Diagnostic Accuracy of MRI for Assessment of T Category, Lymph Node Metastases, and Circumferential Resection Margin Involvement in Patients with Rectal Cancer: A Systematic Review and Meta-analysis

Al-Sukhni, Eisar; Milot, Laurent; Fruitman, Mark; Beyene, Joseph; Victor, J. Charles; Schmocker, Selina; Brown, Gina; McLeod, Robin S.; Kennedy, Erin

doi:10.1245/s10434-011-2210-5

Cited by 469 publications

(335 citation statements)

References 89 publications

(81 reference statements)

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“…Algebally et al [14] also reported 84% sensitivity, 97% specificity and 94% accuracy. Our results are close to the results of Al-Sukhni et al [21] that were 95% specificity and 93% sensitivity.…”

Section: Discussionsupporting

confidence: 91%

“…Tumor extension near but >1 mm distant from the circumferential resection margin is sometimes referred to as a threatened circumferential resection margin. [21] Our results showed MRI sensitivity of CRM assessment reaching 96%, specificity 94% and accuracy 96%. Algebally et al [14] also reported 84% sensitivity, 97% specificity and 94% accuracy.…”

Section: Discussionmentioning

confidence: 49%

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Rectal Carcinoma, Recent Staging Strategy by MRI Using Diffusion Weighted Sequence

Mousa¹,

Abdella²

2017

IJMI

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Abstract:Objective: MRI is currently the imaging modality of choice for the detection, characterization, and staging of rectal cancer. A variety of examinations have been used for preoperative staging of rectal cancer, including digital rectal examination, endorectal (endoscopic) ultrasound, CT, and MRI. Endoscopic ultrasound is the imaging modality of choice for small and small superficial tumors. MRI is superior to CT for assessing invasion to adjacent organs and structures, especially low tumors that carry a high risk of recurrence. Background: Colorectal cancer (CRC) is the third most common cancer in both sexes combined worldwide, after prostate and breast cancer with an incidence of 40 in 100,000. Rectal carcinoma accounts for more than one-third of colorectal tumors and is associated with significant morbidity and mortality. Currently, MRI using diffusion weighted sequence is the most sensitive and specific modality in staging rectal cancer as it is able to depict the mesorectal fascia and its relation to the tumor margins precisely. Methods: This study included 50 patients, (32 male and 18 female) previously diagnosed as cancer rectum based on proctoscope and histopathological biopsy. The age range of the patients was from 18 years to 78 years. All patients will be subjected to the following: detailed history, clinical examination, proctoscopic assessment and histopathological data. All patients underwent MRI of the pelvis specifically cancer rectum protocol. Results: The most frequently encountered clinical presentation among cancer rectum patients was bleeding per rectum (14), constipation (26), incidentally discovered liver metastasis (6) and intestinal obstruction (4). MRI evaluation of T staging in correlation to the histopathological examination showed sensitivity (80%), specificity (93%), accuracy (94%). Lymph node (LN) metastatic spread was evaluated by MRI and showed sensitivity (87%), specificity (92%), accuracy (92.6%), PPV (84.8%) and NPV (96.7%). Regarding circumferential resection margin (CRM) MRI assessment revealed; sensitivity (96%), specificity (94%), accuracy (96%), PPV (95%) and NPV (94.3%). Conclusions: MRI is an accurate and sensitive imaging method delineating tumoral margins, mesorectal fascia involvement, lymph nodes, and distant metastasis. MRI can accurately delineate the mesorectal fascia involvement, which is one of the main decision points in planning treatment.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 49%

Rectal Carcinoma, Recent Staging Strategy by MRI Using Diffusion Weighted Sequence

Mousa¹,

Abdella²

2017

IJMI

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“…37 MRI specificity was 75 % for tumor stage and 71 % for lymph node involvement. 38 A thorough workup cannot completely confirm that a tumor will be definitively treated with local excision.…”

Section: Patient Selectionmentioning

confidence: 99%

Sphincter-Sparing Surgery in Patients with Low-Lying Rectal Cancer: Techniques, Oncologic Outcomes, and Functional Results

