize the multi-omics information and discriminate responders and non-responders. Combining all available radiomic and metabolomic features, the classifier delivered an AUC of 0.864 (± 0.083, p-value < 10-3) with a best-point sensitivity of 90.9% and a specificity of 81.8%. Our results suggest that a multi-omics approach, integrating radiomics and metabolomic data, can enhance the predictive value of standard MRI and could help to avoid unnecessary surgical treatments and their associated long-term complications.
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Affiliation(s)
- Ilaria Cicalini
- Center for Advanced Studies and Technology (CAST), University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
- Department of Innovative Technologies in Medicine and Odontoiatry, "G. d'Annunzio" University, Chieti, Italy
| | - Antonio Maria Chiarelli
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Piero Chiacchiaretta
- Department of Innovative Technologies in Medicine and Odontoiatry, "G. d'Annunzio" University, Chieti, Italy.
| | - David Perpetuini
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Consuelo Rosa
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | | | - Martina d'Annibale
- Department of Radiology, SS. Annunziata Hospital, "G. d'Annunzio" University, Via dei Vestini, 66100, ChietiChieti, Italy
| | - Stefano Trebeschi
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Giulio Cocco
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, "G. D'Annunzio" University, Chieti, Italy
| | - Marco Narciso
- Department of Radiology, SS. Annunziata Hospital, "G. d'Annunzio" University, Via dei Vestini, 66100, ChietiChieti, Italy
| | - Antonio Corvino
- Medical, Movement and Wellbeing Sciences Department, Via Medina 40, 80133, Naples, Italy
| | - Sebastiano Cinalli
- Division of Pathology, ASST of Valtellina and Alto Lario, Sondrio, Italy
| | - Domenico Genovesi
- Department of Medical, Oral and Biotechnological Sciences and CeSI-MeT, "G. D'Annunzio" University of Chieti, Via dei Vestini, 66100, Chieti, Italy
| | - Paola Lanuti
- Center for Advanced Studies and Technology (CAST), University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
- Department of Medicine and Aging Science, "G. D'Annunzio" University of Chieti, Via dei Vestini, 66100, Chieti, Italy
| | - Silvia Valentinuzzi
- Center for Advanced Studies and Technology (CAST), University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
- Department of Pharmacy, "G. D'Annunzio" University of Chieti, Via dei Vestini, 66100, Chieti, Italy
| | - Damiana Pieragostino
- Center for Advanced Studies and Technology (CAST), University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
- Department of Innovative Technologies in Medicine and Odontoiatry, "G. d'Annunzio" University, Chieti, Italy
| | - Davide Brocco
- Clinical Oncology Unit, SS. Annunziata Hospital, Via dei Vestini, 66100, Chieti, Italy
| | - Regina G H Beets-Tan
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Nicola Tinari
- Department of Medicine and Aging Science, "G. D'Annunzio" University of Chieti, Via dei Vestini, 66100, Chieti, Italy
| | - Stefano L Sensi
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Liborio Stuppia
- Center for Advanced Studies and Technology (CAST), University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
- Department of Psychological, Health and Territory Sciences, "G. d'Annunzio" University of Chieti-Pescara, 66100, Chieti, Italy
| | - Piero Del Boccio
- Center for Advanced Studies and Technology (CAST), University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
- Department of Pharmacy, "G. D'Annunzio" University of Chieti, Via dei Vestini, 66100, Chieti, Italy
| | - Massimo Caulo
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
- Department of Radiology, SS. Annunziata Hospital, "G. d'Annunzio" University, Via dei Vestini, 66100, ChietiChieti, Italy
| | - Andrea Delli Pizzi
- Department of Innovative Technologies in Medicine and Odontoiatry, "G. d'Annunzio" University, Chieti, Italy
- Department of Radiology, SS. Annunziata Hospital, "G. d'Annunzio" University, Via dei Vestini, 66100, ChietiChieti, Italy
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López Llobet E, Coronado Poggio M, Lancha Hernández C, Martín Hervás C, Travaglio Morales D, Monachello Araujo D, Rodado Marina S, Domínguez Gadea L. Controversy in the initial nodal staging of rectal cancer (MRI or PET/CT?). Rev Esp Med Nucl Imagen Mol 2024; 43:500004. [PMID: 38527730 DOI: 10.1016/j.remnie.2024.500004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/06/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVE To compare the usefulness of MRI and PET/CT in nodal staging (N) of patients with locally advanced rectal cancer (LARC). MATERIAL AND METHODS Retrospective study of patients with LARC, who completed their initial staging with PET/CT, between January-20 and March-23. Regional nodes were assessed, and N was determined using both techniques according to TNM criteria. Concordance between MRI and PET/CT was analyzed. The accuracy of both techniques was calculated for those patients who underwent direct surgery. Non-regional pelvic lymph nodes were evaluated by both modalities. RESULTS Among the 73 patients, 48 were ultimately diagnosed with a locally advanced stage. Of these, 39 underwent neoadjuvant treatment (chemoradiotherapy) followed by surgery, and 9 direct surgery. In 25, the PET/CT extension study revealed distant disease, leading to systemic treatment. Weak concordance was observed between MRI and PET/CT in determining N (k=0.286; p<0.005). Out of 73 patients, 31(42%) exhibited concordance, and 42(58%) showed discordance. In 83% of the discordant cases, MRI overstaged compared to PET/CT, with 17 cases indicating nodal involvement (N+) by MRI and N0 by PET/CT. Diagnostic accuracy was 78% for both techniques. Sensitivity, specificity, positive predictive value, and negative predictive value were 80%, 75%, 80%, and 75% for MRI, and 60%, 100%, 100%, and 67%, for PET/CT. PET/CT identified pelvic metastatic adenopathies in 8 patients that were not visible/doubtful by MRI. CONCLUSIONS In the initial nodal staging of rectal cancer MRI overstages relative to PET/CT. Both modalities are complementary, PET/CT offers higher specificity and MRI higher sensitivity.
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80
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Cui Y, Song M, Tie J, Li S, Wang H, Zhang Y, Geng J, Liu Z, Teng H, Sui X, Zhu X, Cai Y, Li Y, Wang W. Clinicopathological factors predict residual lymph node metastasis in locally advanced rectal cancer with ypT0-2 after neoadjuvant chemoradiotherapy. J Cancer Res Clin Oncol 2024; 150:176. [PMID: 38575793 PMCID: PMC10995092 DOI: 10.1007/s00432-024-05662-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/21/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE Residual lymph node metastases (RLNM) remained a great concern in the implementation of organ-preserving strategies and led to poor prognosis in locally advanced rectal cancer (LARC). In this study, we aimed to identify the clinicopathological factors correlated with RLNM in LARC patients with ypT0-2 after neoadjuvant chemoradiotherapy (NCRT). METHODS We retrospectively analyzed 417 patients histologically diagnosed middle-low LARC after NCRT and total mesorectal excision (TME), whose pathological staging was ypT0-2. All patients received pelvic magnetic resonance imaging (MRI) before NCRT. The radiation doses were 50-50.6 Gy for the planning gross tumor volume and 41.8-45 Gy for the planning target volume, respectively. A nomogram for predicting RLNM was constructed using a binary logistic regression. Nomogram performance was assessed by receiver operating characteristic (ROC) curve, calibration curve, decision curve analysis (DCA) and clinical impact curve (CIC). RESULTS After surgery, 191 patients (45.8%) were ypT0, 43 patients (10.3%) were ypT1 and 183 patients (43.9%) were ypT2, and a total of 49 patients (11.8%) were found the presence of RLNM. Multivariable analyses identified MRI-defined mesorectal fascia (MRF)-positive, high-grade histopathology at biopsy, advanced ypT-category, and the presence of perineural invasion (PNI) as the predictive factors. The nomogram, incorporating all these predictors, showed good discrimination and calibration efficacy, with the areas under the ROC curve of 0.690 (95% CI: 0.610-0.771). Both DCA and CIC demonstrated that this nomogram has good clinical usefulness. CONCLUSION The nomogram model can predict RLNM in patients with ypT0-2 tumors. It can help select suitable patients for performing organ-preserving strategies after NCRT.
