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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) 2024:10.1007/s00261-024-04203-0. [PMID: 38446179 DOI: 10.1007/s00261-024-04203-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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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Lv B, Cheng X, Xie Y, Cheng Y, Yang Z, Wang Z, Jin E. Predictive value of lesion morphology in rectal cancer based on MRI before surgery. BMC Gastroenterol 2023; 23:318. [PMID: 37726671 PMCID: PMC10510204 DOI: 10.1186/s12876-023-02910-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/02/2023] [Indexed: 09/21/2023] Open
Abstract
OBJECTIVE To explore the relationship of MRI morphology of primary rectal cancer with extramural vascular invasion (EMVI), metastasis and local recurrence. MATERIALS AND METHODS This retrospective study included 153 patients with rectal cancer. Imaging factors and histopathological index including nodular projection (NP), cord sign (CS) at primary tumor margin, irregular nodules (IN) of mesorectum, MRI-detected peritoneal reflection invasion (PRI), range of rectal wall invasion (RRWI), patterns and length of tumor growth, maximal extramural depth (EMD), histologically confirmed local node involvement (hLN), MRI T stage, MRI N stage, MRI-detected extramural vascular invasion (mEMVI) and histologically confirmed extramural vascular invasion (hEMVI) were evaluated. Determining the relationship between imaging factors and hEMVI, synchronous metastasis and local recurrence by univariate analysis and multivariable logistic regression, and a nomogram validated internally via Bootstrap self-sampling was constructed based on the latter. RESULTS Thirty-eight cases of hEMVI, fourteen cases of synchronous metastasis and ten cases of local recurrence were observed among 52 NP cases. There were 50 cases of mEMVI with moderate consistency with hEMVI (Kappa = 0.614). NP, CS, EMD and mEMVI showed statistically significant differences in the negative and positive groups of hEMVI, synchronous metastasis, and local recurrence. Compared to patients with local mass growth, the rectal tumor with circular infiltration had been found to be at higher risk of synchronous metastasis and local recurrence (P < 0.05). NP and IN remained as significant predictors for hEMVI, and mEMVI was a predictor for synchronous metastasis, while PRI and mEMVI were predictors for local recurrences. The nomogram for predicting hEMVI demonstrated a C-index of 0.868, sensitivity of 86.0%, specificity of 79.6%, and accuracy of 81.7%. CONCLUSION NP, CS, IN, large EMD, mEMVI, and circular infiltration are significantly associated with several adverse prognostic indicators. The nomogram based on NP has good predictive performance for preoperative EMVI. mEMVI is a risk factor for synchronous metastasis. PRI and mEMVI are risk factors for local recurrence.
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Affiliation(s)
- Baohua Lv
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong-an Road, Beijing, 100050, China
- Department of Radiology, Taian City Central Hospital, Tai'an, 271099, China
| | - Xiaojuan Cheng
- Clinical Skills Center, Taian City Central Hospital, Tai'an, 271099, China
| | - Yuanzhong Xie
- Department of Radiology, Taian City Central Hospital, Tai'an, 271099, China
| | - Yanling Cheng
- Respiratory department of Shandong second rehabilitation hospital, Tai'an, 271000, China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong-an Road, Beijing, 100050, China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong-an Road, Beijing, 100050, China
| | - Erhu Jin
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong-an Road, Beijing, 100050, China.
