Evaluation of the implementation of the sigmoid take‐off landmark in the Netherlands

Hazen, Sanne-Marije J. A.; Sluckin, Tania C.; Horsthuis, Karin; Lambregts, Doenja M J; Tanis, Pieter J.; Kusters, Miranda

doi:10.1111/codi.16005

Cited by 9 publications

(8 citation statements)

References 21 publications

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“…The Dutch Snapshot Research group recently performed a study in which a large group of 86 multidisciplinary participants (including radiologists, surgeons, and residents) from 45 hospitals in the Netherlands were asked to apply the STO for tumor localization on MRI in 20 cases before and after having received a dedicated training. Overall agreement with an expert-reference improved from 53% before training to 71% after the training (20). These results confirm that training and teaching have a positive effect when applying the STO as a landmark for the localization of rectal and sigmoid tumors on imaging.…”

Section: Discussionmentioning

confidence: 99%

Pelvic CT in addition to MRI to differentiate between rectal and sigmoid cancer on imaging using the sigmoid take-off as a landmark

et al. 2022

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Background The sigmoid take-off (STO) is a recently established landmark to discern rectal from sigmoid cancer on imaging. STO-assessment can be challenging on magnetic resonance imaging (MRI) due to varying axial planes. Purpose To establish the benefit of using computed tomography (CT; with consistent axial planes), in addition to MRI, to anatomically classify rectal versus sigmoid cancer using the STO. Material and Methods A senior and junior radiologist retrospectively classified 40 patients with rectal/rectosigmoid cancers using the STO, first on MRI-only (sagittal and oblique-axial views) and then using a combination of MRI and axial CT. Tumors were classified as rectal/rectosigmoid/sigmoid (according to published STO definitions) and then dichotomized into rectal versus sigmoid. Diagnostic confidence was documented using a 5-point scale. Results Adding CT resulted in a change in anatomical tumor classification in 4/40 cases (10%) for the junior reader and in 6/40 cases (15%) for the senior reader. Diagnostic confidence increased significantly after adding CT for the junior reader (mean score 3.85 vs. 4.27; P < 0.001); confidence of the senior reader was not affected (4.28 vs. 4.25; P = 0.80). Inter-observer agreement was similarly good for MRI only (κ=0.77) and MRI + CT (κ=0.76). Readers reached consensus on the classification of rectal versus sigmoid cancer in 78%–85% of cases. Conclusion Availability of a consistent axial imaging plane – in the case of this study provided by CT – in addition to a standard MRI protocol with sagittal and oblique-axial imaging views can be helpful to more confidently localize tumors using the STO as a landmark, especially for more junior readers.

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Section: Discussionmentioning

confidence: 99%

Pelvic CT in addition to MRI to differentiate between rectal and sigmoid cancer on imaging using the sigmoid take-off as a landmark

et al. 2022

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“…Hazen et al had 86 experts classify 20 rectal tumors below or above the sigmoid takeoff and found a high positive predictive value, and that training improved the agreement from 53% to 70%. That study used a various group of experts including radiologist, interns, PhD students, surgeons, and physician assistants, and not everyone was used to assess the sigmoid takeoff as a standard imaging landmark, which may have caused the low agreement (70%) [ 13 ]. Other studies have also found a high agreement in validating the sigmoid takeoff between experienced radiologists [ 2 , 14 ], and a study comparing CT scan with MRI images found no significant difference in the sigmoid takeoff [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Interobserver Reliability and the Sigmoid Takeoff—An Interobserver Study

Pedersen

Otto

Vagn-Hansen

et al. 2022

Cancers

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Background: Colorectal cancer is the second most common cancer worldwide. The sigmoid takeoff is the landmark where the colon sigmoid curves toward the sacrum viewed from sagittal magnetic resonance imaging (MRI). The purpose of this study was to assess interobserver variability in the assessment of the anal verge and anorectal junction in patients diagnosed with rectal cancer on magnetic resonance imaging (MRI). Materials and Methods: The rectal MRI examinations were performed using a 1.5- or 3.0-tesla unit using an anterior coil and a standard scan protocol. Two senior radiologists assessed MRI scans from patients under investigation for rectal cancer. The two observers assessed the anal verge and takeoff in cm independently. Difference in agreement between the observers were evaluated using intraclass correlation (ICC) and graphically by Bland–Altman plots. Results: The study population (n = 122) included 68 (55.7%) female and 54 (44.3%) male subjects. The overall median age was 69.5 years (range 39–95 years). There was perfect agreement between the two observers when defining rectal tumor above or below the takeoff landmark. The reliability of measuring the distance from the anal verge to the sigmoid takeoff was 0.712. Conclusion: Overall, the study found a moderate reliability in assessing the location of the sigmoid takeoff, with a low difference in the distance measuring, as well as a good consensus concerning the determination of tumors in relation to the sigmoid takeoff. Routine implementation of this information within the report seems reasonable.

