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Chen L, Zhu W, Zhang W, Chen E, Zhou W. Magnetic resonance imaging radiomics-based prediction of severe inflammatory response in locally advanced rectal cancer patients after neoadjuvant radiochemotherapy. Langenbecks Arch Surg 2024; 409:218. [PMID: 39017754 PMCID: PMC11255083 DOI: 10.1007/s00423-024-03416-7] [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: 10/19/2023] [Accepted: 07/12/2024] [Indexed: 07/18/2024]
Abstract
PURPOSE To predict severe inflammatory response after neoadjuvant radiochemotherapy in locally advanced rectal cancer (RC) patients using magnetic resonance imaging (MRI) radiomics models. METHODS This retrospective study included patients who underwent radical surgery for RC cancer after neoadjuvant radiochemotherapy between July 2017 and December 2019 at XXX Hospital. MRI radiomics features were extracted from T2WI images before (pre-nRCT-RF) and after (post-nRCT-RF) neoadjuvant radiochemotherapy, and the variation of radiomics features before and after neoadjuvant radiochemotherapy (delta-RF) were calculated. Eight, eight, and five most relevant features were identified for pre-nRCT-RF, post-nRCT-RF, and delta-RF, respectively. RESULTS Eighty-six patients were included and randomized 3:1 to the training and test set (n = 65 and n = 21, respectively). The prediction model based on delta-RF had areas under the curve (AUCs) of 0.80 and 0.85 in the training and test set, respectively. A higher rate of difficult operations was observed in patients with severe inflammation (65.5% vs. 42.9%, P = 0.045). CONCLUSION The prediction model based on MRI delta-RF may be a useful tool for predicting severe inflammatory response after neoadjuvant radiochemotherapy in locally advanced RC patients.
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Affiliation(s)
- Li Chen
- Department of Colorectal Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China.
| | - Wenchao Zhu
- Department of Radiology, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Wei Zhang
- Department of Colorectal Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Engeng Chen
- Department of Colorectal Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Wei Zhou
- Department of Colorectal Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
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Lorenzo Liñán MÁ, García Armengol J, Martín Martín GP, Martínez Sanjuán V, Roig Vila JV. Validation of pelvic magnetic resonance imaging as the method of choice to determine the distance to the anal margin in rectal cancer. Cir Esp 2022; 100:772-779. [PMID: 36064169 DOI: 10.1016/j.cireng.2022.08.015] [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: 03/17/2021] [Accepted: 07/06/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Distance from anal verge of rectal tumours and their anatomical relationships contribute to determine the multidisciplinary therapeutic strategy based on the combination of radio-chemotherapy and radical surgery. Our aims are to investigate which is the most accurate method for the preoperative measuring of the distance from the anal verge in rectal tumours and if the pelvic MRI can substitute the classical instrumental methods. METHODS Prospective study of diagnostic precision between flexible colonoscopy (FC), preoperative rigid rectosigmoidoscopy (pRR) and pelvic MRI in patients scheduled to radical surgery. Rigid intraoperative rectoscopy (iRR) was considered the reference test. The correlations between the different techniques and their determination coefficient as well as the intraclass correlation coefficient and the degree of agreement between the different tests were analyzed. RESULTS 96 patients (65% males), mean age (SD): 68 (14.1) years were included. 72% received neoadjuvant treatment. The mean distance to the anal margin measured by FC = 103.5 mm, was significantly greater than others, which had similar values: pRR = 81.1; MRI = 77.4; iRR = 82.9 mm (P < .001). A significant intraclass correlation was observed and there was high agreement between all pre- and intraoperative measurements except for the performed by FC, which overestimated the results. MRI provided more individualized and accurate information. CONCLUSIONS There is variability between the measurement methods, being colonoscopy the least reliable. MRI offers objective, comparable, accurate and individualized values that can replace those obtained by pRR for tumours of any location in the rectum.