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Lv B, Cheng X, Cheng Y, Wang Z, Jin E. Identifying Tumor Deposits in Patients with Locally Advanced Rectal Cancer: Using Multiplanar High-Resolution T2WI. Curr Med Imaging 2023; 20:CMIR-EPUB-134064. [PMID: 37622559 DOI: 10.2174/1573405620666230825113550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/09/2023] [Accepted: 07/21/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND The prognosis of postoperative tumor deposits (TDs) is worse than positive lymph node metastases alone. OBJECTIVE To detect TDs by using multiplanar high-resolution T2-weighted imaging (HRT2WI). MATERIAL AND METHODS This retrospective study enrolled 130 patients with locally advanced rectal cancer (LARC). Using pathology-proven tumor deposits (pTDs) as the gold standard, all patients were divided into the pTDs-negative and pTDs-positive groups, the correlation of clinicopathological factors and image features [such as MRI-detected tumor deposits (mTDs), MRI-detected metastatic lymph node (mLN), MRI-detected extramural vascular invasion (mEMVI), maximal extramural depth (EMD), etc.] with pTDs were analyzed by univariate analysis and multivariate binary logistic regression analysis, and the nomogram was established based on the latter. The diagnostic efficiency was evaluated by the receiver operating characteristic curve (ROC) analysis and area under curve (AUC). RESULTS mTDs, mLN, mEMVI, and EMD were significantly different between the pTDs-positive and pTDs-negative groups (P < 0.05), with the AUC of 0.767, 0.746, 0.664 and 0.644, respectively. mTDs and mLN were independent risk factors for pTDs (odds ratio: 5.74 and 3.90, P < 0.05). The AUC, sensitivity, specificity, negative predictive value, and accuracy of the nomogram were 0.814 (95% CI: 0.720 ~ 0.908), 73.9%, 79.4%, 93.4%, and 78.5%, respectively. Seventeen of 23 patients with pTDs were identified as mTDs, with a moderate agreement between pTDs and mTDs (Kappa=0.419). CONCLUSION Multiplanar HRT2WI can be used as a preoperative diagnostic tool to identify TDs in LARC. The combined model constructed by mTDs and mLN shows a good diagnostic performance for TDs.
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Affiliation(s)
- Baohua Lv
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Xiaojuan Cheng
- Clinical Skills Center, Taian Central Hospital, Tai'an 271099, China
| | - Yanling Cheng
- Respiratory department, Shandong second rehabilitation hospital, Tai'an 271000, China
| | - Zhaohua Wang
- Department of Radiology, Taian Central Hospital, Tai'an 271099, China
| | - Erhu Jin
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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Kazi M, Ankathi S, Saklani A. Changing the goal posts with tumour deposits - but are we changing outcomes? Colorectal Dis 2023. [PMID: 36932720 DOI: 10.1111/codi.16538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/02/2023] [Accepted: 02/09/2023] [Indexed: 03/19/2023]
Affiliation(s)
- Mufaddal Kazi
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Suman Ankathi
- Homi Bhabha National Institute, Mumbai, India.,Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
| | - Avanish Saklani
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
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Zhu K, Chen Z, Cui L, Zhao J, Liu Y, Cao J. The Preoperative Diagnostic Performance of Multi-Parametric Quantitative Assessment in Rectal Carcinoma: A Preliminary Study Using Synthetic Magnetic Resonance Imaging. Front Oncol 2022; 12:682003. [PMID: 35707367 PMCID: PMC9190242 DOI: 10.3389/fonc.2022.682003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/19/2022] [Indexed: 12/24/2022] Open
Abstract
Objective Synthetic MRI (SyMRI) can reconstruct different contrast-weighted images(T1, T2, PD) and has shorter scan time, easier post-processing and better reproducibility. Some studies have shown splendid correlation with conventional mapping techniques and no degradation in the quality of syMRI images compared with conventional MRI. It is crucial to select an individualized treatment plan based on the preoperative images of rectal carcinoma (RC). We tried to explore the feasibility of syMRI on T, N stage and extramural vascular invasion (EMVI) of rectal cancer. Materials and Methods A total of 100 patients (37 females and 63 males) diagnosed with rectal carcinoma were enrolled. All the patients underwent preoperative pelvic MR examinations including conventional MR sequence and synthetic MRI. Two radiologists evaluated the MRI findings of each rectal carcinoma and EMVI score in consensus. The values for T1, T2 relaxation times and PD value were measured in tumor(ROI-1) and pararectal fat