Preoperative MRI accuracy after neoadjuvant chemoradiation for locally advanced rectal cancer.
magnetic resonance imaging
neoadjuvant chemoradiotherapy
rectal neoplasms
tumor response
Journal
Medicine and pharmacy reports
ISSN: 2668-0572
Titre abrégé: Med Pharm Rep
Pays: Romania
ID NLM: 101742144
Informations de publication
Date de publication:
Jul 2023
Jul 2023
Historique:
received:
16
05
2022
revised:
01
06
2022
accepted:
27
06
2022
medline:
14
8
2023
pubmed:
14
8
2023
entrez:
14
8
2023
Statut:
ppublish
Résumé
To evaluate the performance of magnetic resonance imaging (MRI) in restaging locally advanced rectal cancers (LARC) after neoadjuvant chemoradiotherapy (nCRT), with pathologic correlation. 80 patients with LARC treated with neoadjuvant therapy, with restaging MRI and surgery, were enrolled and prospectively reviewed. The diagnostic accuracy of the restaging MRI was assessed for tumor (ymrT), nodal status (ymrN), circumferential resection margin (ymrCRM), extramural vascular invasion (ymrEMVI) and tumoral deposits (ymrN1c) by calculating the sensitivity (Se), specificity (Sp), negative predictive values (NPV) and positive predictive values (PPV). Response to treatment was classified as good response (complete/near complete) vs. poor response (poor/partial response). The agreement between the tumor regression grade at MRI (mrTRG) and pathology (pTRG) was reported, as well the performance of mrTRG to identify good responders. The correlation between restaging MRI and histopathology was assessed by Spearman correlation coefficient. The MRI accuracy ranged between 63.8% and 92.5% for T stage and was 81.3% for N stage. All MRI parameters evaluated at restaging were statistically significant correlated with histopathology evaluation, but EMVI. There was moderate correlation for N and N1c and a positive strong correlation for T, CRM and TRG (Spearman correlation coefficient of 0.390 for mrN1c-pN1c, 0.428 for mrN-pN, 0.522 for mrCRM-pCRM, 0.550 for mrT-pT and 0.731 for mrTRG-pTRG). Diagnostic accuracy of anal sphincter invasion was 91.3%, with a negative predictive value (NPV) of 100%. Accuracy rate varied between 70% for partial response to 93.75% for complete response after nCRT. MR imaging had good accuracy in restaging LARCs after nCRT. Our results showed high MRI accuracy in detecting anal sphincter involvement for low rectal tumors, with high NPV to exclude tumoral invasion. Restaging MRI predicted well the tumor regression grade, with good diagnostic performance in differentiating good responders from poor/partial responders. The accuracy was high for detecting complete response.
Sections du résumé
Background and aims
UNASSIGNED
To evaluate the performance of magnetic resonance imaging (MRI) in restaging locally advanced rectal cancers (LARC) after neoadjuvant chemoradiotherapy (nCRT), with pathologic correlation.
Methods
UNASSIGNED
80 patients with LARC treated with neoadjuvant therapy, with restaging MRI and surgery, were enrolled and prospectively reviewed. The diagnostic accuracy of the restaging MRI was assessed for tumor (ymrT), nodal status (ymrN), circumferential resection margin (ymrCRM), extramural vascular invasion (ymrEMVI) and tumoral deposits (ymrN1c) by calculating the sensitivity (Se), specificity (Sp), negative predictive values (NPV) and positive predictive values (PPV). Response to treatment was classified as good response (complete/near complete) vs. poor response (poor/partial response). The agreement between the tumor regression grade at MRI (mrTRG) and pathology (pTRG) was reported, as well the performance of mrTRG to identify good responders. The correlation between restaging MRI and histopathology was assessed by Spearman correlation coefficient.