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Affiliation(s)
- Miguel Ángel Lorenzo Liñán
- Servicio de Cirugía General y Digestiva, Hospital Universitario Torrecárdenas, Almería, Spain; Servicio de Cirugía General y del Aparato Digestivo, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
| | - Juan García Armengol
- Centro Europeo de Cirugía Colorrectal, Hospital Vithas Valencia 9 de Octubre, Valencia, Spain; Servicio de Cirugía General y del Aparato Digestivo, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Gonzalo Pablo Martín Martín
- Cirugía, Centro Médico Teknon, Barcelona, Spain; Servicio de Cirugía General y del Aparato Digestivo, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Vicente Martínez Sanjuán
- Servicio de Radiología y Resonancia Magnética, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - José Vicente Roig Vila
- Centro Europeo de Cirugía Colorrectal, Hospital Vithas Valencia 9 de Octubre, Valencia, Spain; Servicio de Cirugía General y del Aparato Digestivo, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
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3
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Patel S, Kazi M, Desouza AL, Sukumar V, Gori J, Bal M, Saklani A. Outcomes of rectal cancer patients with a positive pathological circumferential resection margin. Langenbecks Arch Surg 2022; 407:1151-1159. [PMID: 34988641 DOI: 10.1007/s00423-021-02392-6] [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: 05/26/2021] [Accepted: 11/30/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Evidence-based management of positive pathological circumferential resection margin (pCRM) following preoperative radiation and an adequate rectal resection for rectal cancers is lacking. METHODS Retrospective analysis of prospectively maintained single-centre institutional database was done to study the patterns of failure and management strategies after a rectal cancer surgery with a positive pCRM. RESULTS A total of 86 patients with rectal adenocarcinoma with a positive pCRM were identified over 8 years (2011-2018). Majority had low-lying rectal cancers (90.7%) and were operated after preoperative radiotherapy (95.3%). Operative procedures included abdomino-perineal resections, inter-sphincteric resections, low anterior resections and pelvic exenteration in 61 (70.9%), 9 (10.5%), 11(12.8%) and 5 (5.8%) patients respectively. A total of 83 (96.5%) received chemotherapy as the sole adjuvant treatment modality while 2 patients (2.3%) were given post-operative radiotherapy and 1 patient underwent revision surgery. A total of 53 patients (61.6%) had recurrence, with 16 (18.6%), 20 (23.2%), 8(9.3%) and 9 (10.5%) patients having locoregional, systemic, peritoneal and simultaneous local-systemic relapse. Systemic recurrences were more often detected either by surveillance in an asymptomatic patient (20.1%) while local (13.1%) and peritoneal (13.2%) recurrences were more often symptomatic (p = 0.000). The 2-year overall survival (OS) and disease-free survival (DFS) of the cohort was 82.4% and 74.0%. Median local recurrence-free survival (LRFS) was 10.3 months. CONCLUSIONS Patients with a positive pCRM have high local and distal relapse rates. Systemic relapses are more often asymptomatic as compared to peritoneal or locoregional relapse and detected on follow-up surveillance. Hence, identification of such recurrences while still salvageable via an intensive surveillance protocol is desirable.
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Affiliation(s)
- Swapnil Patel
- Colorectal Division, Department of GI & HPB Surgery, Tata Memorial Centre, Homi Bhabha National University Mumbai, Mumbai, India, 400012
| | - Mufaddal Kazi
- Colorectal Division, Department of GI & HPB Surgery, Tata Memorial Centre, Homi Bhabha National University Mumbai, Mumbai, India, 400012
| | - Ashwin L Desouza
- Colorectal Division, Department of GI & HPB Surgery, Tata Memorial Centre, Homi Bhabha National University Mumbai, Mumbai, India, 400012
| | - Vivek Sukumar
- Colorectal Division, Department of GI & HPB Surgery, Tata Memorial Centre, Homi Bhabha National University Mumbai, Mumbai, India, 400012
| | - Jayesh Gori
- Colorectal Division, Department of GI & HPB Surgery, Tata Memorial Centre, Homi Bhabha National University Mumbai, Mumbai, India, 400012
| | - Munita Bal
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National University Mumbai, Mumbai, India, 400012
| | - Avanish Saklani
- Colorectal Division, Department of GI & HPB Surgery, Tata Memorial Centre, Homi Bhabha National University Mumbai, Mumbai, India, 400012.
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4
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Lorenzo Liñán MÁ, García Armengol J, Martín Martín GP, Martínez Sanjuán V, Roig Vila JV. Validation of pelvic magnetic resonance imaging as the method of choice to determine the distance to the anal margin in rectal cancer. Cir Esp 2021; 100:S0009-739X(21)00245-1. [PMID: 34493375 DOI: 10.1016/j.ciresp.2021.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/30/2021] [Accepted: 07/06/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Distance from anal verge of rectal tumors and their anatomical relationships contribute to determine the multidisciplinary therapeutic strategy based on the combination of radio-chemotherapy and radical surgery. Our aims are to investigate which is the most accurate method for the preoperative measuring of the distance from the anal verge in rectal tumors and if the pelvic MRI can substitute the classical instrumental methods. METHODS Prospective study of diagnostic precision between flexible colonoscopy (FC), preoperative rigid rectosigmoidoscopy (pRR) and pelvic MRI in patients scheduled to radical surgery. Rigid intraoperative rectoscopy (iRR) was considered the reference test. The correlations between the different techniques and their determination coefficient as well as the intraclass correlation coefficient and the degree of agreement between the different tests were analyzed. RESULTS 96 patients (65% males), mean age (SD): 68 (14.1) years were included. 72% received neoadjuvant treatment. The mean distance to the anal margin measured by FC=103.5mm, was significantly greater than others, which had similar values: pRR=81.1; MRI=77.4; iRR=82.9mm (P<.001). A significant intraclass correlation was observed and there was high agreement between all pre- and intraoperative measurements except for the performed by FC, which overestimated the results. MRI provided more individualized and accurate information. CONCLUSIONS There is variability between the measurement methods, being colonoscopy the least reliable. MRI offers objective, comparable, accurate and individualized values that can replace those obtained by pRR for tumors of any location in the rectum.
