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Karahacioglu D, Taskin OC, Esmer R, Armutlu A, Saka B, Ozata IH, Rencuzogullari A, Bugra D, Balik E, Adsay V, Gurses B. Performance of CT in the locoregional staging of colon cancer: detailed radiology-pathology correlation with special emphasis on tumor deposits, extramural venous invasion and T staging. Abdom Radiol (NY) 2024; 49:1792-1804. [PMID: 38446179 DOI: 10.1007/s00261-024-04203-0] [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: 11/02/2023] [Revised: 01/03/2024] [Accepted: 01/12/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE To investigate the performance of computed tomography (CT) in the local staging of colon cancer in different segments, with emphasis on parameters that have been found to be significant for rectal cancer, namely, extramural venous invasion (EMVI) and tumor deposits (TDs). METHODS CT and pathology data from 137 patients were independently reviewed by radiology and pathology teams. The performance of CT in categorizing a given patient into good, versus poor prognostic groups was assessed for each segment, as well as the presence of lymph nodes (LNs), TDs and EMVIs. Discordant cases were re-evaluated to determine potential sources of error. Elastic stain was applied for EMVI discordance. RESULTS The T staging accuracy was 80.2%. For T stage stratification, CT performed slightly better in the left colon, and the lowest accuracy was in the transverse colon. Under-staging was more common (in 12.4%), and most of the mis-staged cases were in sigmoid colon. According to the first comprehensive correlative analysis, the sensitivity, specificity, and accuracy of CT for detecting TDs were found to be 57.9%, 92.4%, 87.6%, respectively. These figures were 44.7%, 72.7%, and 63.5% for LN, and 58.5%, 82.1% and 73% for EMVI. The detection rate was better for multifocal EMVI. The detection rate was also comparable (although substantially underestimated) for LNs, with the half of the LNs missed by CT being < 5 mm. Four patients that were classified as TD by CT, disclosed to be LNs by pathology. Correlative analysis led to refinement of the pathology criteria, with subsequent modifications of the initial reports in 13 (9.5%) patients. CONCLUSION Overall, CT performed well in the evaluation of colon cancer, as did TD and EMVI. It is advisable to include these parameters in CT-based staging. Radiologists should be aware of the pitfalls that occur more commonly in different segments.
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Affiliation(s)
- Duygu Karahacioglu
- Department of Radiology, Koç University School of Medicine, 34010, Istanbul, Turkey.
| | - Orhun Cig Taskin
- Department of Pathology, Koç University School of Medicine, Istanbul, Turkey
| | - Rohat Esmer
- Koç University School of Medicine, Istanbul, Turkey
| | - Ayse Armutlu
- Department of Pathology, Koç University School of Medicine, Istanbul, Turkey
| | - Burcu Saka
- Department of Pathology, Koç University School of Medicine, Istanbul, Turkey
| | - Ibrahim Halil Ozata
- Department of General Surgery, Koç University School of Medicine, Istanbul, Turkey
| | - Ahmet Rencuzogullari
- Department of General Surgery, Koç University School of Medicine, Istanbul, Turkey
| | - Dursun Bugra
- Department of General Surgery, Koç University School of Medicine, Istanbul, Turkey
| | - Emre Balik
- Department of General Surgery, Koç University School of Medicine, Istanbul, Turkey
| | - Volkan Adsay
- Department of Pathology, Koç University School of Medicine, Istanbul, Turkey
| | - Bengi Gurses
- Department of Radiology, Koç University School of Medicine, 34010, Istanbul, Turkey
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Eberhardt SC. Detection of Extranodal Extension at Pretreatment Rectal Cancer MRI: Promising for Staging and Prognosis. Radiology 2024; 310:e240582. [PMID: 38530177 DOI: 10.1148/radiol.240582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Affiliation(s)
- Steven C Eberhardt
- From the Department of Radiology, University of New Mexico, MSC10 5530, 1 University of New Mexico, Albuquerque, NM 87131
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García-Figueiras R, Baleato-González S, Canedo-Antelo M, Alcalá L, Marhuenda A. Imaging Advances on CT and MRI in Colorectal Cancer. CURRENT COLORECTAL CANCER REPORTS 2021. [DOI: 10.1007/s11888-021-00468-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Simu P, Jung I, Banias L, Kovacs Z, Fulop ZZ, Bara T, Simu I, Gurzu S. Synchronous Colorectal Cancer: Improving Accuracy of Detection and Analyzing Molecular Heterogeneity-The Main Keys for Optimal Approach. Diagnostics (Basel) 2021; 11:diagnostics11020314. [PMID: 33671994 PMCID: PMC7919277 DOI: 10.3390/diagnostics11020314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/04/2021] [Accepted: 02/11/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND In patients with synchronous colorectal cancer (SCRC), understanding the underlying molecular behavior of such cases is mandatory for designing individualized therapy. The aim of this paper is to highlight the importance of transdisciplinary evaluation of the pre- and post-operative assessment of patients with SCRCs, from imaging to molecular investigations. METHODS Six patients with SCRCs presented with two carcinomas each. In addition to the microsatellite status (MSS), the epithelial mesenchymal transition was checked in each tumor using the biomarkers β-catenin and E-cadherin, same as KRAS and BRAF mutations. RESULTS In two of the patients, the second tumor was missed at endoscopy, but diagnosed by a subsequent computed-tomography-scan (CT-scan). From the six patients, a total of 11 adenocarcinomas (ADKs) and one squamous cell carcinoma (SCC) were analyzed. All the examined carcinomas were BRAF-wildtype microsatellite stable tumors with an epithelial histological subtype. In two of the six cases, KRAS gene status showed discordance between the two synchronous tumors, with mutations in the index tumors and wildtype status in the companion ones. CONCLUSIONS Preoperative CT-scans can be useful for detection of synchronous tumors which may be missed by colonoscopy. Where synchronous tumors are identified, therapy should be based on the molecular profile of the indexed tumors.