space(ROI-2) and analyzed independently. A receiver operating characteristic (ROC) analysis was performed. Correlations between the T1, T2 and PD values and EMVI score were also evaluated. Results Compared with the normal rectal wall, the values of T1 and T2 relaxation times of the tumor were significantly higher (P <0.001). There was no statistically significant difference in the PD value (P >0.05). As for ROI, the ROI of pararectal fat space(ROI-2) had better significance than rectal cancer lesion (ROI-1). T2 value of ROI-1 and T1 value of ROI-2 were higher in the pEMVI positive group than in the negative group (P=0.002 and 0.001) and T1 value of ROI-2 had better performance with an AUC of 0.787, (95% CI:0.693- 0.882). T1 value, T2 value and PD value from ROI-2 were effective for both T and N stage of rectal cancer. High-grade pathological stage had showed higher T1 value (PT stage=0.013,PN stage=0.035), lower T2 value (PT stage=0.025,PN stage=0.034) and lower PD value (PT stage=0.017). We also enrolled the characteristics with P < 0.05 in the combined model which had better diagnostic efficacy. A significant positive correlation was found between the T1 value of pararectal fat space(ROI-2) and EMVI score (r value = 0.519, P<0.001). The T2 value(r=0.213,P=0.049) and PD value(r=0.354,P=0.001) from ROI-1 was correlated with EMVI score. Correlation analysis did not show any significant associations between T2 value of tumor, T2, PD values of pararectal fat space and EMVI scores. Conclusion Synthetic MRI can provide multi-parameter quantitative image maps with a easier measurement and slightly shorter acquisition time compared with conventional MRI. The measurement of multi-parametric quantitative values contributes to diagnosing the tumor and evaluating T stage, N stage and EMVI. It has the potential to be used as a preoperative diagnostic and grading technique in rectal carcinoma.
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Affiliation(s)
- Kexin Zhu
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Zhicheng Chen
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Lingling Cui
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jinli Zhao
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yi Liu
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jibin Cao
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
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Altinmakas E, Dogan H, Taskin OC, Ozoran E, Bugra D, Adsay V, Balik E, Gurses B. Extramural venous invasion ( EMVI) revisited: a detailed analysis of various characteristics of EMVI and their role as a predictive imaging biomarker in the neoadjuvant treatment response in rectal cancer. Abdom Radiol (NY) 2022; 47:1975-1987. [PMID: 35332398 DOI: 10.1007/s00261-022-03495-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE To assess whether size, diameter, and large vein involvement of MR-detected extramural venous invasion (MR-EMVI) have an impact on neoadjuvant therapy response in rectal adenocarcinoma. METHODS 57 patients with locally advanced rectal adenocarcinoma scanned with MRI before and after neoadjuvant therapy were included. Two abdominal radiologists evaluated the images with special emphasis on EMVI, on initial staging and after neoadjuvant treatment. The sensitivity and specificity of MRI for detection of rest EMVI were determined. The association of various MR-EMVI characteristics including number, size, and main vein involvement with treatment response was investigated. In subjects with discordance of radiology and pathology, elastin stain was performed, and images and slides were re-evaluated on site with a multidisciplinary approach. RESULTS At initial evaluation, 17 patients were MR-EMVI negative (29.8%) and 40 were MR-EMVI positive (70.2%). Complete/near-complete responders had less number (mean 1.45) and smaller diameter of MR-EMVI (mean 1.8 mm), when compared with partial responders (2.54 and 3.3 mm; p < 0.005). The sensitivity of MRI for rest EMVI detection was high, specificity was moderate, and in one patient elastin stain changed the final decision. In five patients with rest MR-EMVI positivity, carcinoma histopathologically had a distinctive serpiginous perivascular spread, growing along the track of vascular bundle, although it did not appear in intravascular spaces. CONCLUSION This study demonstrates that not only the presence, but also size and number of EMVI that may be significant clinically and thus these parameters also ought to be incorporated to the MRI evaluation and prognostication of treatment response. From pathology perspective, tumors growing alongside major vessels may also reflect EMVI even if they are not demonstrably "intravascular."