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Affiliation(s)
- Yujun Cui
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Maxiaowei Song
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Jian Tie
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Shuai Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Hongzhi Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Yangzi Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Jianhao Geng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Zhiyan Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Huajing Teng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Xin Sui
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Xianggao Zhu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Yong Cai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Yongheng Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, 100142, China.
| | - Weihu Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, 100142, China.
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Safont MJ, García-Figueiras R, Hernando-Requejo O, Jimenez-Rodriguez R, Lopez-Vicente J, Machado I, Ayuso JR, Bustamante-Balén M, De Torres-Olombrada MV, Domínguez Tristancho JL, Fernández-Aceñero MJ, Suarez J, Vera R. Interdisciplinary Spanish consensus on a watch-and-wait approach for rectal cancer. Clin Transl Oncol 2024; 26:825-835. [PMID: 37787973 DOI: 10.1007/s12094-023-03322-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/07/2023] [Indexed: 10/04/2023]
Abstract
Watch-and-wait has emerged as a new strategy for the management of rectal cancer when a complete clinical response is achieved after neoadjuvant therapy. In an attempt to standardize this new clinical approach, initiated by the Spanish Cooperative Group for the Treatment of Digestive Tumors (TTD), and with the participation of the Spanish Association of Coloproctology (AECP), the Spanish Society of Pathology (SEAP), the Spanish Society of Gastrointestinal Endoscopy (SEED), the Spanish Society of Radiation Oncology (SEOR), and the Spanish Society of Medical Radiology (SERAM), we present herein a consensus on a watch-and-wait approach for the management of rectal cancer. We have focused on patient selection, the treatment schemes evaluated, the optimal timing for evaluating the clinical complete response, the oncologic outcomes after the implementation of this strategy, and a protocol for surveillance of these patients.
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Affiliation(s)
- Maria Jose Safont
- Oncology Department, Consorcio Hospital General Universitario de Valencia. Valencia University, Av. de les Tres Creus, 2, 46014, València, Spain.
| | - Roberto García-Figueiras
- Radiology Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | - Jorge Lopez-Vicente
- Gastroenterology Department, Hospital Universitario de Mostoles, Mósteles, Spain
| | - Isidro Machado
- Instituto Valenciano de Oncología, Valencia, Spain
- Pathology Department, Patologika Laboratory QuironSalud, Valencia, Spain
- Pathology Department, University of Valencia, Valencia, Spain
| | | | - Marco Bustamante-Balén
- Gastrointestinal Endoscopy Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | | | - Mª Jesús Fernández-Aceñero
- Surgical Pathology Department, Hospital Clínico San Carlos, IdiSSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Javier Suarez
- General Surgery Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Ruth Vera
- Medical Oncology Department, Hospital Universitario de Navarra, Instituto de Investigación (Idisna), Pamplona, Spain
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Barbaro B, Carafa MRPI, Minordi LM, Testa P, Tatulli G, Carano D, Fiorillo C, Chiloiro G, Romano A, Valentini V, Gambacorta MA. Magnetic resonance imaging for assessment of rectal cancer nodes after chemoradiotherapy: A single center experience. Radiother Oncol 2024; 193:110124. [PMID: 38309586 DOI: 10.1016/j.radonc.2024.110124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 01/14/2024] [Accepted: 01/30/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Accurate nodal restaging is becoming clinically more important in patients with locally advanced rectal cancer (LARC) with the emergence of organ-preserving treatment after a good response to neoadjuvant chemoradiotherapy (nCRT). PURPOSE To evaluate the accuracy of MRI in identifying negative N status (ypN0 patients) in LARC after nCRT. MATERIAL AND METHODS 191 patients with LARC underwent MRI before and 6-8 weeks after nCRT and subsequent total mesorectal excision. Short-axis diameter of mesorectal lymph nodes was evaluated on the high resolution T2-weighted images to compare MRI restaging with histopathology.. RESULTS 146 and 45 patients had a negative N status (ypN0) and positive N status (ypN + ), respectively. On restaging MRI, the 70 % reduction in size of the largest node was associated with an area under the curve (AUC) of 0.818 to predict ypN0 stage, with a sensitivity of 93.3 % and a negative predictive value (NPV) of 95.4 %. No nodes were observed in 38 pts (37 pts ypN0 and 1 patient ypN + ), with sensitivity and NPV of nodes disappearance for ypN0 stage of 93.3 % and 92.5 % respectively. A 2.2 mm cut-off in short-axis diameter was associated with an AUC of 0.83 for the prediction of ypN0 nodal stage, with sensitivity and NPV of 79,5% and 91.1 % respectively. CONCLUSION A reduction in size of 70 % of the largest limph-node on MRI at rectal cancer restaging has high sensitivity and NPV for prediction of ypN0 stage after nCRT. The high NPV of node disappearance and of a ≤ 2.2 mm short-axis diameter is confirmed.
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Affiliation(s)
- Brunella Barbaro
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology. Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Maria Rachele PIa Carafa
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology. Università Cattolica del Sacro Cuore, Rome, Italy
| | - Laura Maria Minordi
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology. Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Priscilla Testa
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology. Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giulia Tatulli
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology. Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Davide Carano
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology. Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Claudio Fiorillo
- Digestive Surgery Unit, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Giuditta Chiloiro
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology. Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Angela Romano
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology. Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Valentini
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology. Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Maria Antonietta Gambacorta
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology. Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
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83
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Gulevski S, Frennered A, Trägårdh E, Nilsson MP, Johnsson A, Buchwald P, Blomqvist L, Zackrisson S. MRI morphological characteristics of lymph nodes in anal squamous cell carcinoma. Abdom Radiol (NY) 2024; 49:1042-1050. [PMID: 38319345 PMCID: PMC10954875 DOI: 10.1007/s00261-023-04182-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 02/07/2024]
Abstract
OBJECTIVES Pre-treatment staging of anal squamous cell carcinoma (ASCC) includes pelvic MRI and [18F]-fluorodeoxyglucose positron emission tomography with computed tomography (PET-CT). MRI criteria to define lymph node metastases (LNMs) in ASCC are currently lacking. The aim of this study was to describe the morphological characteristics of lymph nodes (LNs) on MRI in ASCC patients with PET-CT-positive LNs. METHODS ASCC patients treated at Skåne University Hospital between 2009 and 2017 were eligible for inclusion if at least one positive LN according to PET-CT and a pre-treatment MRI were present. All PET-CT-positive LNs and PET-CT-negative LNs were retrospectively identified on baseline MRI. Each LN was independently classified according to pre-determined morphological characteristics by two radiologists blinded to clinical patient information. RESULTS Sixty-seven ASCC patients were included, with a total of 181 PET-CT-positive LNs identified on baseline MRI with a median short-axis diameter of 9.0 mm (range 7.5-12 mm). MRI morphological characteristics of PET-CT-positive LNs included regular contour (87%), round shape (89%), and homogeneous signal intensity on T2-weighed images (67%). An additional 78 PET-CT-negative LNs were identified on MRI. These 78 LNs had a median size of 6.8 mm (range 5.5-8.0 mm). The majority of PET-CT-negative LNs had a regular contour, round shape, and a homogeneous signal that was congruent to the primary tumor. CONCLUSIONS There are MRI-specific morphological characteristics for pelvic LNs in ASCC. PET-CT-positive and negative LNs share similar morphological features apart from size, with PET-CT-positive LNs being significantly larger. Further studies are needed to determine discrimination criteria for LNM in ASCC.