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Affiliation(s)
- Miguel Ángel Lorenzo Liñán
- Servicio de Cirugía General y Digestiva, Hospital Universitario Torrecárdenas, , Almería, España; La filiación de Miguel Ángel Lorenzo Liñán, Juan García Armengol, Gonzalo Pablo Martin Martin y José Vicente Roig Vila en el momento de la realización de este artículo era: Servicio de Cirugía General y del Aparato Digestivo, Consorcio Hospital General Universitario de Valencia, Valencia, España.
| | - Juan García Armengol
- Centro Europeo de Cirugía Colorrectal, Hospital Vithas Valencia 9 de Octubre, Valencia, España; La filiación de Miguel Ángel Lorenzo Liñán, Juan García Armengol, Gonzalo Pablo Martin Martin y José Vicente Roig Vila en el momento de la realización de este artículo era: Servicio de Cirugía General y del Aparato Digestivo, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - Gonzalo Pablo Martín Martín
- Cirugía, Centro Médico Teknon, Barcelona, España; La filiación de Miguel Ángel Lorenzo Liñán, Juan García Armengol, Gonzalo Pablo Martin Martin y José Vicente Roig Vila en el momento de la realización de este artículo era: Servicio de Cirugía General y del Aparato Digestivo, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - Vicente Martínez Sanjuán
- Servicio de Radiología y Resonancia Magnética, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - José Vicente Roig Vila
- Centro Europeo de Cirugía Colorrectal, Hospital Vithas Valencia 9 de Octubre, Valencia, España; La filiación de Miguel Ángel Lorenzo Liñán, Juan García Armengol, Gonzalo Pablo Martin Martin y José Vicente Roig Vila en el momento de la realización de este artículo era: Servicio de Cirugía General y del Aparato Digestivo, Consorcio Hospital General Universitario de Valencia, Valencia, España
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5
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Antunes JT, Ofshteyn A, Bera K, Wang EY, Brady JT, Willis JE, Friedman KA, Marderstein EL, Kalady MF, Stein SL, Purysko AS, Paspulati R, Gollamudi J, Madabhushi A, Viswanath SE. Radiomic Features of Primary Rectal Cancers on Baseline T 2 -Weighted MRI Are Associated With Pathologic Complete Response to Neoadjuvant Chemoradiation: A Multisite Study. J Magn Reson Imaging 2020; 52:1531-1541. [PMID: 32216127 PMCID: PMC7529659 DOI: 10.1002/jmri.27140] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Twenty-five percent of rectal adenocarcinoma patients achieve pathologic complete response (pCR) to neoadjuvant chemoradiation and could avoid proctectomy. However, pretreatment clinical or imaging markers are lacking in predicting response to chemoradiation. Radiomic texture features from MRI have recently been associated with therapeutic response in other cancers. PURPOSE To construct a radiomics texture model based on pretreatment MRI for identifying patients who will achieve pCR to neoadjuvant chemoradiation in rectal cancer, including validation across multiple scanners and sites. STUDY TYPE Retrospective. SUBJECTS In all, 104 rectal cancer patients staged with MRI prior to long-course chemoradiation followed by proctectomy; curated from three institutions. FIELD STRENGTH/SEQUENCE 1.5T-3.0T, axial higher resolution T2 -weighted turbo spin echo sequence. ASSESSMENT Pathologic response was graded on postsurgical specimens. In total, 764 radiomic features were extracted from single-slice sections of rectal tumors on processed pretreatment T2 -weighted MRI. STATISTICAL TESTS Three feature selection schemes were compared for identifying radiomic texture descriptors associated with pCR via a discovery cohort (one site, N = 60, cross-validation). The top-selected radiomic texture features were used to train and validate a random forest classifier model for pretreatment identification of pCR (two external sites, N = 44). Model performance was evaluated via area under the curve (AUC), accuracy, sensitivity, and specificity. RESULTS Laws kernel responses and gradient organization features were most associated with pCR (P ≤ 0.01); as well as being commonly identified across all feature selection schemes. The radiomics model yielded a discovery AUC of 0.699 ± 0.076 and a hold-out validation AUC of 0.712 with 70.5% accuracy (70.0% sensitivity, 70.6% specificity) in identifying pCR. Radiomic texture features were resilient to variations in magnetic field strength as well as being consistent between two different expert annotations. Univariate analysis revealed no significant associations of baseline clinicopathologic or MRI findings with pCR (P = 0.07-0.96). DATA CONCLUSION Radiomic texture features from pretreatment MRIs may enable early identification of potential pCR to neoadjuvant chemoradiation, as well as generalize across sites. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Jacob T. Antunes
