Preoperative assessment of local tumor extent in advanced rectal cancer: CT or high-resolution MRI?

Beets-Tan, R. G. H.; Beets, Geerard L.; Borstlap, A. C. W.; Oei, T. K.; Teune, T.M.; Meyenfeldt, M.F. von; Engelshoven, Jos M. A. van

doi:10.1007/s002610000086

Cited by 137 publications

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“…For T-staging, the accuracy of phased-array MRI is similar to MRI with an endorectal coil (21). Although the initial results of phased-array MRI were poor, with an accuracy of 55% for Dukes classification and T-staging, subsequent studies using different techniques have reported sensitivity values above 90%, specificities of 70% to 98%, and an overall accuracy of 90% (29,(43)(44)(45).…”

Section: Discussionmentioning

confidence: 74%

“…The sensitivity and specificity were 97% and 98% for MRI and 70% and 85% for CT, respectively. The accuracy was 80% for MRI and 19% for CT (43).…”

Section: Discussionmentioning

confidence: 87%

“…CRM involvement is associated with a higher risk of pelvic recurrence and poorer survival (17). According to Beets-Tan et al (43), CRM can be predicted using MRI with a high accuracy and consistency, which allows for the preoperative identification of patients who are at risk of recurrence. Even with a successful TME, CRM positivity was 15%-20% (53).…”

Section: Discussionmentioning

confidence: 99%

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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

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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...

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Section: Discussionmentioning

confidence: 74%

“…The sensitivity and specificity were 97% and 98% for MRI and 70% and 85% for CT, respectively. The accuracy was 80% for MRI and 19% for CT (43).…”

Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

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“…Close agreement between MRI measurements and histopathological measurement of the crm have been shown [15,19]. The absence of crm involvement at histology can be predicted when the distance between the edge of the tumour and the mrf measures more than 1 mm on MRI, with a negative predictive value of up to 93% [14,20].…”

Section: Discussionmentioning

confidence: 78%

MRI demonstration of the effect of neoadjuvant radiotherapy on rectal carcinoma

et al. 2007

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“…Esto incluye el estudio metabólico habitual con parámetros nutricionales (albúmina, recuento de linfocitos), el antígeno carcinoembrionario (CEA), la rectoscopía o la colonoscopía con biopsia y los estudios por imágenes. La tomografía computada (TC) tiene una sensibilidad que no supera el 70% y una especificidad del 85%, dada la dificultad para discriminar entre tumor y fibrosis y permite mostrar eventualmente focos a distancia (hígado, pulmón), por lo que se recomienda una TC de tórax, abdomen y pelvis 6 . La resonancia magnética (RM) de la pelvis es más sensible para precisar el compromiso de los órganos pelvianos pero tiene limitaciones en los pacientes irradiados 7 .…”

Section: Evaluación Preoperatoria De La Rlunclassified

¿se Justifica El Tratamiento De La Recidiva Local Del Cáncer De Recto?

2014

Rev Chil Cir

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Treatment of local relapses of rectal cancerThe treatment of local relapses of rectal cancer requires a multimodal strategy. The preoperative assessment should consider the performance status of the patient, determine the precise anatomical involvement and look for distant metastases. The risk factors for a local relapse are the height of the tumor, the type of intervention, an elevated carcinoembryonic antigen in the preoperative period, the circumferential margin involvement and the stage of the tumor. The prognostic factors for an established local relapse are the type of surgery for the primary tumor (local excision, anterior or abdominoperineal resection), the type of relapse (staging), the presence of symptoms (profound pelvic pain) and specially the possibility of achieving a complete resection. A systematic analysis of 55 reports concluded that a radical resection with curative intention was achieved in 40% of cases. Preoperative external or intraoperative radiotherapy was used in 12 to 97% and 8 to 91% of cases respectively. Thirty days postoperative mortality was 2.2%, the rates of local control of the tumor ranged from 29 to 100% and five years survival was at least 25% with a superior limit of 41%. Although there are no clear guidelines for the management of these patients, there is a growing consensus in the use of preoperative radiotherapy to achieve better surgical results. Therefore a multimodal treatment of local relapses is justified.Key words: Rectal cancer, local relapse, surgery. ResumenEl tratamiento actual de la recidiva local (RL) del cáncer de recto representa un verdadero desafío para el equipo multidisciplinario que debe manejar esta seria complicación con una estrategia de terapia multimodal. La evaluación preoperatoria de la RL considera el status perfomance del paciente y busca establecer el compromiso anatómico preciso, así como descartar enfermedad a distancia. Entre los factores de riesgo para la ocurrencia de una RL destacan la altura del tumor (bajo), el tipo de intervención (RAP), el CEA preoperatorio elevado, la perforación intraoperatoria, el compromiso del margen circunferencial y el estadio del tumor

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Preoperative assessment of local tumor extent in advanced rectal cancer: CT or high-resolution MRI?

Cited by 137 publications

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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

MRI demonstration of the effect of neoadjuvant radiotherapy on rectal carcinoma

¿se Justifica El Tratamiento De La Recidiva Local Del Cáncer De Recto?

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