Bordeianou

Maguire

Alavi

et al. 2014

Journal of Gastrointestinal Surgery

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Background Rectal cancer management has evolved into a complex multimodality approach with survival, local recurrence, and quality of life parameters being the relevant endpoints. Surgical treatment for low rectal cancer has changed dramatically over the past 100 years. Discussion Abdominoperineal resection, once the standard of care for all rectal cancers, has become much less frequently utilized as surgeons devise and test new techniques for preserving the sphincters, maintaining continuity, and performing oncologically sound ultra-low anterior or local resections. Progress in rectal cancer surgery has been driven by improved understanding of the anatomy and pathophysiology of the disease, innovative surgical technique, improved technology, multimodality approaches, and increased appreciation of the patient's quality of life. The patient with a low rectal cancer, once almost universally destined for impotence and a colostomy, now has the real potential for improved survival, avoidance of a permanent stoma, and preservation of the normal route of defecation.Keywords Rectal cancer . Sphincter preservation . Total mesorectal excision . Anterior resection . Intersphincteric resection . Local excision rectal cancer Historical BackgroundThe modern era of rectal cancer surgery began with the description of the abdominoperineal resection (APR) by Miles in 1908. Prior perineal and sacral approaches (e.g., Kraske approach) to rectal cancer resection produced high rates of complications, cancer recurrence, poor quality of life (QOL), and poor overall survival. Miles' operation reflected greater understanding of the natural history of rectal cancer that was based on postmortem examination of his patients after perineal resection. He observed cancerous implants in the pelvic peritoneum, mesorectum, and affected nodes of the left common iliac bifurcation. These findings led him to develop a "cylindrical concept" of the spread of rectal cancer to upward, downward, and lateral zones. 1 The original operation included resection of the rectum, sigmoid, mesorectum, nodes of the iliac bifurcation, and a perineal component to include the anus and levator ani muscles. Postoperative mortality was high initially, but local recurrence decreased

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“…Further substantial progress in terms of local recurrence reduction was achieved with the advent of quality-assured total mesorectal excision (TME; [15]). The next step was the introduction of magnetic resonance imaging (MRI) as a routine preoperative staging tool [1] facilitating the visualization of the distance between tumor and mesorectal fascia. If this distance is ≥1 mm on MRI, a negative circumferential resection margin (CRM) is assumed, provided that total mesorectal excision surgery is performed adequately.…”

Section: Rectal Cancermentioning

confidence: 99%

Rectal cancer

et al. 2013

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When is the local recurrence risk low enough to refrain from the aim to prevent it?Local recurrence (LR) of rectal cancer is a devastating incident for each affected individual [2,21]. Thus, along with the attempt of improving survival, local tumor control has been an essential goal in the management of rectal cancer. Adjuvant radiotherapy (RT) with or without chemotherapy (ChT) reduced local recurrence and became a standard treatment in the 1980s [14], which was later on gradually replaced by preoperative RT (nRT) [9,45] or neoadjuvant radiochemotherapy (nRCT) [3,4,10,34,37]. Further substantial progress in terms of local recurrence reduction was achieved with the advent of quality-assured total mesorectal excision (TME; [15]). The next step was the introduction of magnetic resonance imaging (MRI) as a routine preoperative staging tool [1] facilitating the visualization of the distance between tumor and mesorectal fascia. If this distance is ≥1 mm on MRI, a negative circumferential resection margin (CRM) is assumed, provided that total mesorectal excision surgery is performed adequately. A negative CRM (defined as ≥1 mm on pathological work-up) has consecutively been identified and validated as an important surrogate parameter to predict the individual LR risk [12]. Results of the MERCURY study group (Magnetic Resonance Imaging in Rectal Cancer European Equivalence Study) whose authors propagated and investigated MRI-based treatment for rectal cancer were encouraging [23,43] and promoted similar attempts in the German-speaking community such as the OCUM study (optimized surgery and MRI-based multimodal therapy of rectal cancer). Preliminary results were recently published [22,42] and are commented in this editorial.Altogether, 230 patients with rectal cancer clinically staged as cT2-4, any cN, cM0 were included in this observational study. The anticipated CRM assessed by MRI (mrCRM) was used as a decision tool for selecting patients (n=230) either to undergo primary surgery (n=134) or to receive nRCT (n=96). For the lower third of the rectum (defined as <6 cm from the anal verge, 37%), nRCT was performed in all cT3 and cT4 tumors, irrespective of the anticipated CRM status; tumors of the middle third (i.e., 6 to <12 cm) were treated by nRCT in case of positive mrCRM only. For the upper third (12-16 cm), the decision was left to the discretion of the treating center. Clinically positive lymph nodes did not influence the choice of therapy; in patients with pathologically positive lymph nodes, chemotherapy was offered according to the standard of the respective centers. Postoperative RCT was restricted to patients with an involved CRM (pCRM ≤1 mm) [42].The mrCRM was positive in 74/230 patients, 72 in the nRCT group and 2 of the patients selected for surgery alone. A pathologically positive CRM (pCRM) occurred in 5.7% of all patients (nCRT: 11%, primary surgery: 1.5%). Pathology revealed complete remission (ypT0N0) after nRCT in 15% of patients, a partial remission in 67%. Even in patients whose margins were involv...

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Diagnostic Accuracy of MRI for Assessment of T Category, Lymph Node Metastases, and Circumferential Resection Margin Involvement in Patients with Rectal Cancer: A Systematic Review and Meta-analysis

Abstract: BACKGROUND: MRI is increasingly being used for rectal cancer staging. The

Cited by 469 publications

References 89 publications

Rectal Carcinoma, Recent Staging Strategy by MRI Using Diffusion Weighted Sequence

Rectal Carcinoma, Recent Staging Strategy by MRI Using Diffusion Weighted Sequence

Sphincter-Sparing Surgery in Patients with Low-Lying Rectal Cancer: Techniques, Oncologic Outcomes, and Functional Results

Rectal cancer

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