Effectiveness of preoperative staging in rectal cancer: digital rectal examination, endoluminal ultrasound or magnetic resonance imaging?

Brown, Gina; Davies, S. J.; Williams, Geraint T.; Bourne, Michael W.; Newcombe, Robert G.; Radcliffe, A. G.; Blethyn, J.; Dallimore, N S; Rees, B I; Phillips, Ceri; Maughan, T

doi:10.1038/sj.bjc.6601871

Cited by 184 publications

(98 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The mesorectal fascia represents the CRM, and tumoral involvement of the CRM has a high recurrence rate (49). Therefore, the main purpose of the preoperative staging of rectal tumors with MRI is to identify patients with T3 lesions, a subset of whom have potential CRM involvement and may benefit from neoadjuvant treatment (e.g., radiation therapy and chemotherapy) (20).…”

Section: Discussionmentioning

confidence: 99%

The ability of phased-array MRI in preoperative staging of primary rectal cancer: correlation with histopathological results

Karatağ

Karatağ²,

Özkurt³

et al. 2011

Diagn Interv Radiol

View full text Add to dashboard Cite

20T he prognosis and treatment of rectal carcinoma depends on the tumor stage at presentation (1). Local tumor extent, involved lymph nodes, and the presence of distant metastases are the main factors that influence prognosis (1-5). A poor prognosis of rectal cancer is associated with a high risk of metastases and local recurrence (6). Incomplete removal of the tumor is the major cause of local recurrence, which varies from 3% to 32% (7,8). Total mesorectal excision (TME) is the standard surgical approach in primary rectal cancer. TME involves the removal of the mesorectum, which contains the rectal tumor, all local draining nodes and the mesorectal fat by sharp dissection along the mesorectal fascia (9-12). This minimizes the chance of any tumor being left behind and results in a substantial reduction of the high local recurrence rate to less than 10% (8, 13) even without adjunctive treatment (13,14). When performing TME, knowledge of the relationship of the tumor to the circumferential resection margin (CRM) is important. When the CRM is involved with the tumor, the risk of local recurrence is high (9,(15)(16)(17).Chemoradiation therapy is the standard adjunctive preoperative treatment for patients with a high likelihood of curative resection failure (14,18). According to the recent literature, patients who received preoperative chemoradiation therapy had a lower rate of local recurrence compared to patients who received postoperative chemotherapy and radiation therapy (1,19). Therefore, there is a need for preoperative imaging methods to aid in the identification of patients with extrarectal spread who may benefit from preoperative chemoradiation therapy (20).Magnetic resonance imaging (MRI) is the most promising diagnostic method for the preoperative local staging of rectal cancer (8,21). Spatial resolution has dramatically improved with advances in MRI techniques, such as the use of endorectal and phased-array coils (22,23). Current evidence suggests that MRI is the most accurate technique for predicting tumor stage (24) because it provides an assessment of the local prognostic factors, including the extent of extramural tumor spread, the involvement of the lateral resection margin, the involvement of neighboring organs in the pelvis, the presence of local lymph node metastases, extramural lymphovascular infiltration and peritoneal involvement (9,25,26).The purposes of this study were to evaluate the accuracy of MRI performed with phased-array coil for preoperative local tumor staging in patients with rectal cancer and emphasize the importance of the preoperative differentiation of T2 tumors from T3 so the appropriate treatment plan can be applied. Materials and methods PatientsTwenty-four patients with histopathologically proven primary rectal cancer were prospectively examined using MRI with a phased-array PURPOSEThis study evaluated the accuracy of phased-array magnetic resonance imaging (MRI) for preoperative local tumor staging in primary rectal cancer and emphasized the importance of the preoperativ...

show abstract

Section: Discussionmentioning

confidence: 99%

The ability of phased-array MRI in preoperative staging of primary rectal cancer: correlation with histopathological results

Karatağ

Karatağ²,

Özkurt³

et al. 2011

Diagn Interv Radiol

View full text Add to dashboard Cite

show abstract

“…The introduction of trans-rectal EUS has made it easier to see the pattern of the layers of the rectal wall, improving treatment allocation by establishing the depth of tumor invasion more accurately [16][17][18] . EUS is the most accurate tool for evaluating local invasion of rectal cancer and perirectal lymph nodes.…”

Section: Mezzi G Et Al Eus and Mri In Rectal Cancermentioning

confidence: 99%

Endoscopic ultrasound and magnetic resonance imaging forre-staging rectal cancer after radiotherapy