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Affiliation(s)
- Patricia Simu
- Department of Radiology and Imaging, ‘George Emil Palade’ University of Medicine, Pharmacy, Sciences and Technology, 530149 Targu Mures, Romania; (P.S.); (I.S.)
- Department of Pathology, ‘George Emil Palade’ University of Medicine, Pharmacy, Sciences and Technology, 530149 Targu Mures, Romania; (I.J.); (L.B.)
| | - Ioan Jung
- Department of Pathology, ‘George Emil Palade’ University of Medicine, Pharmacy, Sciences and Technology, 530149 Targu Mures, Romania; (I.J.); (L.B.)
| | - Laura Banias
- Department of Pathology, ‘George Emil Palade’ University of Medicine, Pharmacy, Sciences and Technology, 530149 Targu Mures, Romania; (I.J.); (L.B.)
- Department of Pathology, Clinical County Emergency Hospital, 530150 Targu Mures, Romania;
| | - Zsolt Kovacs
- Department of Pathology, Clinical County Emergency Hospital, 530150 Targu Mures, Romania;
- Department of Biochemistry, ‘George Emil Palade’ University of Medicine, Pharmacy, Sciences and Technology, 530149 Targu Mures, Romania
| | - Zsolt Zoltan Fulop
- Department of Surgery, ‘George Emil Palade’ University of Medicine, Pharmacy, Sciences and Technology, 530149 Targu Mures, Romania; (Z.Z.F.); (T.B.)
| | - Tivadar Bara
- Department of Surgery, ‘George Emil Palade’ University of Medicine, Pharmacy, Sciences and Technology, 530149 Targu Mures, Romania; (Z.Z.F.); (T.B.)
| | - Iunius Simu
- Department of Radiology and Imaging, ‘George Emil Palade’ University of Medicine, Pharmacy, Sciences and Technology, 530149 Targu Mures, Romania; (P.S.); (I.S.)
| | - Simona Gurzu
- Department of Pathology, ‘George Emil Palade’ University of Medicine, Pharmacy, Sciences and Technology, 530149 Targu Mures, Romania; (I.J.); (L.B.)
- Department of Pathology, Clinical County Emergency Hospital, 530150 Targu Mures, Romania;
- Research Center (CCAMF), ‘George Emil Palade’ University of Medicine, Pharmacy, Sciences and Technology, 540139 Targu Mures, Romania
- Correspondence: ; Tel.: +40-745-673550; Fax: +40-265-210407
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Huddy JR, Crockett M, Nizar AS, Smith R, Malki M, Barber N, Tilney HS. Experiences of a "COVID protected" robotic surgical centre for colorectal and urological cancer in the COVID-19 pandemic. J Robot Surg 2021; 16:59-64. [PMID: 33570736 PMCID: PMC7877309 DOI: 10.1007/s11701-021-01199-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 01/17/2021] [Indexed: 12/13/2022]
Abstract
The recent COVID-19 pandemic led to the cancellation of elective surgery across the United Kingdom. Re-establishing elective surgery in a manner that ensures patient and staff safety has been a priority. We report our experience and patient outcomes from setting up a "COVID protected" robotic unit for colorectal and renal surgery that housed both the da Vinci Si (Intuitive, Sunnyvale, CA, USA) and the Versius (CMR Surgical, Cambridge, UK) robotic systems. "COVID protected" robotic surgery was undertaken in a day-surgical unit attached to the main hospital. A standard operating procedure was developed in collaboration with the trust COVID-19 leadership team and adapted to national recommendations. 60 patients underwent elective robotic surgery in the initial 10-weeks of the study. This included 10 colorectal procedures and 50 urology procedures. Median length of stay was 4 days for rectal cancer procedures, 2 days less than prior to the COVID period, and 1 day for renal procedures. There were no instances of in-patient coronavirus transmission. Six rectal cancer patients waited more than 62 days for their surgery because of the initial COVID peak but none had an increase T-stage between pre-operative staging and post-operative histology. Robotic surgery can be undertaken in "COVID protected" units within acute hospitals in a safe way that mitigates the increased risk of undergoing major surgery in the current pandemic. Some benefits were seen such as reduced length of stay for colorectal patients that may be associated with having a dedicated unit for elective robotic surgical services.