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, OH 44106
| | - Asya Ofshteyn
- University Hospitals Cleveland Medical Center, Department of Surgery, Cleveland, OH, 44106
| | - Kaustav Bera
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, OH 44106
| | - Erik Y. Wang
- University Hospitals Cleveland Medical Center, Department of Surgery, Cleveland, OH, 44106
| | - Justin T. Brady
- University Hospitals Cleveland Medical Center, Department of Surgery, Cleveland, OH, 44106
| | - Joseph E. Willis
- University Hospitals Cleveland Medical Center, Department of Pathology, Cleveland, OH, 44106
| | - Kenneth A. Friedman
- University Hospitals Cleveland Medical Center, Department of Pathology, Cleveland, OH, 44106
| | - Eric L. Marderstein
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, 44106
| | - Matthew F. Kalady
- Cleveland Clinic, Department of Colorectal Surgery, Cleveland, OH, 44106
| | - Sharon L. Stein
- University Hospitals Cleveland Medical Center, Department of Surgery, Cleveland, OH, 44106
| | - Andrei S. Purysko
- Cleveland Clinic, Section of Abdominal Imaging and Nuclear Radiology Department, Cleveland, OH, 44195
| | - Rajmohan Paspulati
- University Hospitals Cleveland Medical Center, Department of Radiology, Cleveland, OH, 44106
| | - Jayakrishna Gollamudi
- University Hospitals Cleveland Medical Center, Department of Radiology, Cleveland, OH, 44106
| | - Anant Madabhushi
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, OH 44106
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, 44106
| | - Satish E. Viswanath
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, OH 44106
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Simpson G, Hopley P, Wilson J, Day N, Haworth A, Montazeri A, Smith D, Titu L, Anderson J, Agbamu D, Walsh C. Long-term outcomes of real world 'watch and wait' data for rectal cancer after neoadjuvant chemoradiotherapy. Colorectal Dis 2020; 22:1568-1576. [PMID: 32686268 DOI: 10.1111/codi.15177] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/13/2020] [Indexed: 12/27/2022]
Abstract
AIM A 'watch and wait' (W&W) strategy after neoadjuvant long-course chemoradiotherapy (NACRT) remains controversial. Whilst encouraging short-term data exist, the strategy will be judged on long-term data. We present long-term, real-world UK data from a single National Health Service trust. METHODS An analysis was performed of a prospectively maintained W&W database over 9 years between 2010 and 2018. Outcome measures include incidence and time to regrowth and overall and disease-free survival. RESULTS We diagnosed 563 rectal cancers in 9 years. In all, 283 patients underwent rectal resection (50.3%). NACRT was used in 155 patients for margin-threatened tumours on staging MRI. Forty-nine patients (31.6%) experienced either a 'near complete' or a complete clinical response (cCR) at their 10 weeks post-NACRT assessment (MRI and endoscopy). The median age was 69 years (range 44-83), and the male to female ratio was 32:17. The median follow-up was 38 months (range 12-96). The median tumour distance from the anal verge was 7 cm (1-15 cm). Twenty-two patients had a cCR on initial assessment and 27 patients had a 'near' cCR. Of those 27 who experienced a 'near' cCR, 17 (63%) progressed to cCR on repeat assessment and 10 (37%) did not. Of these 10 patients, seven underwent standard surgical resection and three were unfit for surgery. R0 for the seven with delayed resection was 100%. Of 39 patients (22 cCR and 17 'near' cCR who progressed to cCR) (25.2% of those receiving NACRT), six patients experienced local regrowth (15.4%). The median time to local regrowth was 29 months (15-60 months). One of these six patients underwent salvage abdominoperineal resection, one was advised to have contact radiotherapy and four opted against surgery and also had contact radiotherapy. The overall survival was 100% at 2 years and 90% at 5 years. Disease-free survival was 90.47% at 2 years and 74.8% at 5 years. CONCLUSION A W&W treatment strategy was employed safely in this patient cohort with acceptable rates of local regrowth and survival.