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Affiliation(s)
| | - Anna Frennered
- Diagnostic Radiology, Department of Translational Medicine, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Elin Trägårdh
- Clinical Physiology and Nuclear Medicine, Department of Translational Medicine, Skåne University Hospital and Lund University, Malmö, Sweden
| | - Martin P Nilsson
- Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Anders Johnsson
- Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Pamela Buchwald
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | - Lennart Blomqvist
- Department of Radiation Physics/Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Sophia Zackrisson
- Diagnostic Radiology, Department of Translational Medicine, Skåne University Hospital, Lund University, Malmö, Sweden
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Kim HY, Cho SH, Jang JK, Kim B, Lee CM, Lim JS, Moon SK, Oh SN, Seo N, Park SH. Interpretation of Complete Tumor Response on MRI Following Chemoradiotherapy of Rectal Cancer: Inter-Reader Agreement and Associated Factors in Multi-Center Clinical Practice. Korean J Radiol 2024; 25:351-362. [PMID: 38528693 PMCID: PMC10973736 DOI: 10.3348/kjr.2023.1213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/29/2024] [Accepted: 02/03/2024] [Indexed: 03/27/2024] Open
Abstract
OBJECTIVE To measure inter-reader agreement and identify associated factors in interpreting complete response (CR) on magnetic resonance imaging (MRI) following chemoradiotherapy (CRT) for rectal cancer. MATERIALS AND METHODS This retrospective study involved 10 readers from seven hospitals with experience of 80-10210 cases, and 149 patients who underwent surgery after CRT for rectal cancer. Using MRI-based tumor regression grading (mrTRG) and methods employed in daily practice, the readers independently assessed mrTRG, CR on T2-weighted images (T2WI) denoted as mrCRT2W, and CR on all images including diffusion-weighted images (DWI) denoted as mrCRoverall. The readers described their interpretation patterns and how they utilized DWI. Inter-reader agreement was measured using multi-rater kappa, and associated factors were analyzed using multivariable regression. Correlation between sensitivity and specificity of each reader was analyzed using Spearman coefficient. RESULTS The mrCRT2W and mrCRoverall rates varied widely among the readers, ranging 18.8%-40.3% and 18.1%-34.9%, respectively. Nine readers used DWI as a supplement sequence, which modified interpretations on T2WI in 2.7% of cases (36/1341 [149 patients × 9 readers]) and mostly (33/36) changed mrCRT2W to non-mrCRoverall. The kappa values for mrTRG, mrCRT2W, and mrCRoverall were 0.56 (95% confidence interval: 0.49, 0.62), 0.55 (0.52, 0.57), and 0.54 (0.51, 0.57), respectively. No use of rectal gel, larger initial tumor size, and higher initial cT stage exhibited significant association with a higher inter-reader agreement for assessing mrCRoverall (P ≤ 0.042). Strong negative correlations were observed between the sensitivity and specificity of individual readers (coefficient, -0.718 to -0.963; P ≤ 0.019). CONCLUSION Inter-reader agreement was moderate for assessing CR on post-CRT MRI. Readers' varying standards on MRI interpretation (i.e., threshold effect), along with the use of rectal gel, initial tumor size, and initial cT stage, were significant factors associated with inter-reader agreement.
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Affiliation(s)
- Hae Young Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Seung Hyun Cho
- Department of Radiology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jong Keon Jang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Bohyun Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chul-Min Lee
- Department of Radiology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Joon Seok Lim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Kyoung Moon
- Department of Radiology, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Soon Nam Oh
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Nieun Seo
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seong Ho Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
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85
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Li QY, Yang D, Guan Z, Yan XY, Li XT, Sun RJ, Lu QY, Zhang XY, Sun YS. Extranodal Extension at Pretreatment MRI and the Prognostic Value for Patients with Rectal Cancer. Radiology 2024; 310:e232605. [PMID: 38530176 DOI: 10.1148/radiol.232605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Background Detection of extranodal extension (ENE) at pathology is a poor prognostic indicator for rectal cancer, but whether ENE can be identified at pretreatment MRI is, to the knowledge of the authors, unknown. Purpose To evaluate the performance of pretreatment MRI in detecting ENE using a matched pathologic reference standard and to assess its prognostic value in patients with rectal cancer. Materials and Methods This single-center study included a prospective development data set consisting of participants with rectal adenocarcinoma who underwent pretreatment MRI and radical surgery (December 2021 to January 2023). MRI characteristics were identified by their association with ENE-positive nodes (χ2 test and multivariable logistic regression) and the performance of these MRI features was assessed (area under the receiver operating characteristic curve [AUC]). Interobserver agreement was assessed by Cohen κ coefficient. The prognostic value of ENE detected with MRI for predicting 3-year disease-free survival was assessed by Cox regression analysis in a retrospective independent validation cohort of patients with locally advanced rectal cancer (December 2019 to July 2020). Results The development data set included 147 participants (mean age, 62 years ± 11 [SD]; 87 male participants). The retrospective cohort included 110 patients (mean age, 60 years ± 9; 79 male participants). Presence of vessel interruption and fusion (both P < .001), heterogeneous internal structure, and the broken-ring and tail signs (odds ratio range, 4.10-23.20; P value range, <.001 to .002) were predictors of ENE at MRI, and together achieved an AUC of 0.91 (95% CI: 0.88, 0.93) in detecting ENE. Interobserver agreement was moderate for the presence of vessel interruption and fusion (κ = 0.46 for both) and substantial for others (κ = 0.61-0.67). The presence of ENE at pretreatment MRI was independently associated with worse 3-year disease-free survival (hazard ratio, 3.00; P = .02). Conclusion ENE can be detected at pretreatment MRI, and its presence was associated with worse prognosis for patients with rectal cancer. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Eberhardt in this issue.
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Affiliation(s)
- Qing-Yang Li
- From the Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Rd, Hai Dian District, Beijing 100142, China
| | - Ding Yang
- From the Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Rd, Hai Dian District, Beijing 100142, China
| | - Zhen Guan
- From the Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Rd, Hai Dian District, Beijing 100142, China
| | - Xin-Yue Yan
- From the Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Rd, Hai Dian District, Beijing 100142, China
| | - Xiao-Ting Li
- From the Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Rd, Hai Dian District, Beijing 100142, China
| | - Rui-Jia Sun
- From the Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Rd, Hai Dian District, Beijing 100142, China
| | - Qiao-Yuan Lu
- From the Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Rd, Hai Dian District, Beijing 100142, China
| | - Xiao-Yan Zhang
- From the Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Rd, Hai Dian District, Beijing 100142, China
| | - Ying-Shi Sun
- From the Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Rd, Hai Dian District, Beijing 100142, China
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86
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Troester AM, Gaertner WB. Contemporary management of rectal cancer. Surg Open Sci 2024; 18:17-22. [PMID: 38312301 PMCID: PMC10832461 DOI: 10.1016/j.sopen.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/02/2024] [Indexed: 02/06/2024] Open
Abstract
The management of rectal cancer has undergone significant changes over the past 50 years, and this has been associated with major improvements in overall outcomes and quality of life. From standardization of total mesorectal excision to refinements in radiation delivery and shifting of chemoradiotherapy treatment to favor a neoadjuvant approach, as well as the development of targeted chemotherapeutics, these management strategies have continually aimed to achieve locoregional and systemic control while limiting adverse effects and enhance overall survival. This article highlights evolving aspects of rectal cancer therapy including improved staging modalities, total neoadjuvant therapy, the role of short-course and more selective radiotherapy strategies, as well as organ preservation. We also discuss the evolving role of minimally invasive surgery and comment on lateral pelvic lymph node dissection. Key message Rectal cancer management is constantly evolving through refinements in radiation timing and delivery, modification of chemoradiotherapy treatment schedules, and increasing utilization of minimally invasive surgical techniques and organ preservation strategies. This manuscript aims to provide a synopsis of recent changes in the management of rectal cancer, highlighting contemporary modifications in neoadjuvant approaches and surgical management to enhance the knowledge of surgeons who care for this challenging population.