Mezzi¹,

Arcidiacono²,

Carrara³

et al. 2009

WJG

View full text Add to dashboard Cite

AIM:To compare the sensitivity and specificity of two imaging techniques, endoscopic ultrasound (EUS) and magnetic resonance imaging (MRI), in patients with rectal cancer after neoadjuvant chemoradiation therapy. And we compared EUS and MRI data with histological findings from surgical specimens. METHODS:Thirty-nine consecutive patients (51.3% Male; mean age: 68.2 ± 8.9 years) with histologically confirmed distal rectal cancer were examined for staging. All patients underwent EUS and MRI imaging before and after neoadjuvant chemoradiation therapy. RESULTS:After neoadjuvant chemoradiation, EUS and MRI correctly classified 46% (18/39) and 44% (17/39) of patients, respectively, in line with their histological T stage (P > 0.05). These proportions were higher for both techniques when nodal involvement was considered: 69% (27/39) and 62% (24/39). When patients were sorted into T and N subgroups, the diagnostic accuracy of EUS was better than MRI for patients with T0-T2 (44% vs 33%, P > 0.05) and N0 disease (87% vs 52%, P = 0.013). However, MRI was more accurate than EUS in T and N staging for patients with more advanced disease after radiotherapy, though these differences did not reach statistical significance.CONCLUSION: EUS and MRI are accurate imaging techniques for staging rectal cancer. However, after neoadjuvant RT-CT, the role of both methods in the assessment of residual rectal tumors remains uncertain.

show abstract

“…Positron emission tomography (PET) is useful adjunct to systemic and regional staging, especially of a recurrent rectal cancer, but is rarely used as part of loco-regional staging of rectal cancer preoperatively [3,4] . The utility of ERUS and MRI for preoperative local staging of rectal carcinoma has been widely demonstrated [5][6][7] . In our study, we compared the ability of ERUS and pelvic phased-array MRI for preoperative local staging of rectal carcinoma.…”

Section: Introductionmentioning

confidence: 99%

Endorectal ultrasonography versus phased-array magnetic resonance imaging for preoperative staging of rectal cancer

Halefoğlu¹,

Yıldırım²,

Avlanmis³

et al. 2008

WJG

View full text Add to dashboard Cite

AIM:To compare the diagnostic accuracy of pelvic phased-array magnetic resonance imaging (MRI) and endorectal ultrasonography (ERUS) in the preoperative staging of rectal carcinoma. METHODS: Thirty-four patients (15 males, 19 females) with ages ranging between 29 and 75 who have biopsy proven rectal tumor underwent both MRI and ERUS examinations before surgery. All patients were evaluated to determine the diagnostic accuracy of depth of transmural tumor invasion and lymph node metastases. Imaging results were correlated with histopathological findings regarded as the gold standard and both modalities were compared in terms of predicting preoperative local staging of rectal carcinoma. RESULTS: The pathological T stage of the tumors was: pT1 in 1 patient, pT2 in 9 patients, pT3 in 21 patients and pT4 in 3 patients. The pathological N stage of the tumors was: pN0 in 19 patients, pN1 in 9 patients and pN2 in 6 patients. The accuracy of T staging for MRI was 89.70% (27 out of 34). The sensitivity was 79.41% and the specificity was 93.14%. The accuracy of T staging for ERUS was 85.29% (24 out of 34). The sensitivity was 70.59% and the specificity was 90.20%. Detection of lymph node metastases using phased-array MRI gave an accuracy of 74.50% (21 out of 34). The sensitivity and specificity was found to be 61.76% and 80.88%, respectively. By using ERUS in the detection of lymph node metastases, an accuracy of 76.47% (18 out of 34) was obtained. The sensitivity and specificity were found to be 52.94% and 84.31%, respectively. CONCLUSION: ERUS and phased-array MRI are complementary methods in the accurate preoperative staging of rectal cancer. In conclusion, we can state that phased-array MRI was observed to be slightly superior in determining the depth of transmural invasion (T stage) and has same value in detecting lymph node metastases (N stage) as compared to ERUS.

show abstract

Effectiveness of preoperative staging in rectal cancer: digital rectal examination, endoluminal ultrasound or magnetic resonance imaging?

Cited by 184 publications

References 26 publications

The ability of phased-array MRI in preoperative staging of primary rectal cancer: correlation with histopathological results

The ability of phased-array MRI in preoperative staging of primary rectal cancer: correlation with histopathological results

Endoscopic ultrasound and magnetic resonance imaging forre-staging rectal cancer after radiotherapy

Endorectal ultrasonography versus phased-array magnetic resonance imaging for preoperative staging of rectal cancer

Contact Info

Product

Resources

About