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Affiliation(s)
- Emre Altinmakas
- Department of Radiology, Koç University School of Medicine, 34010, Istanbul, Turkey
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hakan Dogan
- Department of Radiology, Koç University School of Medicine, 34010, Istanbul, Turkey
| | - Orhun Cig Taskin
- Department of Pathology, Koç University School of Medicine, Istanbul, Turkey
| | - Emre Ozoran
- Department of General Surgery, Koç University School of Medicine, Istanbul, Turkey
| | - Dursun Bugra
- Department of General Surgery, Koç University School of Medicine, Istanbul, Turkey
| | - Volkan Adsay
- Department of Pathology, Koç University School of Medicine, Istanbul, Turkey
| | - Emre Balik
- Department of General Surgery, Koç University School of Medicine, Istanbul, Turkey
| | - Bengi Gurses
- Department of Radiology, Koç University School of Medicine, 34010, Istanbul, Turkey.
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Chandramohan A, Mittal R, Dsouza R, Yezzaji H, Eapen A, Simon B, John R, Singh A, Ram TS, Jesudason MR, Masih D, Karuppusami R. Prognostic significance of MR identified EMVI, tumour deposits, mesorectal nodes and pelvic side wall disease in locally advanced rectal cancer. Colorectal Dis 2022; 24:428-438. [PMID: 34954863 DOI: 10.1111/codi.16032] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/03/2021] [Accepted: 12/21/2021] [Indexed: 02/08/2023]
Abstract
AIM To study the prognostic significance of MRI identified tumour deposits (TD), extramural vascular invasion (EMVI), lymph node metastases (LNM) and pelvic sidewall (PSW) disease in rectal cancer. METHODS This IRB approved study was conducted on patients with stage IIA-IIIC rectal adenocarcinoma treated with neoadjuvant long course chemoradiotherapy (LCCRT) and total mesorectal excision (TME) type of surgery between 2012-2018. A radiologist blinded to outcome reviewed staging and restaging magnetic resonance imaging (MRI) for TD, EMVI, LNM and PSW. The agreement between four radiologists was studied and we obtained outcome data from a prospectively maintained database. The prognostic significance of imaging findings was assessed. RESULTS A total of 297 (186 males) patients with a mean age of 47.3 (SD14.4) years were included in the study. The majority had T3 (n = 206) or T4 (n = 59) stage disease. The mean duration of follow-up was 49.3 ± 25 months (6.6-101 months). 5-year overall (OS) and disease-free survival (DFS) was 84% and 74%, respectively. Staging and restaging MRI had EMVI in 49.5% and 31.3%; TD in 47.5% and 31.6%; LNM in 61.1% and 38.1% and PSW in 11.4% and 6.1%. OS was adversely affected by EMVI, TD and PSW with the adjusted HR (aHR) of 3.32, 3.31, 3.27 for staging MRI and 2.99, 3.1, 2.81 for restaging MRI, respectively, p < 0.05. DFS was affected by EMVI (aHR = 1.85, 2.33) and TD (aHR = 1.83, 2.19), p < 0.05. Persistence of these findings after LCCRT led to worst outcome. Intra- and interobserver agreement for EMVI, TD and LN was 0.789, 0.734, 0.406 and 0.449, 0.354, 0.376, respectively, p < 0.001. CONCLUSIONS MRI identified that TD, EMVI and PSW disease are independent poor prognostic indicators in rectal cancer patients. Interobserver agreement for these findings was moderate to fair.