Results
UNASSIGNED
The MRI accuracy ranged between 63.8% and 92.5% for T stage and was 81.3% for N stage. All MRI parameters evaluated at restaging were statistically significant correlated with histopathology evaluation, but EMVI. There was moderate correlation for N and N1c and a positive strong correlation for T, CRM and TRG (Spearman correlation coefficient of 0.390 for mrN1c-pN1c, 0.428 for mrN-pN, 0.522 for mrCRM-pCRM, 0.550 for mrT-pT and 0.731 for mrTRG-pTRG). Diagnostic accuracy of anal sphincter invasion was 91.3%, with a negative predictive value (NPV) of 100%. Accuracy rate varied between 70% for partial response to 93.75% for complete response after nCRT.
Conclusions
UNASSIGNED
MR imaging had good accuracy in restaging LARCs after nCRT. Our results showed high MRI accuracy in detecting anal sphincter involvement for low rectal tumors, with high NPV to exclude tumoral invasion. Restaging MRI predicted well the tumor regression grade, with good diagnostic performance in differentiating good responders from poor/partial responders. The accuracy was high for detecting complete response.
Identifiants
pubmed: 37577010
doi: 10.15386/mpr-2542
pii: cm-96-258
pmc: PMC10419690
doi:
Types de publication
Journal Article
Langues
eng
Pagination
258-268Références
Magn Reson Imaging Clin N Am. 2020 Feb;28(1):117-126
pubmed: 31753231
AJR Am J Roentgenol. 2008 Nov;191(5):1517-22
pubmed: 18941094
Radiology. 2008 Feb;246(2):454-62
pubmed: 18227541
Eur J Cancer. 2014 Jan;50(1):1.e1-1.e34
pubmed: 24183379
Insights Imaging. 2020 Sep 3;11(1):100
pubmed: 32880782
Int J Colorectal Dis. 2016 Jun;31(6):1157-62
pubmed: 27055660
Ann Surg Oncol. 2015 Nov;22(12):3873-80
pubmed: 26198074
Radiology. 2013 Oct;269(1):101-12
pubmed: 23801777
AJR Am J Roentgenol. 2017 Mar;208(3):W79-W84
pubmed: 27959622
Eur Radiol. 2018 Apr;28(4):1465-1475
pubmed: 29043428
J Clin Oncol. 2011 Oct 1;29(28):3753-60
pubmed: 21876084
J Natl Compr Canc Netw. 2020 Jul;18(7):806-815
pubmed: 32634771
Br J Cancer. 2017 Nov 7;117(10):1478-1485
pubmed: 28934761
Radiother Oncol. 2020 Apr;145:223-228
pubmed: 32065902
Int J Radiat Oncol Biol Phys. 2005 Jul 1;62(3):752-60
pubmed: 15936556
J Clin Oncol. 2011 Dec 10;29(35):4633-40
pubmed: 22067400
Asian J Surg. 2021 Jan;44(1):275-279
pubmed: 32712044
J Clin Oncol. 2019 Jan 1;37(1):33-43
pubmed: 30403572
Radiology. 2009 Jul;252(1):71-80
pubmed: 19403847
Eur J Radiol. 2021 May;138:109628
pubmed: 33721764
Dis Colon Rectum. 2011 Oct;54(10):1260-4
pubmed: 21904140
Cancer Manag Res. 2021 Jun 01;13:4317-4328
pubmed: 34103987
Radiology. 2009 Jul;252(1):81-91
pubmed: 19403848
Br J Surg. 2008 Feb;95(2):229-36
pubmed: 17932879
Radiographics. 2019 Mar-Apr;39(2):538-556
pubmed: 30844347
Abdom Radiol (NY). 2021 Jul;46(7):3044-3057
pubmed: 33651124
Ann R Coll Surg Engl. 2019 Sep;101(7):441-452
pubmed: 30855163
AJR Am J Roentgenol. 2008 Dec;191(6):1827-35
pubmed: 19020255
Br J Surg. 2018 Nov;105(12):1671-1679
pubmed: 29893988
Insights Imaging. 2019 Feb 13;10(1):15
pubmed: 30758688