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Affiliation(s)
- Alexander M. Troester
- Department of Surgery, University of Minnesota, Minneapolis, MN, United States of America
| | - Wolfgang B. Gaertner
- Department of Surgery, University of Minnesota, Minneapolis, MN, United States of America
- Division of Colon & Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN, United States of America
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87
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El Khababi N, Beets-Tan RGH, Tissier R, Lahaye MJ, Maas M, Curvo-Semedo L, Dresen RC, van Griethuysen JJM, Nougaret S, Beets GL, van Triest B, Taylor SA, Lambregts DMJ. Outcomes and potential impact of a virtual hands-on training program on MRI staging confidence and performance in rectal cancer. Eur Radiol 2024; 34:1746-1754. [PMID: 37646807 PMCID: PMC10873460 DOI: 10.1007/s00330-023-10167-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/27/2023] [Accepted: 07/16/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVES To explore the potential impact of a dedicated virtual training course on MRI staging confidence and performance in rectal cancer. METHODS Forty-two radiologists completed a stepwise virtual training course on rectal cancer MRI staging composed of a pre-course (baseline) test with 7 test cases (5 staging, 2 restaging), a 1-day online workshop, 1 month of individual case readings (n = 70 cases with online feedback), a live online feedback session supervised by two expert faculty members, and a post-course test. The ESGAR structured reporting templates for (re)staging were used throughout the course. Results of the pre-course and post-course test were compared in terms of group interobserver agreement (Krippendorf's alpha), staging confidence (perceived staging difficulty), and diagnostic accuracy (using an expert reference standard). RESULTS Though results were largely not statistically significant, the majority of staging variables showed a mild increase in diagnostic accuracy after the course, ranging between + 2% and + 17%. A similar trend was observed for IOA which improved for nearly all variables when comparing the pre- and post-course. There was a significant decrease in the perceived difficulty level (p = 0.03), indicating an improved diagnostic confidence after completion of the course. CONCLUSIONS Though exploratory in nature, our study results suggest that use of a dedicated virtual training course and web platform has potential to enhance staging performance, confidence, and interobserver agreement to assess rectal cancer on MRI virtual training and could thus be a good alternative (or addition) to in-person training. CLINICAL RELEVANCE STATEMENT Rectal cancer MRI reporting quality is highly dependent on radiologists' expertise, stressing the need for dedicated training/teaching. This study shows promising results for a virtual web-based training program, which could be a good alternative (or addition) to in-person training. KEY POINTS • Rectal cancer MRI reporting quality is highly dependent on radiologists' expertise, stressing the need for dedicated training and teaching. • Using a dedicated virtual training course and web-based platform, encouraging first results were achieved to improve staging accuracy, diagnostic confidence, and interobserver agreement. • These exploratory results suggest that virtual training could thus be a good alternative (or addition) to in-person training.
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Affiliation(s)
- Najim El Khababi
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1106 BE, Amsterdam, The Netherlands
- GROW School for oncology and reproduction, University of Maastricht, Maastricht, The Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1106 BE, Amsterdam, The Netherlands
- GROW School for oncology and reproduction, University of Maastricht, Maastricht, The Netherlands
| | - Renaud Tissier
- Biostatistics Unit, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Max J Lahaye
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1106 BE, Amsterdam, The Netherlands
- GROW School for oncology and reproduction, University of Maastricht, Maastricht, The Netherlands
| | - Monique Maas
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1106 BE, Amsterdam, The Netherlands
- GROW School for oncology and reproduction, University of Maastricht, Maastricht, The Netherlands
| | - Luís Curvo-Semedo
- Department of Radiology, Centro Hospitalar E Universitario de Coimbra EPE, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Raphaëla C Dresen
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Joost J M van Griethuysen
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1106 BE, Amsterdam, The Netherlands
- Department of Radiology, UMC Utrecht, Utrecht, The Netherlands
| | - Stephanie Nougaret
- Medical Imaging Department, Montpellier Cancer Institute, Montpellier Cancer Research Institute (U1194), University of Montpellier, Montpellier, France
| | - Geerard L Beets
- GROW School for oncology and reproduction, University of Maastricht, Maastricht, The Netherlands
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Baukelien van Triest
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Stuart A Taylor
- Department of Radiology, University College London Hospitals Biomedical Research Centre, London, UK
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1106 BE, Amsterdam, The Netherlands.
- GROW School for oncology and reproduction, University of Maastricht, Maastricht, The Netherlands.
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88
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Wei Y, Wang H, Chen Z, Zhu Y, Li Y, Lu B, Pan K, Wen C, Cao G, He Y, Zhou J, Pan Z, Wang M. Deep Learning-Based Multiparametric MRI Model for Preoperative T-Stage in Rectal Cancer. J Magn Reson Imaging 2024; 59:1083-1092. [PMID: 37367938 DOI: 10.1002/jmri.28856] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/24/2023] [Accepted: 05/29/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Conventional MRI staging can be challenging in the preoperative assessment of rectal cancer. Deep learning methods based on MRI have shown promise in cancer diagnosis and prognostication. However, the value of deep learning in rectal cancer T-staging is unclear. PURPOSE To develop a deep learning model based on preoperative multiparametric MRI for evaluation of rectal cancer and to investigate its potential to improve T-staging accuracy. STUDY TYPE Retrospective. POPULATION After cross-validation, 260 patients (123 with T-stage T1-2 and 134 with T-stage T3-4) with histopathologically confirmed rectal cancer were randomly divided to the training (N = 208) and test sets (N = 52). FIELD STRENGTH/SEQUENCE 3.0 T/Dynamic contrast enhanced (DCE), T2-weighted imaging (T2W), and diffusion-weighted imaging (DWI). ASSESSMENT The deep learning (DL) model of multiparametric (DCE, T2W, and DWI) convolutional neural network were constructed for evaluating preoperative diagnosis. The pathological findings served as the reference standard for T-stage. For comparison, the single parameter DL-model, a logistic regression model composed of clinical features and subjective assessment of radiologists were used. STATISTICAL TESTS The receiver operating characteristic curve (ROC) was used to evaluate the models, the Fleiss' kappa for the intercorrelation coefficients, and DeLong test for compare the diagnostic performance of ROCs. P-values less than 0.05 were considered statistically significant. RESULTS The Area Under Curve (AUC) of the multiparametric DL-model was 0.854, which was significantly higher than the radiologist's assessment (AUC = 0.678), clinical model (AUC = 0.747), and the single parameter DL-models including T2W-model (AUC = 0.735), DWI-model (AUC = 0.759), and DCE-model (AUC = 0.789). DATA CONCLUSION In the evaluation of rectal cancer patients, the proposed multiparametric DL-model outperformed the radiologist's assessment, the clinical model as well as the single parameter models. The multiparametric DL-model has the potential to assist clinicians by providing more reliable and precise preoperative T staging diagnosis. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Yaru Wei
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China
| | - Haojie Wang
- Cixi Biomedical Research Institute, Wenzhou Medical University, Zhejiang, China
- Key Laboratory of Intelligent Medical Imaging of Wenzhou, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhongwei Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ying Zhu
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yingfa Li
- Key Laboratory of Intelligent Medical Imaging of Wenzhou, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Beichen Lu
- Key Laboratory of Intelligent Medical Imaging of Wenzhou, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Kehua Pan
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Caiyun Wen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guoquan Cao
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yun He
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jiejie Zhou
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhifang Pan
- Key Laboratory of Intelligent Medical Imaging of Wenzhou, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Meihao Wang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China
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Xia W, Li D, He W, Pickhardt PJ, Jian J, Zhang R, Zhang J, Song R, Tong T, Yang X, Gao X, Cui Y. Multicenter Evaluation of a Weakly Supervised Deep Learning Model for Lymph Node Diagnosis in Rectal Cancer at MRI. Radiol Artif Intell 2024; 6:e230152. [PMID: 38353633 PMCID: PMC10982819 DOI: 10.1148/ryai.230152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 12/13/2023] [Accepted: 01/24/2024] [Indexed: 03/07/2024]
Abstract
Purpose To develop a Weakly supervISed model DevelOpment fraMework (WISDOM) model to construct a lymph node (LN) diagnosis model for patients with rectal cancer (RC) that uses preoperative MRI data coupled with postoperative patient-level pathologic information. Materials and Methods In this retrospective study, the WISDOM model was built using MRI (T2-weighted and diffusion-weighted imaging) and patient-level pathologic information (the number of postoperatively confirmed metastatic LNs and resected LNs) based on the data of patients with RC between January 2016 and November 2017. The incremental value of the model in assisting radiologists was investigated. The performances in binary and ternary N staging were evaluated using area under the receiver operating characteristic curve (AUC) and the concordance index (C index), respectively. Results A total of 1014 patients (median age, 62 years; IQR, 54-68 years; 590 male) were analyzed, including the training cohort (n = 589) and internal test cohort (n = 146) from center 1 and two external test cohorts (cohort 1: 117; cohort 2: 162) from centers 2 and 3. The WISDOM model yielded an overall AUC of 0.81 and C index of 0.765, significantly outperforming junior radiologists (AUC = 0.69, P < .001; C index = 0.689, P < .001) and performing comparably with senior radiologists (AUC = 0.79, P = .21; C index = 0.788, P = .22). Moreover, the model significantly improved the performance of junior radiologists (AUC = 0.80, P < .001; C index = 0.798, P < .001) and senior radiologists (AUC = 0.88, P < .001; C index = 0.869, P < .001). Conclusion This study demonstrates the potential of WISDOM as a useful LN diagnosis method using routine rectal MRI data. The improved radiologist performance observed with model assistance highlights the potential clinical utility of WISDOM in practice. Keywords: MR Imaging, Abdomen/GI, Rectum, Computer Applications-Detection/Diagnosis Supplemental material is available for this article. Published under a CC BY 4.0 license.