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Affiliation(s)
| | - Rohin Mittal
- Department of Colorectal Surgery, Christian Medical College, Vellore, India
| | - Romina Dsouza
- Department of Radiology, Christian Medical College, Vellore, India
| | - Harish Yezzaji
- Department of Colorectal Surgery, Christian Medical College, Vellore, India
| | - Anu Eapen
- Department of Radiology, Christian Medical College, Vellore, India
| | - Betty Simon
- Department of Radiology, Christian Medical College, Vellore, India
| | - Reetu John
- Department of Radiology, Christian Medical College, Vellore, India
| | - Ashish Singh
- Department of Medical Oncology, Christian Medical College, Vellore, India
| | - Thomas S Ram
- Department of Radiation Oncology, Christian Medical College, Vellore, India
| | - Mark R Jesudason
- Department of Colorectal Surgery, Christian Medical College, Vellore, India
| | - Dipti Masih
- Department of Pathology, Christian Medical College, Vellore, India
| | - Reka Karuppusami
- Department of Biostatistics, Christian Medical College, Vellore, India
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Sofic A, Husic-Selimovic A, Efendic A, Sehic A, Julardzija F, Cizmic M, Beslagic E, Aladjuz-Granov L. MRI Evaluation of Extramural Venous Invasion ( EMVI) with Rectal Carcinoma Using High Resolution T2 and Combination of High Resolution T2 and Contrast Enhanced T1 Weighted Imaging. Acta Inform Med 2021; 29:113-117. [PMID: 34584334 PMCID: PMC8443141 DOI: 10.5455/aim.2021.29.113-117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/17/2021] [Indexed: 01/12/2023] Open
Abstract
Background: EMVI is a direct invasion of a vein by a tumor. As a predictor of hematogenous metastasis, it is a poor prognostic factor in rectal cancer and can be accurately identified on MRI prior to surgical procedure. Objective: To evaluate the role of contrast-enhanced T1-weighted magnetic resonance imaging (CET1WI) in addition to high-resolution T2-weighted imaging (HRT2WI) in assessing extramural venous invasion (EMVI) of rectal cancer. Methods: In all 195 patients with rectal cancer, HRT2WI and CET1WI sequences were produced within pre-operative MRI for the purpose of assessing for the presence of EMVI (mrEMVI). CET1WI sequences were produced following administration of Gadolinium contrast medium. mrEMVI assessment results were classified into two groups. Group A consisted of mrEMVI assessment results obtained using HRT2WI sequences only. Group B consisted of mrEMVI assessment results obtained using a combination of HRT2WI + CET1WI sequences. Results obtained for each group (A and B) were correlated with a histopathological finding (pEMVI) as a reference standard. Results: Out of a total of 195 rectal cancer patients, mrEMVI was positive in 41 (21%) patients in group A, and in 45 (23%) patients in group B. Histopathological finding demonstrated pEMVI in 54 (27.7%) patients. A statistical analysis of group A (HRT2WI sequences) resulted in 75.9% sensitivity to mrEMVI and 96.4% specificity, Positive Predictive Value of 89.1% and Negative Predictive Value of 91.2% (95% confidence interval (CI), p< 0.05). Statistical analysis of group B (HRT2WI + CET1WI sequences) resulted in 83.3% sensitivity to mrEMVI and 98.5% specificity, Positive Predictive Value of 89.1% and Negative Predictive Value of 91.2% (CI 95%, p< 0.05). Conclusion: T1-weighted magnetic resonance imaging (CET1WI) in addition to high-resolution T2-weighted imaging (HRT2WI) increased evaluation of extramural venous invasion (EMVI) of rectal cancer.
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Affiliation(s)
- Amela Sofic
- Department of Radiology, General Hospital "Prim.dr.Abdulah Nakaš" Sarajevo, Bosnia and Herzegovin
| | - Azra Husic-Selimovic
- Department of Internal medicine, General Hospital "Prim.dr.Abdulah Nakaš", Sarajevo, Bosnia and Herzegovina
| | - Alma Efendic
- Department of Radiology, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina
| | - Adnan Sehic
- Department of Radiological Technology, Faculty of Health Studies, University of Sarajevo, Bosnia and Herzegovina
| | - Fuad Julardzija
- Department of Radiological Technology, Faculty of Health Studies, University of Sarajevo, Bosnia and Herzegovina
| | - Midhat Cizmic
- Department of Radiology, General Hospital "Prim.dr.Abdulah Nakaš" Sarajevo, Bosnia and Herzegovin