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Affiliation(s)
- G Simpson
- Wirral University Teaching Hospital, Wirral, UK
| | - P Hopley
- Wirral University Teaching Hospital, Wirral, UK
| | - J Wilson
- Wirral University Teaching Hospital, Wirral, UK
| | - N Day
- Wirral University Teaching Hospital, Wirral, UK
| | - A Haworth
- Wirral University Teaching Hospital, Wirral, UK
| | | | - D Smith
- Wirral University Teaching Hospital, Wirral, UK
| | - L Titu
- Wirral University Teaching Hospital, Wirral, UK
| | - J Anderson
- Wirral University Teaching Hospital, Wirral, UK
| | - D Agbamu
- Wirral University Teaching Hospital, Wirral, UK
| | - C Walsh
- Wirral University Teaching Hospital, Wirral, UK
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Ding L, Liu G, Zhang X, Liu S, Li S, Zhang Z, Guo Y, Lu Y. A deep learning nomogram kit for predicting metastatic lymph nodes in rectal cancer. Cancer Med 2020; 9:8809-8820. [PMID: 32997900 PMCID: PMC7724302 DOI: 10.1002/cam4.3490] [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: 04/20/2020] [Revised: 09/10/2020] [Accepted: 09/10/2020] [Indexed: 12/14/2022] Open
Abstract
Background Preoperative diagnoses of metastatic lymph nodes (LNs) by the most advanced deep learning technology of Faster Region‐based Convolutional Neural Network (Faster R‐CNN) have not yet been reported. Materials and Methods In total, 545 patients with pathologically confirmed rectal cancer between January 2016 and March 2019 were included and were randomly allocated with a split ratio of 2:1 to the training and validation sets, respectively. The MRI images for metastatic LNs were evaluated by Faster R‐CNN. Multivariate regression analyses were used to develop the predictive models. Faster R‐CNN nomograms were constructed based on the multivariate analyses in the training sets and were validated in the validation sets. Results The Faster R‐CNN nomogram for predicting metastatic LN status contained predictors of age, metastatic LNs by Faster R‐CNN and differentiation degrees of tumors, with areas under the curves (AUCs) of 0.862 (95% CI: 0.816‐0.909) and 0.920 (95% CI: 0.876‐0.964) in the training and validation sets, respectively. The Faster R‐CNN nomogram for predicting LN metastasis degree contained predictors of metastatic LNs by Faster R‐CNN and differentiation degrees of tumors, with AUCs of 0.859 (95% CI: 0.804‐0.913) and 0.886 (95% CI: 0.822‐0.950) in the training and validation sets, respectively. Calibration plots and decision curve analyses demonstrated good calibrations and clinical utilities. The two nomograms were used jointly as a kit for predicting metastatic LNs. Conclusion The Faster R‐CNN nomogram kit exhibits excellent performance in discrimination, calibration, and clinical utility and is convenient and reliable for predicting metastatic LNs preoperatively. Clinical trial registration: ChiCTR‐DDD‐17013842.