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Affiliation(s)
- Jeremy R Huddy
- Department of Colorectal Surgery, Frimley Park Hospital, Camberley, UK
- Department of Surgery & Cancer, Imperial College London, London, UK
| | - Matthew Crockett
- Frimley Renal Cancer Centre, Frimley Park Hospital, Camberley, UK
| | - A Shiyam Nizar
- Department of Colorectal Surgery, Frimley Park Hospital, Camberley, UK
| | - Ralph Smith
- Department of Colorectal Surgery, Frimley Park Hospital, Camberley, UK
| | - Manar Malki
- Frimley Renal Cancer Centre, Frimley Park Hospital, Camberley, UK
| | - Neil Barber
- Frimley Renal Cancer Centre, Frimley Park Hospital, Camberley, UK
| | - Henry S Tilney
- Department of Colorectal Surgery, Frimley Park Hospital, Camberley, UK.
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Atre ID, Eurboonyanun K, Noda Y, Parakh A, O'Shea A, Lahoud RM, Sell NM, Kunitake H, Harisinghani MG. Utility of texture analysis on T2-weighted MR for differentiating tumor deposits from mesorectal nodes in rectal cancer patients, in a retrospective cohort. Abdom Radiol (NY) 2021; 46:459-468. [PMID: 32700214 DOI: 10.1007/s00261-020-02653-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/27/2020] [Accepted: 07/09/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The purpose of the study was to evaluate the utility of MR texture analysis for differentiating tumor deposits from mesorectal nodes in rectal cancer. MATERIALS AND METHODS Pretreatment MRI of 40 patients performed between 2006 and 2018 with pathologically proven tumor deposits and/or malignant nodes in the setting of rectal cancer were retrospectively reviewed. In total, 25 tumor deposits (TDs) and 71 positive lymph nodes (LNs) were analyzed for morphological and first-order texture analysis features on T2-weighted axial images. MR morphological features (lesion shape, size, signal heterogeneity, contrast enhancement) were analyzed and agreed in consensus by two experienced radiologists followed by assessment with Fisher's exact test. Texture analysis of the lesions was performed using TexRAD, a proprietary software algorithm. First-order texture analysis features (mean, standard deviation, skewness, entropy, kurtosis, MPP) were obtained after applying spatial scaling filters (SSF; 0, 2, 3, 4, 5, 6). Univariate analysis was performed with non-parametric Mann-Whitney U test. The results of univariate analysis were reassessed with generalized estimating equations followed by multivariate analysis. Using histopathology as a gold standard, diagnostic accuracy was assessed by obtaining area under the receiver operating curve. RESULTS MR morphological parameter, lesion shape was a strong discriminator between TDs and LNs with a p value of 0.02 (AUC: 0.76, 95% CI of 0.66 to 0.84, SE: 0.06) and sensitivity, specificity of 90% and 68%, respectively. Skewness extracted at fine filter (SSF-2) was the only significant texture analysis parameter for distinguishing TDs from LNs with p value of 0.03 (AUC: 0.70, 95% CI of 0.59 to 0.79, SE: 0.06) and sensitivity, specificity of 70% and 72%, respectively. When lesion shape and skewness-2 were combined into a single model, the diagnostic accuracy was improved with AUC of 0.82 (SE: 0.05, 95% CI of 0.72 to 0.88 with p value of < 0.01). This model also showed a high sensitivity of 91% with specificity of 68%. CONCLUSION Lesion shape on MR can be a useful predictor for distinguishing TDs from positive LNs in rectal cancer patients. When interpreted along with MR texture parameter of skewness, accuracy is further improved.