| | - Eldina Beslagic
- Department of Radiology, General Hospital "Prim.dr.Abdulah Nakaš" Sarajevo, Bosnia and Herzegovin
| | - Lejla Aladjuz-Granov
- Department of Radiology, General Hospital "Prim.dr.Abdulah Nakaš" Sarajevo, Bosnia and Herzegovin
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Qwaider YZ, Sell NM, Stafford CE, Kunitake H, Ricciardi R, Bordeianou LG, Deshpande V, Goldstone RN, Cauley CE, Berger DL. Adjuvant Chemotherapy Benefits on Patients with Extramural Vascular Invasion in Stages II and III Colon Cancer. J Gastrointest Surg 2021; 25:2019-25. [PMID: 33009639 DOI: 10.1007/s11605-020-04810-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/16/2020] [Accepted: 09/22/2020] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Extramural vascular invasion (EMVI) is a poor prognostic factor in colon cancer. However, the benefit of adjuvant chemotherapy in patients with EMVI is not well defined. The objective of this study is to determine if there is a survival benefit for using adjuvant chemotherapy in patients with EMVI-positive colon cancers. METHODS We performed a retrospective review of all patients with stages II and III colon adenocarcinoma who underwent surgical resection between 2004 and 2015. Cox regression was used to determine the effect of chemotherapy on EMVI-positive patients while adjusting for the extent of invasion, regional lymph node metastasis, histologic grade, age, site of tumor, and ASA score. RESULTS A total of 750 patients were included in this study. Extramural vascular invasion was present in 93 out of 387 stage II patients (24%) and 187 out of 363 stage III patients (52%). The Cox regression model showed that in patients with EMVI, those who did not receive adjuvant chemotherapy had a 1.6-fold (1.1-2.3) increase in the hazard of death compared with those who received chemotherapy. CONCLUSIONS Patients who were EMVI-negative fared better than those who were EMVI-positive. In patients who were EMVI-positive, adjuvant chemotherapy improved overall survival.
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Rutegård MK, Båtsman M, Blomqvist L, Rutegård M, Axelsson J, Ljuslinder I, Rutegård J, Palmqvist R, Brännström F, Brynolfsson P, Riklund K. Rectal cancer: a methodological approach to matching PET/MRI to histopathology. Cancer Imaging 2020; 20:80. [PMID: 33129352 PMCID: PMC7603757 DOI: 10.1186/s40644-020-00347-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 09/17/2020] [Indexed: 12/18/2022] Open
Abstract
Purpose To enable the evaluation of locoregional disease in the on-going RECTOPET (REctal Cancer Trial on PET/MRI/CT) study; a methodology to match mesorectal imaging findings to histopathology is presented, along with initial observations. Methods FDG-PET/MRI examinations were performed in twenty-four consecutively included patients with rectal adenocarcinoma. In nine patients, of whom five received neoadjuvant treatment, a postoperative MRI of the surgical specimen was performed. The pathological cut-out was performed according to clinical routine with the addition of photo documentation of each slice of the surgical specimen, meticulously marking the location, size, and type of pathology of each mesorectal finding. This allowed matching individual nodal structures from preoperative MRI, via the specimen MRI, to histopathology. Results Preoperative MRI identified 197 mesorectal nodal structures, of which 92 (47%) could be anatomically matched to histopathology. Of the matched nodal structures identified in both MRI and histopathology, 25% were found to be malignant. These malignant structures consisted of lymph nodes (43%), tumour deposits (48%), and extramural venous invasion (9%). One hundred eleven nodal structures (55%) could not be matched anatomically. Of these, 97 (87%) were benign lymph nodes, and 14 (13%) were malignant nodal structures. Five were malignant lymph nodes, and nine were tumour deposits, all of which had a short axis diameter < 5 mm. Conclusions We designed a method able to anatomically match and study the characteristics of individual mesorectal nodal structures, enabling further research on the impact of each imaging modality. Initial observations suggest that small malignant nodal structures assessed as lymph nodes in MRI often comprise other forms of mesorectal tumour spread. Trial registration Clinical Trials Identifier:NCT03846882.