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Affiliation(s)
- Lei Ding
- Department of Epidemiology and Health Statistics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.,Department of Quality Management and Evaluation, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Guangwei Liu
- Shandong Key Laboratory of Digital Medicine and Computer Assisted Surgery, Qingdao University, Qingdao, Shandong, China.,Department of Outpatient Administration, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xianxiang Zhang
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Shanglong Liu
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Shuai Li
- State Key Laboratory of Virtual Reality Technology and Systems, Beihang University, Beijing, China
| | - Zhengdong Zhang
- State Key Laboratory of Virtual Reality Technology and Systems, Beihang University, Beijing, China
| | - Yuting Guo
- State Key Laboratory of Virtual Reality Technology and Systems, Beihang University, Beijing, China
| | - Yun Lu
- Shandong Key Laboratory of Digital Medicine and Computer Assisted Surgery, Qingdao University, Qingdao, Shandong, China.,Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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8
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Artificial intelligence system of faster region-based convolutional neural network surpassing senior radiologists in evaluation of metastatic lymph nodes of rectal cancer. Chin Med J (Engl) 2019; 132:379-387. [PMID: 30707177 PMCID: PMC6595714 DOI: 10.1097/cm9.0000000000000095] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND An artificial intelligence system of Faster Region-based Convolutional Neural Network (Faster R-CNN) is newly developed for the diagnosis of metastatic lymph node (LN) in rectal cancer patients. The primary objective of this study was to comprehensively verify its accuracy in clinical use. METHODS Four hundred fourteen patients with rectal cancer discharged between January 2013 and March 2015 were collected from 6 clinical centers, and the magnetic resonance imaging data for pelvic metastatic LNs of each patient was identified by Faster R-CNN. Faster R-CNN based diagnoses were compared with radiologist based diagnoses and pathologist based diagnoses for methodological verification, using correlation analyses and consistency check. For clinical verification, the patients were retrospectively followed up by telephone for 36 months, with post-operative recurrence of rectal cancer as a clinical outcome; recurrence-free survivals of the patients were compared among different diagnostic groups, by methods of Kaplan-Meier and Cox hazards regression model. RESULTS Significant correlations were observed between any 2 factors among the numbers of metastatic LNs separately diagnosed by radiologists, Faster R-CNN and pathologists, as evidenced by rradiologist-Faster R-CNN of 0.912, rPathologist-radiologist of 0.134, and rPathologist-Faster R-CNN of 0.448 respectively. The value of kappa coefficient in N staging between Faster R-CNN and pathologists was 0.573, and this value between radiologists and pathologists was 0.473. The 3 groups of Faster R-CNN, radiologists and pathologists showed no significant differences in the recurrence-free survival time for stage N0 and N1 patients, but significant differences were found for stage N2 patients. CONCLUSION Faster R-CNN surpasses radiologists in the evaluation of pelvic metastatic LNs of rectal cancer, but is not on par with pathologists. TRIAL REGISTRATION www.chictr.org.cn (No. ChiCTR-DDD-17013842).
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9
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Lu Y, Yu Q, Gao Y, Zhou Y, Liu G, Dong Q, Ma J, Ding L, Yao H, Zhang Z, Xiao G, An Q, Wang G, Xi J, Yuan W, Lian Y, Zhang D, Zhao C, Yao Q, Liu W, Zhou X, Liu S, Wu Q, Xu W, Zhang J, Wang D, Sun Z, Gao Y, Zhang X, Hu J, Zhang M, Wang G, Zheng X, Wang L, Zhao J, Yang S. Identification of Metastatic Lymph Nodes in MR Imaging with Faster Region-Based Convolutional Neural Networks. Cancer Res 2018; 78:5135-5143. [PMID: 30026330 DOI: 10.1158/0008-5472.can-18-0494] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 05/15/2018] [Accepted: 07/09/2018] [Indexed: 12/25/2022]
Abstract
MRI is the gold standard for confirming a pelvic lymph node metastasis diagnosis. Traditionally, medical radiologists have analyzed MRI image features of regional lymph nodes to make diagnostic decisions based on their subjective experience; this diagnosis lacks objectivity and accuracy. This study trained a faster region-based convolutional neural network (Faster R-CNN) with 28,080 MRI images of lymph node metastasis, allowing the Faster R-CNN to read those images and to make diagnoses. For clinical verification, 414 cases of rectal cancer at various medical centers were collected, and Faster R-CNN-based diagnoses were compared with radiologist diagnoses using receiver operating characteristic curves (ROC). The area under the Faster R-CNN ROC was 0.912, indicating a more effective and objective diagnosis. The Faster R-CNN diagnosis time was 20 s/case, which was much shorter than the average time (600 s/case) of the radiologist diagnoses.Significance: Faster R-CNN enables accurate and efficient diagnosis of lymph node metastases. Cancer Res; 78(17); 5135-43. ©2018 AACR.