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Affiliation(s)
- Isha D Atre
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Room 270, White Building, Boston, MA, 02114, USA.
| | - Kulyada Eurboonyanun
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Room 270, White Building, Boston, MA, 02114, USA
| | - Yoshifumi Noda
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Room 270, White Building, Boston, MA, 02114, USA
| | - Anushri Parakh
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Room 270, White Building, Boston, MA, 02114, USA
| | - Aileen O'Shea
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Room 270, White Building, Boston, MA, 02114, USA
| | - Rita Maria Lahoud
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Room 270, White Building, Boston, MA, 02114, USA
| | - Naomi M Sell
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Hiroko Kunitake
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Mukesh G Harisinghani
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Room 270, White Building, Boston, MA, 02114, USA
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Junquera-Olay S, Baleato-González S, Canedo-Antelo M, Capeans-González L, Santiago-Pérez MI, Garcia-Figueiras R. "Rectal cancer survival: A retrospective analysis of MRI features and their association with prognosis". Curr Probl Diagn Radiol 2021; 51:30-37. [PMID: 33483190 DOI: 10.1067/j.cpradiol.2020.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/05/2020] [Accepted: 12/31/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE To assess rectal cancer aggressiveness using magnetic resonance (MR) imaging features and to investigate their relationship with patient prognosis. MATERIALS AND METHODS Clinical information and Pelvic MR scans of 106 consecutive patients with primary rectal cancer (RC) were analyzed. Clinical symptoms, age, sex, tumor location, and patient´s survival were recorded. The variables investigated by MR were: depth or mural/extramural tumor involvement, distance to mesorectal margin, lymph node involvement, vascular, peritoneal or sphincter complex infiltration. The association between imaging features and disease-free survival (DFS) was also assessed using a Kaplan-Meier model. Differences between survival curves were tested for significance using the Mantel-Cox LogRank test. RESULTS The final study population was 106 patients (65 males, 41 females). The median age was 69.5 years (range, 39-92 years). No significant differences were found between death risk and sex, age or tumor location (p>0,05). However, the relative risk (RR) of tumor mortality increased significantly with the presence of the variables: vascular infiltration (×5), T4 tumors (× 4.57), N2 lymph node involvement (more than 3 affected nodes × 4.11) and mesorectal fascia involvement (× 3,77). CONCLUSION Tumor extension, number of pathological lymph nodes, mesorectal fascia involvement and vascular infiltration values obtained on initial MR imaging staging showed a significant difference for disease-free survival in RC at six years of control.
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Affiliation(s)
- Sonsoles Junquera-Olay
- Department of Radiology, Santiago de Compostela University Hospital, Choupana Avenue, Santiago de Compostela, Coruña, 15706, Spain.
| | - Sandra Baleato-González
- Department of Radiology, Santiago de Compostela University Hospital, Choupana Avenue, Santiago de Compostela, Coruña, 15706, Spain
| | - María Canedo-Antelo
- Department of Radiology, Santiago de Compostela University Hospital, Choupana Avenue, Santiago de Compostela, Coruña, 15706, Spain
| | | | | | - Roberto Garcia-Figueiras
- Department of Radiology, Santiago de Compostela University Hospital, Choupana Avenue, Santiago de Compostela, Coruña, 15706, Spain
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Santiago I, Figueiredo N, Parés O, Matos C. MRI of rectal cancer-relevant anatomy and staging key points. Insights Imaging 2020; 11:100. [PMID: 32880782 PMCID: PMC7471246 DOI: 10.1186/s13244-020-00890-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/26/2020] [Indexed: 02/14/2023] Open
Abstract
Rectal cancer has the eighth highest cancer incidence worldwide, and it is increasing in young individuals. However, in countries with a high human development index, mortality is decreasing, which may reflect better patient management, imaging being key. We rely on imaging to establish the great majority of clinical tumour features for therapeutic decision-making, namely tumour location, depth of invasion, lymph node involvement, circumferential resection margin status and extramural venous invasion. Despite major improvements in technique resulting in better image quality, and notwithstanding the dissemination of guidelines and examples of standardised reports, rectal cancer staging is still challenging on the day-to-day practice, and we believe there are three reasons. First, the normal posterior pelvic compartment anatomy and variants are not common knowledge to radiologists; second, not all rectal cancers fit in review paper models, namely the very early, the very low and the mucinous; and third, the key clinical tumour features may be tricky to analyse. In this review, we discuss the normal anatomy of the rectum and posterior compartment of the pelvis, systematise all rectal cancer staging key points and elaborate on the particularities of early, low and mucinous tumours. We also include our suggested reporting templates and a discussion of its comparison to the reporting templates provided by ESGAR and SAR.
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Affiliation(s)
- Inês Santiago
- Radiology Department, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal. .,Nova Medical School, Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal. .,Champalimaud Research, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal.
| | - Nuno Figueiredo
- Colorectal Surgery, Digestive Unit, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal
| | - Oriol Parés
- Radiation Oncology Department, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal
| | - Celso Matos
- Radiology Department, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal.,Champalimaud Research, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal
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