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Affiliation(s)
| | | | - Wenguang He
- From the Department of Medical Imaging, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China (W.X., J.J., R.Z., X.G.); Department of Radiology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan 030013, China (D.L., J.Z., R.S., X.Y., X.G., Y.C.); Department of Radiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (W.H.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, Madison, Wis (P.J.P.); Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China (T.T.); Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China (T.T.); and Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China (Y.C.)
| | - Perry J. Pickhardt
- From the Department of Medical Imaging, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China (W.X., J.J., R.Z., X.G.); Department of Radiology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan 030013, China (D.L., J.Z., R.S., X.Y., X.G., Y.C.); Department of Radiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (W.H.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, Madison, Wis (P.J.P.); Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China (T.T.); Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China (T.T.); and Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China (Y.C.)
| | - Junming Jian
- From the Department of Medical Imaging, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China (W.X., J.J., R.Z., X.G.); Department of Radiology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan 030013, China (D.L., J.Z., R.S., X.Y., X.G., Y.C.); Department of Radiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (W.H.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, Madison, Wis (P.J.P.); Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China (T.T.); Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China (T.T.); and Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China (Y.C.)
| | - Rui Zhang
- From the Department of Medical Imaging, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China (W.X., J.J., R.Z., X.G.); Department of Radiology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan 030013, China (D.L., J.Z., R.S., X.Y., X.G., Y.C.); Department of Radiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (W.H.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, Madison, Wis (P.J.P.); Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China (T.T.); Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China (T.T.); and Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China (Y.C.)
| | - Junjie Zhang
- From the Department of Medical Imaging, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China (W.X., J.J., R.Z., X.G.); Department of Radiology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan 030013, China (D.L., J.Z., R.S., X.Y., X.G., Y.C.); Department of Radiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (W.H.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, Madison, Wis (P.J.P.); Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China (T.T.); Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China (T.T.); and Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China (Y.C.)
| | - Ruirui Song
- From the Department of Medical Imaging, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China (W.X., J.J., R.Z., X.G.); Department of Radiology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan 030013, China (D.L., J.Z., R.S., X.Y., X.G., Y.C.); Department of Radiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (W.H.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, Madison, Wis (P.J.P.); Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China (T.T.); Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China (T.T.); and Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China (Y.C.)
| | - Tong Tong
- From the Department of Medical Imaging, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China (W.X., J.J., R.Z., X.G.); Department of Radiology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan 030013, China (D.L., J.Z., R.S., X.Y., X.G., Y.C.); Department of Radiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (W.H.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, Madison, Wis (P.J.P.); Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China (T.T.); Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China (T.T.); and Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China (Y.C.)
| | - Xiaotang Yang
- From the Department of Medical Imaging, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China (W.X., J.J., R.Z., X.G.); Department of Radiology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan 030013, China (D.L., J.Z., R.S., X.Y., X.G., Y.C.); Department of Radiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (W.H.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, Madison, Wis (P.J.P.); Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China (T.T.); Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China (T.T.); and Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China (Y.C.)
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Shur JD, Qiu S, Johnston E, Tait D, Fotiadis N, Kontovounisios C, Rasheed S, Tekkis P, Riddell A, Koh DM. Multimodality Imaging to Direct Management of Primary and Recurrent Rectal Adenocarcinoma Beyond the Total Mesorectal Excision Plane. Radiol Imaging Cancer 2024; 6:e230077. [PMID: 38363197 PMCID: PMC10988347 DOI: 10.1148/rycan.230077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/11/2023] [Accepted: 01/10/2024] [Indexed: 02/17/2024]
Abstract
Rectal tumors extending beyond the total mesorectal excision (TME) plane (beyond-TME) require particular multidisciplinary expertise and oncologic considerations when planning treatment. Imaging is used at all stages of the pathway, such as local tumor staging/restaging, creating an imaging-based "roadmap" to plan surgery for optimal tumor clearance, identifying treatment-related complications, which may be suitable for radiology-guided intervention, and to detect recurrent or metastatic disease, which may be suitable for radiology-guided ablative therapies. Beyond-TME and exenterative surgery have gained acceptance as potentially curative procedures for advanced tumors. Understanding the role, techniques, and pitfalls of current imaging techniques is important for both radiologists involved in the treatment of these patients and general radiologists who may encounter patients undergoing surveillance or patients presenting with surgical complications or intercurrent abdominal pathology. This review aims to outline the current and emerging roles of imaging in patients with beyond-TME and recurrent rectal malignancy, focusing on practical tips for image interpretation and surgical planning in the beyond-TME setting. Keywords: Abdomen/GI, Rectum, Oncology © RSNA, 2024.
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Affiliation(s)
- Joshua D. Shur
- From the Royal Marsden Hospital NHS Foundation Trust, Downs Road,
Sutton SM2 5PT, England (J.D.S., S.Q., E.J., D.T., N.F., C.K., S.R.,
P.T., A.R., D.M.K.); and Institute of Cancer Research, Sutton, England (E.J.,
N.F., D.M.K.)
| | - Sheng Qiu
- From the Royal Marsden Hospital NHS Foundation Trust, Downs Road,
Sutton SM2 5PT, England (J.D.S., S.Q., E.J., D.T., N.F., C.K., S.R.,
P.T., A.R., D.M.K.); and Institute of Cancer Research, Sutton, England (E.J.,
N.F., D.M.K.)
| | - Edward Johnston
- From the Royal Marsden Hospital NHS Foundation Trust, Downs Road,
Sutton SM2 5PT, England (J.D.S., S.Q., E.J., D.T., N.F., C.K., S.R.,
P.T., A.R., D.M.K.); and Institute of Cancer Research, Sutton, England (E.J.,
N.F., D.M.K.)
| | - Diana Tait
- From the Royal Marsden Hospital NHS Foundation Trust, Downs Road,
Sutton SM2 5PT, England (J.D.S., S.Q., E.J., D.T., N.F., C.K., S.R.,
P.T., A.R., D.M.K.); and Institute of Cancer Research, Sutton, England (E.J.,
N.F., D.M.K.)
| | - Nicos Fotiadis
- From the Royal Marsden Hospital NHS Foundation Trust, Downs Road,
Sutton SM2 5PT, England (J.D.S., S.Q., E.J., D.T., N.F., C.K., S.R.,
P.T., A.R., D.M.K.); and Institute of Cancer Research, Sutton, England (E.J.,
N.F., D.M.K.)
| | - Christos Kontovounisios
- From the Royal Marsden Hospital NHS Foundation Trust, Downs Road,
Sutton SM2 5PT, England (J.D.S., S.Q., E.J., D.T., N.F., C.K., S.R.,
P.T., A.R., D.M.K.); and Institute of Cancer Research, Sutton, England (E.J.,
N.F., D.M.K.)
| | - Shahnawaz Rasheed
- From the Royal Marsden Hospital NHS Foundation Trust, Downs Road,
Sutton SM2 5PT, England (J.D.S., S.Q., E.J., D.T., N.F., C.K., S.R.,
P.T., A.R., D.M.K.); and Institute of Cancer Research, Sutton, England (E.J.,
N.F., D.M.K.)
| | - Paris Tekkis
- From the Royal Marsden Hospital NHS Foundation Trust, Downs Road,
Sutton SM2 5PT, England (J.D.S., S.Q., E.J., D.T., N.F., C.K., S.R.,
P.T., A.R., D.M.K.); and Institute of Cancer Research, Sutton, England (E.J.,
N.F., D.M.K.)
| | - Angela Riddell
- From the Royal Marsden Hospital NHS Foundation Trust, Downs Road,
Sutton SM2 5PT, England (J.D.S., S.Q., E.J., D.T., N.F., C.K., S.R.,
P.T., A.R., D.M.K.); and Institute of Cancer Research, Sutton, England (E.J.,
N.F., D.M.K.)
| | - Dow-Mu Koh
- From the Royal Marsden Hospital NHS Foundation Trust, Downs Road,
Sutton SM2 5PT, England (J.D.S., S.Q., E.J., D.T., N.F., C.K., S.R.,
P.T., A.R., D.M.K.); and Institute of Cancer Research, Sutton, England (E.J.,
N.F., D.M.K.)