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Affiliation(s)
- Yun Lu
- Affiliated Hospital of Qingdao University, Qingdao, China. .,Shandong Key Laboratory of Digital Medicine and Computer Assisted Surgery, Qingdao, China
| | - Qiyue Yu
- Affiliated Hospital of Qingdao University, Qingdao, China. .,Shandong Key Laboratory of Digital Medicine and Computer Assisted Surgery, Qingdao, China
| | - Yuanxiang Gao
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yunpeng Zhou
- Affiliated Hospital of Qingdao University, Qingdao, China.,Shandong Key Laboratory of Digital Medicine and Computer Assisted Surgery, Qingdao, China
| | - Guangwei Liu
- Affiliated Hospital of Qingdao University, Qingdao, China.,Shandong Key Laboratory of Digital Medicine and Computer Assisted Surgery, Qingdao, China
| | - Qian Dong
- Affiliated Hospital of Qingdao University, Qingdao, China.,Shandong Key Laboratory of Digital Medicine and Computer Assisted Surgery, Qingdao, China
| | - Jinlong Ma
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lei Ding
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hongwei Yao
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, & National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Zhongtao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, & National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Gang Xiao
- Beijing Hospital & National Center of Gerontology, Beijing. China
| | - Qi An
- Beijing Hospital & National Center of Gerontology, Beijing. China
| | - Guiying Wang
- Fourth Hospital of Hebei Medical University, Hebei, China
| | - Jinchuan Xi
- Fourth Hospital of Hebei Medical University, Hebei, China
| | - Weitang Yuan
- First Affiliated Hospital of Zhengzhou University, Zhenzhou, China
| | - Yugui Lian
- First Affiliated Hospital of Zhengzhou University, Zhenzhou, China
| | | | | | - Qin Yao
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wei Liu
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaoming Zhou
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shuhao Liu
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qingyao Wu
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wenjian Xu
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jianli Zhang
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Dongshen Wang
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhenqing Sun
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yuan Gao
- Affiliated Hospital of Qingdao University, Qingdao, China
| | | | - Jilin Hu
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Maoshen Zhang
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Guanrong Wang
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xuefeng Zheng
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lei Wang
- The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jie Zhao
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shujian Yang
- Affiliated Hospital of Qingdao University, Qingdao, China
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Long-term oncological outcomes of robotic versus laparoscopic total mesorectal excision of mid-low rectal cancer following neoadjuvant chemoradiation therapy. Surg Endosc 2016. [PMID: 27631313 DOI: 10.1007/s00464‐016‐5165‐6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PROPOSE The use of robotic surgery and neoadjuvant chemoradiation therapy (CRT) for rectal cancer is increasing steadily worldwide. However, there are insufficient data on long-term outcomes of robotic surgery in this clinical setting. The aim of this study was to compare the 5-year oncological outcomes of laparoscopic vs. robotic total mesorectal excision for mid-low rectal cancer after neoadjuvant CRT. MATERIALS AND METHODS One hundred thirty-eight patients who underwent robotic (n = 74) or laparoscopic (n = 64) resections between January 2006 and December 2010 for mid and low rectal cancer after neoadjuvant CRT were identified from a prospective database. The long-term oncological outcomes of these patients were analyzed using prospective follow-up data. RESULTS The median follow-up period was 56.1 ± 16.6 months (range 11-101). The 5-year overall survival (OS) rate of the laparoscopic and robotic groups was 93.3 and 90.0 %, respectively, (p = 0424). The 5-year disease-free survival (DFS) rate was 76.0 % (laparoscopic) vs. 76.8 % (robotic) (p = 0.834). In a subgroup analysis according to the yp-stage (complete pathologic response, yp-stage I, yp-stage II, or yp-stage III), the between-group oncological outcomes were not significantly different. The local recurrence rate was 6.3 % (laparoscopic, n = 4) vs. 2.7 % (robotic, n = 2) (p = 0.308). The systemic recurrence rate was 15.6 % (laparoscopic, n = 10) vs. 18.9 % (robotic, n = 14) (p = 0.644). All recurrences occurred within less than 36 months in both groups. The median period of recurrence was 14.2 months. CONCLUSION Robotic surgery for rectal cancer after neoadjuvant CRT can be performed safely, with long-term oncological outcomes comparable to those obtained with laparoscopic surgery. More large-scale studies and long-term follow-up data are needed.
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Lim DR, Bae SU, Hur H, Min BS, Baik SH, Lee KY, Kim NK. Long-term oncological outcomes of robotic versus laparoscopic total mesorectal excision of mid-low rectal cancer following neoadjuvant chemoradiation therapy. Surg Endosc 2016; 31:1728-1737. [PMID: 27631313 DOI: 10.1007/s00464-016-5165-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 07/30/2016] [Indexed: 02/01/2023]
Abstract
PROPOSE The use of robotic surgery and neoadjuvant chemoradiation therapy (CRT) for rectal cancer is increasing steadily worldwide. However, there are insufficient data on long-term outcomes of robotic surgery in this clinical setting. The aim of this study was to compare the 5-year oncological outcomes of laparoscopic vs. robotic total mesorectal excision for mid-low rectal cancer after neoadjuvant CRT. MATERIALS AND METHODS One hundred thirty-eight patients who underwent robotic (n = 74) or laparoscopic (n = 64) resections between January 2006 and December 2010 for mid and low rectal cancer after neoadjuvant CRT were identified from a prospective database. The long-term oncological outcomes of these patients were analyzed using prospective follow-up data. RESULTS The median follow-up period was 56.1 ± 16.6 months (range 11-101). The 5-year overall survival (OS) rate of the laparoscopic and robotic groups was 93.3 and 90.0 %, respectively, (p = 0424). The 5-year disease-free survival (DFS) rate was 76.0 % (laparoscopic) vs. 76.8 % (robotic) (p = 0.834). In a subgroup analysis according to the yp-stage (complete pathologic response, yp-stage I, yp-stage II, or yp-stage III), the between-group oncological outcomes were not significantly different. The local recurrence rate was 6.3 % (laparoscopic, n = 4) vs. 2.7 % (robotic, n = 2) (p = 0.308). The systemic recurrence rate was 15.6 % (laparoscopic, n = 10) vs. 18.9 % (robotic, n = 14) (p = 0.644). All recurrences occurred within less than 36 months in both groups. The median period of recurrence was 14.2 months. CONCLUSION Robotic surgery for rectal cancer after neoadjuvant CRT can be performed safely, with long-term oncological outcomes comparable to those obtained with laparoscopic surgery. More large-scale studies and long-term follow-up data are needed.