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Affiliation(s)
- Miriam K Rutegård
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, Umeå, Sweden.
| | - Malin Båtsman
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | - Lennart Blomqvist
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, Umeå, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Martin Rutegård
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.,Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Jan Axelsson
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, Umeå, Sweden
| | - Ingrid Ljuslinder
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Jörgen Rutegård
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Richard Palmqvist
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | - Fredrik Brännström
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Patrik Brynolfsson
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, Umeå, Sweden
| | - Katrine Riklund
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, Umeå, Sweden
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van den Broek JJ, van der Wolf FSW, Heijnen LA, Schreurs WH. The prognostic importance of MRI detected extramural vascular invasion (mr EMVI) in locally advanced rectal cancer. Int J Colorectal Dis 2020; 35:1849-1854. [PMID: 32488420 DOI: 10.1007/s00384-020-03632-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND MRI detected extramural vascular invasion (mrEMVI) is a poor prognostic factor in rectal cancer patients. The objectives of this study were to assess survival outcomes in patients with and without mrEMVI and to compare the prognostic value of mrEMVI with other rectal cancer features. METHODS In a Dutch high volume rectal cancer center cohort of sixty-seven locally advanced rectal cancer patients, an independent radiologist reviewed all primary staging MRI scans. The presence of mrEMVI was correlated to tumor specific and survival outcomes. RESULTS 20/67 patients had mrEMVI positive rectal cancer. 55% (11/20) developed metachronous metastases, compared with 23% (11/47) in the mrEMVI negative group (OR 4.0, p = 0.01). Overall survival was also decreased with a Hazard ratio of 3.3 (p = 0.01). A multivariable logistic regression with a backward selection procedure was conducted including cT-stage, c-N-stage, extramural tumor invasion depth, mesorectal fascia involvement, distance to anorectal junction, tumor length, mrEMVI, CEA level, and synchronous metastases. After stepwise removal based on p value, only positive mrEMVI remained as a single significant predictor for metachronous metastases (OR: 4.16 , p < 0.05). CONCLUSION Positive mrEMVI is a poor prognostic factor in locally advanced rectal cancer with a 4-fold increased risk of developing metachronous metastases after surgery and a worsened overall survival. mrEMVI also appeared an independent risk factor, with a stronger prediction for metachronous metastases than other MRI-detectable tumor characteristics. mrEMVI should be incorporated in all risk stratification guidelines for rectal cancer.
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Affiliation(s)
- J J van den Broek
- Department of Surgery, Northwest clinics, PO box 501, 1815 JD, Alkmaar, The Netherlands.
| | - F S W van der Wolf
- Department of Radiology, Antonius Hospital Sneek, Sneek, The Netherlands
| | - L A Heijnen
- Department of Surgery, Northwest clinics, PO box 501, 1815 JD, Alkmaar, The Netherlands
| | - W H Schreurs
- Department of Surgery, Northwest clinics, PO box 501, 1815 JD, Alkmaar, The Netherlands
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12
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Abstract
Imaging determines the optimal treatment for rectal cancer patients. High-resolution magnetic resonance imaging (MRI) overcomes many of the known limitations of previous methods. When performed in accordance with the recommended standards, MRI enables accurate staging of both early and advanced rectal cancer, accurate response assessment, the delineation of recurrent disease and planning surgical treatment in a safe and effective manner. Tumour-related high-risk features with known adverse outcomes can be preoperatively identified and treated with neoadjuvant chemoradiotherapy. Further, MRI post-treatment tumour response assessment using TRG grading system also predicts the likely survival outcomes and in the future will be used to modify treatment further by stratification into good and poor responders. There is a paucity of literature with validated outcome data concerning use of diffusion-weighted imaging and positron emission tomography (PET)/computed tomography (CT), and in the absence of any validated methods and outcome data, their use in the initial assessment and restaging after treatment is limited to research protocols. Combination MRI and CT is essential for distant spread assessment and recurrent disease, and currently PET-CT is sometimes used in the workup of patients with recurrent and metastatic disease.