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91
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Pinto RA, Kawaguti FS, Kimura CMS, Corrêa Neto IJF, Nahas CSR, Marques CFS, Bustamante-Lopez LA, Ribeiro-Jr U, Maluf-Filho F, Nahas SC. Comparing three-dimensional endorectal ultrasound and magnification chromoendoscopy for early rectal neoplasia invasion depth assessment. J Gastroenterol Hepatol 2024; 39:346-352. [PMID: 37931782 DOI: 10.1111/jgh.16382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Accurate assessment of invasion depth of early rectal neoplasms is essential for optimal therapy. We aimed to compare three-dimensional endorectal ultrasound (3D-ERUS) with magnification chromoendoscopy (MCE) regarding their accuracy in assessing parietal invasion depth (T). METHODS Patients with middle and distal rectum neoplasms were prospectively included. Two providers blinded to each other's assessment performed 3D-ERUS and MCE, respectively. The T stage assessed through ERUS was compared to the MCE evaluation. The results were compared to the surgical specimen anatomopathological report. Sensitivity, specificity, accuracy, positive (PPV), and negative (NPV) predictive values were calculated for the T stage and for the final therapy (local excision or radical surgery). RESULTS In 8 years, 70 patients were enrolled, and all underwent both exams. MCE and ERUS showed an accuracy of 94.3% and 85.7%, sensitivity of 83.7 and 93.3%, specificity of 96.4 and 83.6%, PPV of 86.7 and 60.9%, and NPV of 96.4 and 97.9%, respectively. Kappa for T stage assessed through ERUS was 0.64 and 0.83 for MCE. CONCLUSION MCE and 3D-ERUS had good diagnostic performance, but the endoscopic method had higher accuracy. Both methods reliably assessed lesion extension, circumferential involvement, and distance from the anal verge.
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Affiliation(s)
- Rodrigo Ambar Pinto
- Division of Colon and Rectal Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Cintia Mayumi Sakurai Kimura
- Division of Colon and Rectal Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Department of Surgery, Stanford School of Medicine, Stanford, California, USA
| | - Isaac José Felippe Corrêa Neto
- Division of Colon and Rectal Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Caio Sérgio Rizkallah Nahas
- Division of Colon and Rectal Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Carlos Frederico Sparapan Marques
- Division of Colon and Rectal Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Leonardo Alfonso Bustamante-Lopez
- Division of Colon and Rectal Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ulysses Ribeiro-Jr
- Division of Gastrointestinal Surgery, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Fauze Maluf-Filho
- Division of Endoscopy, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Sérgio Carlos Nahas
- Division of Colon and Rectal Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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92
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İsmail E, Kutlu B, Acar Hİ, Yörübulut M, Akkoca M, Kocaay AF, Elhan A, Kuzu MA. Lateral Lymph Node Dissection for Locally Advanced Rectal Carcinoma: A Step-by-Step Description of Surgical Anatomical Planes During Cadaveric Dissection and Minimally Invasive Surgery. Surg Laparosc Endosc Percutan Tech 2024; 34:101-107. [PMID: 38134383 DOI: 10.1097/sle.0000000000001241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/15/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE Total mesorectal excision (TME) is accepted as gold standard method in rectal cancer globally. But there is no standard for lateral lymph nodes. Combination of neoadjuvant treatment plus lateral lymph node dissection (LLND) in select patients might be a promising method. Our purpose is to describe the anatomic landmarks of LLND on cadavers and minimally invasive surgery. MATERIALS AND METHODS Local advanced rectal cancer and lateral lymph node (LLN) metastasis are accepted as an indication of neoadjuvant treatment. LLND was performed according to preoperative imaging after radiochemotherapy. RESULTS Twenty-eight (10.5%) of 267 patients with rectal cancer who had suspected lateral lymph node metastasis (LLNM) with magnetic resonance imaging (MRI) underwent LLND in addition to TME after neoadjuvant chemoradiotherapy. Eight of them had LLNM. Three patients had bilateral LLND and only 1 had LLNM. The median number of harvested lymph nodes was 6. The rates of LLNM increased with the presence of poor prognosis markers. One regional and 1 distant recurrence were detected in patients who had no LLN metastasis compared with2 regional and 4 distant recurrences in the LLN-positive group. CONCLUSIONS Local advanced rectal cancer cases may benefit from LLND, but it does not appear to have an effect on overall survival. There is no consensus whether size and/or morphologic criteria in MRI are the ideal guide for LLND.
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Affiliation(s)
- Erkin İsmail
- Acibadem Hospital; Departments of General Surgery and Anatomy, Faculty of Medicine, Ankara University; SBU Etlik City Hospital, Ankara, Turkey
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93
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Robinson E, Balasubramaniam R, Hameed M, Clarke C, Taylor SA, Tolan D, Foley KG. Survey of rectal cancer MRI technique and reporting tumour descriptors in the UK: a multi-centre British Society of Gastrointestinal and Abdominal Radiology (BSGAR) audit. Clin Radiol 2024; 79:117-123. [PMID: 37989667 DOI: 10.1016/j.crad.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/17/2023] [Accepted: 10/21/2023] [Indexed: 11/23/2023]
Abstract
AIM To evaluate variation in magnetic resonance imaging (MRI) technique and reporting of rectal cancer staging examinations across the UK. MATERIALS AND METHODS A retrospective, multi-centre audit was undertaken of imaging protocols and information documented within consecutive MRI rectal cancer reports between March 2020 and August 2021, which were compared against American and European guidelines. Inclusion criteria included histologically proven rectal adenocarcinoma and baseline staging MRI rectum only. RESULTS Fully anonymised data from 924 MRI reports by 78 radiologists at 24 centres were evaluated. Thirty-two per cent of radiologists used template reporting, but these reports offered superior documentation of 13 out of 18 key tumour features compared to free-text reports including T-stage, relation to peritoneal reflection and mesorectal fascia (MRF), nodal status, and presence of extramural venous invasion (EMVI; p<0.027 in each). There was no significant differences in the remaining five features. Across all tumour locations, the tumour relationship to the MRF, the presence of EMVI, and the presence of tumour deposits were reported in 79.5%, 85.6%, and 44% of cases, respectively, and tumour, nodal, and distant metastatic stage documented in 94.4%, 97.7%, and 78.3%. In low rectal tumours, the relationship to the anal sphincter complex was reported in only 54.6%. CONCLUSION Considerable variation exists in rectal cancer MRI acquisition and reporting in this sample of UK centres. Inclusion of key radiological features in reports must be improved for risk stratification and treatment decisions. Template reporting is superior to free-text reporting. Routine adoption of standardised radiology practices should now be considered to improve standards to facilitate personalised precision treatment for patients to improve outcomes.