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Affiliation(s)
- Dae Ro Lim
- Colon and Rectal Surgery Section, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung Uk Bae
- Colon and Rectal Surgery Section, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
- Division of Colorectal Surgery, Department of Surgery, School of Medicine, Keimyung University and Dongsan Medical Center, Daegu, Korea
| | - Hyuk Hur
- Colon and Rectal Surgery Section, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Byung Soh Min
- Colon and Rectal Surgery Section, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung Hyuk Baik
- Colon and Rectal Surgery Section, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Kang Young Lee
- Colon and Rectal Surgery Section, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Nam Kyu Kim
- Colon and Rectal Surgery Section, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
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12
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Towner RA, Smith N, Saunders D, Van Gordon SB, Tyler KR, Wisniewski AB, Greenwood-Van Meerveld B, Hurst RE. Assessment of colon and bladder crosstalk in an experimental colitis model using contrast-enhanced magnetic resonance imaging. Neurogastroenterol Motil 2015; 27:1571-9. [PMID: 26303228 PMCID: PMC4624485 DOI: 10.1111/nmo.12654] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 07/17/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) consists of two chronic remitting-relapsing inflammatory disorders in the colon referred to as ulcerative colitis and Crohn's disease (CD). Inflammatory bowel disease affects about 1.4 million Americans. 2,4,6-trinitrobenzene sulfonic acid (TNBS)-induced colitis is a widely used model of experimental intestinal inflammation with characteristic transmural and segmental lesions that are similar to CD. METHODS Here, we report on the use of contrast-enhanced magnetic resonance imaging (CE-MRI) to monitor in vivo bladder permeability changes resulting from bladder crosstalk following colon TNBS exposure, and TNBS-induced colitis. Changes in MRI signal intensities and histology were evaluated for both colon and bladder regions. KEY RESULTS Uptake of contrast agent in the colon demonstrated a significant increase in signal intensity (SI) for TNBS-exposed rats (p < 0.01) compared to controls. In addition, a significant increase in bladder SI for colon TNBS-exposed rats (p < 0.001) was observed compared to saline controls. Histological damage within the colon was observed, however, bladder histology indicated a normal urothelium in rats with TNBS-induced colitis, despite increased permeability seen by CE-MRI. CONCLUSIONS & INFERENCES Contrast-enhanced MRI was able to quantitatively measure inflammation associated with TNBS-induced colitis, and assess bladder crosstalk measured as an increase in urothelial permeability. Although CE-MRI is routinely used to assess inflammation with IBD, currently there is no diagnostic test to assess bladder crosstalk with this disease, and our developed method may be useful in providing crosstalk information between organ and tissue systems in IBD patients, in addition to colitis.
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Affiliation(s)
- Rheal A. Towner
- Advanced Magnetic Resonance Center, Oklahoma Medical Research Foundation, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA,Corresponding Author: Rheal A. Towner, Ph.D., Director, Advanced Magnetic Resonance Center, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104 USA, , Phone: 405-272-7383
| | - Nataliya Smith
- Advanced Magnetic Resonance Center, Oklahoma Medical Research Foundation, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
| | - Debra Saunders
- Advanced Magnetic Resonance Center, Oklahoma Medical Research Foundation, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
| | - Samuel B. Van Gordon
- Department of Urology, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
| | - Karl R. Tyler
- Department of Physiology, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
| | - Amy B. Wisniewski
- Department of Urology, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
| | | | - Robert E. Hurst
- Department of Urology, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
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