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13
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Abstract
The optimal management of rectal cancer is achieved through a shared multidisciplinary decision making process with accurate staging by imaging being critical for treatment planning. Good quality, high-resolution MRI has become the imaging gold standard as it allows consistent staging and stratification of patients into distinct prognostic groups according to MR-findings. Imaging features other than T and N have been proven to influence patient outcomes, and increasingly these features are taken into consideration when determining treatment options: distance of tumour to the potential circumferential margin (CRM), presence of tumour within the extramural rectal vessels (EMVI), discontinuous tumour deposits (N1c), relationship to the intersphincteric plane in low rectal tumours and to pelvic compartments in advanced disease. The presence or absence of proven adverse MR features should be included in the MRI report and shared with the patient when treatment choices are offered. MRI enables the identification of high risk tumours where the use of neoadjuvant therapy is justified and is a robust method of identifying patients with a strong likelihood of complete response after preoperative treatment.
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Chand M, Bhangu A, Wotherspoon A, Stamp GWH, Swift RI, Chau I, Tekkis PP, Brown G. EMVI-positive stage II rectal cancer has similar clinical outcomes as stage III disease following pre-operative chemoradiotherapy. Ann Oncol 2014; 25:858-863. [PMID: 24667718 DOI: 10.1093/annonc/mdu029] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Stage II rectal cancers comprise a heterogeneous group, and there is significant variability in practise with regards to adjuvant chemotherapy; the survival benefit of chemotherapy is perceived to be <4% in these patients. However, in recent years, the emergence of additional prognostic factors such as extramural venous invasion (EMVI) suggests that there may be sub-stratification of stage II tumours and, further, we may be under-estimating the benefit adjuvant chemotherapy provides in high-risk patients. This study examined the outcomes of patients with stage II and III rectal cancer to determine whether EMVI status influences disease-free survival (DFS). PATIENTS AND METHODS An analysis of a prospectively maintained database was conducted of patients presenting with rectal cancer between 2006 and 2012. All patients underwent curative surgery and had no evidence of metastases at presentation. Clinicopathological factors were compared between stage II and III disease. The primary end point was 3-year DFS; univariate and multivariate analysis was carried out using Cox proportional hazards regression models; hazard ratios (HR) with 95% confidence intervals (CIs) were calculated. RESULTS Four hundred and seventy-eight patients were included: 233 stage II; 245 stage III. The prevalence of EMVI was 34.9%; 57 stage II patients (24.5%) and 110 stage III patients (44.9%). On multivariate analysis, only EMVI status was a significant factor for DFS. The adjusted HR for EMVI either alone or in combination with nodal involvement was 2.08 (95% CI 1.10-2.95) and 2.74 (95% CI 1.66-4.52), respectively. CONCLUSION EMVI is an independently poor prognostic factor for DFS for both stage II and stage III rectal cancer. These results demonstrate that there is risk-stratification within stage II tumours which affects prognosis. When discussing the use of adjuvant chemotherapy with patients that have EMVI-positive stage II tumours, these results provide evidence for a similarly increased risk of distant failure as stage III disease without venous invasion.
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Affiliation(s)
- M Chand
- Department of GI Cancer, Royal Marsden Hospital, Fulham Road, London; Department of Surgery, Croydon University Hospital, London Road, Croydon; Department of Cancer and Surgery, Imperial College, London, UK.
| | - A Bhangu
- Department of GI Cancer, Royal Marsden Hospital, Fulham Road, London; Department of Surgery, Croydon University Hospital, London Road, Croydon; Department of Cancer and Surgery, Imperial College, London, UK
| | - A Wotherspoon
- Department of GI Cancer, Royal Marsden Hospital, Fulham Road, London; Department of Cancer and Surgery, Imperial College, London, UK
| | - G W H Stamp
- Department of GI Cancer, Royal Marsden Hospital, Fulham Road, London; Department of Cancer and Surgery, Imperial College, London, UK
| | - R I Swift
- Department of Surgery, Croydon University Hospital, London Road, Croydon
| | - I Chau
- Department of GI Cancer, Royal Marsden Hospital, Fulham Road, London
| | - P P Tekkis
- Department of GI Cancer, Royal Marsden Hospital, Fulham Road, London; Department of Cancer and Surgery, Imperial College, London, UK
| | - G Brown
- Department of GI Cancer, Royal Marsden Hospital, Fulham Road, London
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