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Affiliation(s)
- E Robinson
- North Bristol NHS Trust, Southmead Road, Westbury-on-Trym Bristol, BS10 5NB, UK.
| | - R Balasubramaniam
- Royal Stoke University Hospital, Newcastle Road, Stoke-on-Trent, Staffordshire, ST4 6QG, UK
| | - M Hameed
- University College Hospital, 235 Euston Road, London, NW1 2BU, UK; University College London, Centre for Medical Imaging, 2nd Floor Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK
| | - C Clarke
- Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, Nottinghamshire, NG7 2UH, UK
| | - S A Taylor
- University College London, Centre for Medical Imaging, 2nd Floor Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK
| | - D Tolan
- Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK.
| | - K G Foley
- Royal Glamorgan Hospital, Ynysmaerdy, Llantrisant, UK; Velindre Cancer Centre, Velindre Road, Whitchurch, Cardiff, CF14 2TL, UK
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Hołdakowska A, Kurkowska K, Pietrzak L, Michalski W, Rutkowski A, Olesiński T, Cencelewicz A, Rydziński M, Socha J, Bujko K. Which tumour factors preclude organ preservation in patients with rectal cancer? Radiother Oncol 2024; 191:110054. [PMID: 38104780 DOI: 10.1016/j.radonc.2023.110054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/06/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND cT3cdT4, cN2, mesorectal nodes > 8 mm, clinically positive lateral nodes, extramural vascular invasion (EMVI) and mesorectal fascia threatening (MRF+) have been utilized as exclusion criteria in several studies on the watch-and-wait (w&w) strategy. Here, our aim was to validate these criteria through a post hoc analysis of two pooled prospective studies on w&w following routine radio(chemo)therapy. METHODS A review of baseline magnetic resonance imaging was performed in a subgroup of 223 patients treated at a single institution. Of these, 17.9 % started w&w, 12.6 % achieved clinical complete response (cCR) and 9.0 % sustained cCR during median follow-up of 54 months. RESULTS The multivariable logistic analysis showed that the proportion of circumferential bowel involvement and EMVI significantly influenced the chance of sustained cCR; odds ratios were 0.063 (95 % confidence interval [CI] 0.008-0.489, p = 0.008), and 0.109 (95 % CI 0.014-0.850, p = 0.034), respectively. Sustained cCR was observed in none of the 57 patients with 90 %-100 % circumferential bowel involvement and in only one of the 89 patients with EMVI. In contrast, cT3cdT4, cN2, mesorectal nodes > 8 mm, clinically positive lateral nodes or MRF+ were not independently associated with sustained cCR. Among the subgroups of patients with these features but without (near-)circular tumour or EMVI+, sustained cCR was observed in 12 %-25 % of patients. CONCLUSION Sustained cCR after routine preoperative radio(chemo)therapy is unlikely in patients with (near-)circular tumour or EMVI, whereas patients with cT3cdT4, cN2, mesorectal nodes > 8 mm, clinically positive lateral nodes and MRF+ should not be denied w&w.
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Affiliation(s)
- Anna Hołdakowska
- Department of Radiology, M. Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Kamila Kurkowska
- Department of Radiology, M. Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Lucyna Pietrzak
- Department of Radiotherapy I, M. Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Wojciech Michalski
- Department of Computational Oncology, M. Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Andrzej Rutkowski
- Department of Surgery of Gastrointestinal Cancers and Neuroendocrine Tumors, M. Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Tomasz Olesiński
- Department of Surgery of Gastrointestinal Cancers and Neuroendocrine Tumors, M. Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Anna Cencelewicz
- Department of Gastroenterological Oncology, M. Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Martin Rydziński
- Department of Radiotherapy I, M. Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Joanna Socha
- Department of Radiotherapy, Military Institute of Medicine - National Research Institute, Warsaw, Poland; Department of Radiotherapy, Regional Oncology Center, Czestochowa, Poland
| | - Krzysztof Bujko
- Department of Radiotherapy I, M. Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland.
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Serracant A, Consola B, Ballesteros E, Sola M, Novell F, Montes N, Serra-Aracil X. How to Study the Location and Size of Rectal Tumors That Are Candidates for Local Surgery: Rigid Rectoscopy, Magnetic Resonance, Endorectal Ultrasound or Colonoscopy? An Interobservational Study. Diagnostics (Basel) 2024; 14:315. [PMID: 38337831 PMCID: PMC10855339 DOI: 10.3390/diagnostics14030315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 01/22/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
1. BACKGROUND Preoperative staging of rectal lesions for transanal endoscopic surgery (TES) comprises digital rectal examination, intraoperative rigid rectoscopy (IRR), endorectal ultrasound (EUS), colonoscopy and rectal magnetic resonance imaging (rMRI). The gold standard for topographic features is IRR. Are the results of the other tests sufficiently reliable to eliminate the need for IRR? rMRI is a key test in advanced rectal cancer and is not operator-dependent. Description of anatomical landmarks is variable. Can we rely on the information regarding topographic features provided by all radiologists? 2. MATERIALS AND METHODS This is a concordance interobservational study involving four diagnostic tests of anatomical characteristics of rectal lesions (colonoscopy, EUS, rectal MRI and IRR), performed by four expert radiologists, regarding topographic rectal features with rMRI. 3. RESULTS Fifty-five rectal tumors were operated on by using TES. The distance of the tumor from the anal verge, location by quadrants, size by quadrants and size of tumor were assessed (IRR as gold standard). For most of the tumors, the correlation between IRR and colonoscopy or EUS was very good (ICC > 0.75); the correlation between rMRI and IRR in respect of the size by quadrants (ICC = 0.092) and location by quadrants (ICC = 0.292) was weak. Topographic landmarks studied by the expert radiologists had an excellent correlation, except for distance from the peritoneal reflection to the anal verge (ICC = 0.606). 4. CONCLUSIONS Anatomical description of rectal lesions by IRR, EUS, colonoscopy and rMRI is reliable. Topographic data obtained by EUS and colonoscopy can serve as a reference to avoid IRR. Determination of these topographic data by rMRI is less reliable. As performed by the expert radiologists, the anatomical study by rMRI is accurate and reproducible.
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Affiliation(s)
- Anna Serracant
- Coloproctology Unit, General and Digestive Surgery Department, Institut d’Investigació i Innovació Parc Tauli I3PT-CERCA, Parc Tauli Hospital Universitari, Universitat Autònoma de Barcelona, Parc Tauli s/n, 08208 Sabadell, Spain; (A.S.); (N.M.)
| | - Beatriz Consola
- Diagnostic Radiology Department, Institut d’Investigació i Innovació Parc Tauli I3PT-CERCA, Parc Tauli Hospital Universitari, Universitat Autònoma de Barcelona, Parc Tauli s/n, 08208 Sabadell, Spain; (B.C.); (E.B.); (M.S.); (F.N.)
| | - Eva Ballesteros
- Diagnostic Radiology Department, Institut d’Investigació i Innovació Parc Tauli I3PT-CERCA, Parc Tauli Hospital Universitari, Universitat Autònoma de Barcelona, Parc Tauli s/n, 08208 Sabadell, Spain; (B.C.); (E.B.); (M.S.); (F.N.)
| | - Marta Sola
- Diagnostic Radiology Department, Institut d’Investigació i Innovació Parc Tauli I3PT-CERCA, Parc Tauli Hospital Universitari, Universitat Autònoma de Barcelona, Parc Tauli s/n, 08208 Sabadell, Spain; (B.C.); (E.B.); (M.S.); (F.N.)
| | - Francesc Novell
- Diagnostic Radiology Department, Institut d’Investigació i Innovació Parc Tauli I3PT-CERCA, Parc Tauli Hospital Universitari, Universitat Autònoma de Barcelona, Parc Tauli s/n, 08208 Sabadell, Spain; (B.C.); (E.B.); (M.S.); (F.N.)
| | - Noemi Montes
- Coloproctology Unit, General and Digestive Surgery Department, Institut d’Investigació i Innovació Parc Tauli I3PT-CERCA, Parc Tauli Hospital Universitari, Universitat Autònoma de Barcelona, Parc Tauli s/n, 08208 Sabadell, Spain; (A.S.); (N.M.)
| | - Xavier Serra-Aracil
- Coloproctology Unit, General and Digestive Surgery Department, Institut d’Investigació i Innovació Parc Tauli I3PT-CERCA, Parc Tauli Hospital Universitari, Universitat Autònoma de Barcelona, Parc Tauli s/n, 08208 Sabadell, Spain; (A.S.); (N.M.)