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“…Patients, at least 18 years of age, with histopathologically confirmed, (deemed) resectable hr-LARC, with the low border of the tumour at or below the sigmoidal take-off as established on MRI, with a World Health Organization (WHO) performance status of ≤ 1, and fit for (modified dose) triplet chemotherapy are eligible for inclusion [ 59 , 60 ]. An expected gross incomplete resection with overt tumour remaining in the patient after resection, tumour invasion in the neuroforamina, encasement of the ischiadic nerve and invasion of the cortex from S2 upwards are considered unresectable.…”

Section: Methodsmentioning

confidence: 99%

Neoadjuvant FOLFOXIRI prior to chemoradiotherapy for high-risk (“ugly”) locally advanced rectal cancer: study protocol of a single-arm, multicentre, open-label, phase II trial (MEND-IT)

et al. 2022

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Background The presence of mesorectal fascia (MRF) invasion, grade 4 extramural venous invasion (EMVI), tumour deposits (TD) or extensive or bilateral extramesorectal (lateral) lymph nodes (LLN) on MRI has been suggested to identify patients with indisputable, extensive locally advanced rectal cancer (LARC), at high risk of treatment failure. The aim of this study is to evaluate whether or not intensified chemotherapy prior to neoadjuvant chemoradiotherapy improves the complete response (CR) rate in these patients. Methods This multicentre, single-arm, open-label, phase II trial will include 128 patients with non-metastatic high-risk LARC (hr-LARC), fit for triplet chemotherapy. To ensure a study population with indisputable, unfavourable prognostic characteristics, hr-LARC is defined as LARC with on baseline MRI at least one of the following characteristics; MRF invasion, EMVI grade 4, enlarged bilateral or extensive LLN at high risk of an incomplete resection, or TD. Exclusion criteria are the presence of a homozygous DPD deficiency, distant metastases, any chemotherapy within the past 6 months, previous radiotherapy within the pelvic area precluding standard chemoradiotherapy, and any contraindication for the planned treatment. All patients will be planned for six two-weekly cycles of FOLFOXIRI (5-fluorouracil, leucovorin, oxaliplatin and irinotecan) prior to chemoradiotherapy (25 × 2 Gy or 28 × 1.8 Gy with concomitant capecitabine). A resection will be performed following radiological confirmation of resectable disease after the completion of chemoradiotherapy. A watch and wait strategy is allowed in case of a clinical complete response. The primary endpoint is the CR rate, described as a pathological CR or a sustained clinical CR one year after chemoradiotherapy. The main secondary objectives are long-term oncological outcomes, radiological and pathological response, the number of resections with clear margins, treatment-related toxicity, perioperative complications, health-related costs, and quality of life. Discussion This trial protocol describes the MEND-IT study. The MEND-IT study aims to evaluate the CR rate after intensified chemotherapy prior to concomitant chemoradiotherapy in a homogeneous group of patients with locally advanced rectal cancer and indisputably unfavourable characteristics, defined as hr-LARC, in order to improve their prognosis. Trial registration Clinicaltrials.gov: NCT04838496, registered on 02–04-2021 Netherlands Trial Register: NL9790. Protocol version Version 3 dd 11–4-2022.

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Evaluation of the implementation of the sigmoid take‐off landmark in the Netherlands

Cited by 9 publications

References 21 publications

Pelvic CT in addition to MRI to differentiate between rectal and sigmoid cancer on imaging using the sigmoid take-off as a landmark

Pelvic CT in addition to MRI to differentiate between rectal and sigmoid cancer on imaging using the sigmoid take-off as a landmark

Interobserver Reliability and the Sigmoid Takeoff—An Interobserver Study

Neoadjuvant FOLFOXIRI prior to chemoradiotherapy for high-risk (“ugly”) locally advanced rectal cancer: study protocol of a single-arm, multicentre, open-label, phase II trial (MEND-IT)

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