Magnetic resonance imaging – evaluation of mesorectal lymphadenopathy in patients with rectal cancer
Authors:
P. Ihnát 1; V. Židlík 2; P. Hanzlíková 3; P. Koscielnik 3; J. Škarda 2
Authors‘ workplace:
Chirugická klinika, Fakultní nemocnice Ostrava, Česká republika
1; Ústav klinické a molekulární patologie a lékařské genetiky, Fakultní nemocnice Ostrava, Česká republika
2; Ústav radiodiagnostický, Fakultní nemocnice Ostrava, Česká republika
3
Published in:
Rozhl. Chir., 2023, roč. 102, č. 5, s. 194-198.
Category:
Original articles
doi:
https://doi.org/10.33699/PIS.2023.102.5.194–198
Overview
Introduction: Multidisciplinary management of patients with rectal cancer presents a gold standard of care; neoadjuvant therapy indications are based on magnetic resonance imaging (MRI) description of the local stage of the carcinoma. Although the accuracy of MRI-based assessment of cancer depth of invasion is satisfactory, its accuracy in the assessment of mesorectal lymphadenopathy is very questionable.
Methods: This was a prospective, single-centre, cohort study focused on the accuracy of preoperative MRI in the assessment of mesorectal lymph nodes (LN). MRI findings of each patient were compared with detailed histopathological examination of rectal specimens.
Results: Forty patients with rectal cancer, undergoing rectal resection with total mesorectal excision were enrolled in the study. MRI assessment of the T-stage was correct in 22 of the 40 study patients (55.0%). T-stage overstaging was noted in 14 (35.0%), and understaging in 4 (10.0%) study patients. According to preoperative MRI (using Horvat’s criteria), there were 50 suspicious/malignant lymph nodes. Only 13 of these 50 LNs (26.0%) were proved malignant on histopathology examination. In total, our study group included 18 patients with suspicious/positive LNs (according to preoperative MRI) who were classified as cN+. MRI diagnosis of malignant lymphadenopathy was correct in only 33.3% of these patients.
Conclusion: MRI shows very low accuracy in the evaluation of mesorectal lymph nodes in patients with rectal cancer. Therefore neoadjuvant therapy should be offered particularly with respect to MRI description of the depth of carcinoma invasion (T-stage and relationship to fascia propria of the rectum).
Keywords:
rectal carcinoma – lymphadenopathy – Lymph nodes – magnetic resonance imaging – accuracy
Sources
1. van de Velde CJ, Boelens PG, Borras JM, et al. EURECCA colorectal: multidisciplinary management: European consensus conference colon & rectum. Eur J Cancer 2014;50(1):1.e1–1.e34. doi:10.1016/j.ejca.2013.06.048. Epub 2013 Oct 31.
2. Glynne-Jones R, Wyrwicz L, Tiret E, et al. ESMO Guidelines Committee. Rectal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018;29(Suppl 4):iv263. doi:10.1093/annonc/mdx224.
3. Tseng M, Soon YY, Vellayappan B, et al. Radiation therapy for rectal cancer. J Gastrointest Oncol. 2019; 10(6):1238–1250. doi:10.21037/jgo.2018.12.04.
4. Rahbari NN, Elbers H, Askoxylakis V, et al. Neoadjuvant radiotherapy for rectal cancer: meta-analysis of randomized controlled trials. Ann Surg Oncol. 2013; 20(13):4169–4182. doi:10.1245/s10434-013-3198-9.
5. Ihnát P, Slívová I, Tulinsky L, et al. Anorectal dysfunction after laparoscopic low anterior rectal resection for rectal cancer with and without radiotherapy (manometry study). J Surg Oncol. 2018;117(4):710–716. doi:10.1002/jso.24885.
6. Kulu Y, Ulrich A, Büchler MW. Resectable rectal cancer: which patient does not need preoperative radiotherapy? Dig Dis. 2012;30 Suppl2:118–125. doi:10.1159/000342040.
7. Tudyka V, Blomqvist L, Beets-Tan RG, et al. EURECCA consensus conference highlights about colon & rectal cancer multidisciplinary management: the radiology experts review. Eur J Surg Oncol. 2014;40(4):469–475. doi:10.1016/j.ejso.2013.10.029.
8. Kaur H, Choi H, You YN, et al. MR imaging for preoperative evaluation of primary rectal cancer: practical considerations. Radiographics 2012;32(2):389–409. doi: 10.1148/rg.322115122.
9. MERCURY Study Group. Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study. BMJ 2006;333(7572):779. doi:10.1136/bmj.38937.646400.55.
10. Beets-Tan RG, Beets GL, Vliegen RF, et al. Accuracy of magnetic resonance imaging in prediction of tumour-free resection margin in rectal cancer surgery. Lancet 2001;357(9255):497–504. doi:10.1016/s0140-6736(00)04040-x.
11. Brown G, Richards CJ, Bourne MW, et al. Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison. Radiology 2003;227(2):371–377. doi:10.1148/radiol.2272011747.
12. Kotanagi H, Fukuoka T, Shibata Y, et al. The size of regional lymph nodes does not correlate with the presence or absence of metastasis in lymph nodes in rectal cancer. J Surg Oncol. 1993;54(4):252–254. doi:10.1002/jso.2930540414.
13. Horvat N, Carlos Tavares Rocha C, Clemente Oliveira B, et al. MRI of rectal cancer: tumor staging, imaging techniques, and management. Radiographics 2019;39(2):367–387. doi:10.1148/rg.2019180114.
14. Guillem JG, Díaz-González JA, Minsky BD, et al. cT3N0 rectal cancer: potential overtreatment with preoperative chemoradiotherapy is warranted. J Clin Oncol. 2008;26(3):368–373. doi:10.1200/JCO.2007.13.5434.
15. Park JS, Jang YJ, Choi GS, et al. Accuracy of preoperative MRI in predicting pathology stage in rectal cancers: node-for-node matched histopathology validation of MRI features. Dis Colon Rectum 2014;57(1):32–38. doi:10.1097/DCR.0000000000000004.
16. Taylor FG, Swift RI, Blomqvist L, et al. A systematic approach to the interpretation of preoperative staging MRI for rectal cancer. AJR Am J Roentgenol. 2008;191(6):1827–1835.
17. Brown G, Richards CJ, Newcombe RG, et al. Rectal carcinoma: thin-section MR imaging for staging in 28 patients. Radiology 1999;211(1):215–222. doi:10.1148/radiology.211.1.r99ap35215.
18. Blomqvist L, Machado M, Rubio C, et al. Rectal tumour staging: MR imaging using pelvic phased-array and endorectal coils vs endoscopic ultrasonography. Eur Radiol. 2000;10(4):653–660. doi:10.1007/s003300050979.
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