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96
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Cai L, Lambregts DMJ, Beets GL, Mass M, Pooch EHP, Guérendel C, Beets-Tan RGH, Benson S. An automated deep learning pipeline for EMVI classification and response prediction of rectal cancer using baseline MRI: a multi-centre study. NPJ Precis Oncol 2024; 8:17. [PMID: 38253770 PMCID: PMC10803303 DOI: 10.1038/s41698-024-00516-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/14/2023] [Indexed: 01/24/2024] Open
Abstract
The classification of extramural vascular invasion status using baseline magnetic resonance imaging in rectal cancer has gained significant attention as it is an important prognostic marker. Also, the accurate prediction of patients achieving complete response with primary staging MRI assists clinicians in determining subsequent treatment plans. Most studies utilised radiomics-based methods, requiring manually annotated segmentation and handcrafted features, which tend to generalise poorly. We retrospectively collected 509 patients from 9 centres, and proposed a fully automated pipeline for EMVI status classification and CR prediction with diffusion weighted imaging and T2-weighted imaging. We applied nnUNet, a self-configuring deep learning model, for tumour segmentation and employed learned multiple-level image features to train classification models, named MLNet. This ensures a more comprehensive representation of the tumour features, in terms of both fine-grained detail and global context. On external validation, MLNet, yielding similar AUCs as internal validation, outperformed 3D ResNet10, a deep neural network with ten layers designed for analysing spatiotemporal data, in both CR and EMVI tasks. For CR prediction, MLNet showed better results than the current state-of-the-art model using imaging and clinical features in the same external cohort. Our study demonstrated that incorporating multi-level image representations learned by a deep learning based tumour segmentation model on primary MRI improves the results of EMVI classification and CR prediction with good generalisation to external data. We observed variations in the contributions of individual feature maps to different classification tasks. This pipeline has the potential to be applied in clinical settings, particularly for EMVI classification.
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Affiliation(s)
- Lishan Cai
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, P. Debyelaan 25, 66202 AZ, Maastricht, The Netherlands
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, P. Debyelaan 25, 66202 AZ, Maastricht, The Netherlands
| | - Geerard L Beets
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, P. Debyelaan 25, 66202 AZ, Maastricht, The Netherlands
- Department of Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Monique Mass
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, P. Debyelaan 25, 66202 AZ, Maastricht, The Netherlands
| | - Eduardo H P Pooch
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, P. Debyelaan 25, 66202 AZ, Maastricht, The Netherlands
| | - Corentin Guérendel
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, P. Debyelaan 25, 66202 AZ, Maastricht, The Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, P. Debyelaan 25, 66202 AZ, Maastricht, The Netherlands
| | - Sean Benson
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
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97
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Nilsson PJ. T3 N1 M0 rectal cancer: optimal initial management is total neoadjuvant therapy. Br J Surg 2024; 111:znad322. [PMID: 37995257 DOI: 10.1093/bjs/znad322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/21/2023] [Indexed: 11/25/2023]
Affiliation(s)
- Per J Nilsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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98
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Peng W, Wan L, Zhao R, Chen S, Dong S, Li L, Zhang H. Novel biomarkers based on dual-energy computed tomography for risk stratification of very early distant metastasis in colorectal cancer after surgery. Quant Imaging Med Surg 2024; 14:618-632. [PMID: 38223086 PMCID: PMC10784072 DOI: 10.21037/qims-23-861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/29/2023] [Indexed: 01/16/2024]
Abstract
Background Very early distant metastasis (VEDM) for patients with colorectal cancer (CRC) following surgery suggests failure of local treatment strategy and few biomarkers are available for its effective risk stratification. This study aimed to explore the potential of quantitative dual-energy computed tomography (DECT) spectral parameters and build models to predict VEDM. Methods Consecutive patients suspected of having CRC and with a clinical indication for enhanced CT from April 2021 to July 2022 at a single institution were prospectively enrolled to undertake spectral CT scanning. The spectral features were extracted by two reviewers and intraclass correlation coefficient (ICC) was used for interobserver agreement evaluation. A total of 16 spectral parameters, including unenhanced effective atomic number, triphasic iodine concentrations (ICs)/normalized ICs (NICs)-A/V/E/1/NIC-A/V/E/spectral curve slopes (λ-A/V/E), two arterial enhancement fractions (AEFs), and venous enhancement fraction (VEF), were determined for analysis. Patients with and without VEDM after surgery were matched using propensity score matching (PSM). The diagnostic performance was assessed using the area under the curve (AUC). Models of multiple modalities were generated. Results In total, 222 patients were included (141 males, age range, 32-83 years) and 13 patients developed VEDM. Interobserver agreement ranged from good to excellent (ICC, 0.773-0.964). A total of three spectral parameters (VEF, λ-V, and 1/NIC-V) exhibited significant discriminatory ability (P<0.05) in predicting VEDM, with AUCs of 0.822 [95% confidence interval (CI): 0.667-0.926], 0.738 (95% CI: 0.573-0.866), and 0.713 (95% CI: 0.546-0.846) and optimal cutoff points of 67.16%, 2.46, and 2.44, respectively. The performance of these spectral parameters was validated in the entire cohort; the combined spectral model showed comparable efficiency to the combined clinical model [AUC, 0.771 (95% CI: 0.622-0.919) vs. 0.779 (95% CI: 0.663-0.894), P>0.05]; the clinical-spectral model achieved further improved AUC of 0.887 (95% CI: 0.812-0.962), which was significantly higher than the combined clinical model (P=0.015), yet not superior to the combined spectral model (P=0.078). Conclusions Novel spectral parameters showed potential in predicting VEDM in CRC following surgery in this preliminary study, which were closely related with spectral perfusion in the venous phase. However, further studies with larger samples are warranted.
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Affiliation(s)
- Wenjing Peng
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lijuan Wan
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rui Zhao
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuang Chen
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shushan Dong
- Clinical Science, Philips Healthcare, Beijing, China
| | - Lin Li
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongmei Zhang
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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99
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Kikano EG, Matalon SA, Eskian M, Lee L, Melnitchouk N, Bleday R, Khorasani R. Concordance of MRI With Pathology for Primary Staging of Rectal Cancer in Routine Clinical Practice: A Single Institution Experience. Curr Probl Diagn Radiol 2024; 53:68-72. [PMID: 37704486 DOI: 10.1067/j.cpradiol.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/01/2023] [Accepted: 08/23/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE MRI is the preferred imaging modality for primary staging of rectal cancer, used to guide treatment. Patients identified with clinical stage I disease receive upfront surgical resection; those with clinical stage II or greater undergo upfront neoadjuvant therapy. Although clinical under-/over-staging may have consequences for patients and presents opportunities for organ preservation, the correlation between clinical and pathologic staging in routine clinical practice within a single institute has not been fully established. METHODS This retrospective, Institutional Review Board-approved study, conducted at a National Cancer Institute-Designated Comprehensive Cancer Center with a multi-disciplinary rectal cancer disease center, included patients undergoing rectal MRI for primary staging January 1, 2018-August 30, 2020. Data collection included patient demographics, initial clinical stage via MRI report, pathologic diagnosis, pathologic stage, and treatment. The primary outcome was concordance of overall clinical and pathologic staging. Secondary outcomes included reasons for mismatched staging. RESULTS A total 105 rectal adenocarcinoma patients (64 males, mean age 57 ± 12.7 years) had staging MRI followed by surgical resection. A total of 28 patients (27%) had mismatched under-/over- staging. Ten patients (10%) were understaged with mismatched T stage group (clinical stage I, pathologic stage II), five (5%) were understaged with mismatched N stage group (clinical stage I, pathologic stage III), and 13 (12%) were overstaged (clinical stage II-III, pathologic stage 0-I). Treatment matched concordance between clinical and pathologic stages was 86%. CONCLUSION MRI for primary rectal cancer staging has high concordance with pathology. Future studies to assess strategies for reducing clinically relevant understaging would be beneficial.
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Affiliation(s)
- Elias G Kikano
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA.
| | - Shanna A Matalon
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Mahsa Eskian
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Leslie Lee
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | - Ron Bleday
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Ramin Khorasani
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA
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100
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Chiloiro G, Gani C, Boldrini L. Rectal Cancer MRI Guided Radiotherapy: A Practical Review for the Physician. Semin Radiat Oncol 2024; 34:64-68. [PMID: 38105095 DOI: 10.1016/j.semradonc.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
MR-guided radiotherapy is a treatment approach that combines the advantages of magnetic resonance imaging (MRI) with the precision of radiation therapy. This practical review provides an overview of the current state-of-the-art of MR-guided radiotherapy for rectal cancer, including its technical aspects, clinical outcomes, and existing limitations. Even though some studies have demonstrated the feasibility and safety of this treatment modality, challenges remain in terms of patient selection, treatment planning optimization, and long-term follow-up. Despite these issues, MR-guided radiotherapy shows promise as a potentially valuable rectal cancer treatment approach.
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Affiliation(s)
- Giuditta Chiloiro
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Cihan Gani
- Department of Radiation Oncology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Luca Boldrini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.
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