Preoperative staging of rectal cancer using magnetic resonance imaging: comparison with pathological staging

Faletti, Riccardo; Gatti, Marco; Arezzo, Alberto; Stola, Silvia; Benedini, Maria C; Bergamasco, Laura; Morino, Mario; Fonio, Paolo

doi:10.23736/s0026-4733.17.07392-8

Cited by 14 publications

(10 citation statements)

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“…In our retrospective study, MRI-involved CRM was an independent risk factor for OS. It was consistent with the result of the MERCURY trial, where MRI-involved CRM showed a decreased OS in comparison with MRI-clear CRM (HR: 1.97, 95% CI: 1.27–3.04, P<0.01) ( 28 ). However, we didn't observe that patients with MRI-involved CRM had a higher risk of LR.…”

Section: Discussionsupporting

confidence: 88%

Prognostic value of CEA and CA19-9 in patients with local advanced rectal cancer receiving neoadjuvant chemoradiotherapy, radical surgery and postoperative chemotherapy

Shan¹,

Gu²,

Shi³

et al. 2021

Transl Cancer Res TCR

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Background: We aim to investigate the prognostic factors and evaluate the role of carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) in local advanced rectal cancer (LARC) patients who received neoadjuvant chemoradiotherapy (neo-CRT), radical surgery and postoperative chemotherapy.Methods: In total, 197 cases of LARC patients who underwent neo-CRT, total mesorectal excision (TME), and adjuvant chemotherapy were recruited. Serum levels of CEA and CA19-9 were detected both at baseline and after neo-chemoradiotherapy. Multivariate analysis was used to assess correlations between levels of CEA and CA19-9 and patients' prognosis (survival, recurrence, and metastasis). Rates of survival, distant metastasis (DM), and local recurrence (LR) were estimated using Kaplan-Meier survival analysis, the log-rank test, and Cox proportional hazards.Results: The median follow-up time was 45.3 months, and a cohort of 197 patients was analyzed; 84 (42.6%) patients had elevated baseline CEA levels, 21 (10.7%) patients had elevated baseline CA19-9 levels, and 14 (7.1%) patients had both; 77.4% (65/84) patients with high CEA levels and 76.2% (16/21) with high CA19-9 levels returned to normal after neo-chemoradiotherapy. The Cox regression model suggested that elevated CEA was associated with an increased risk of disease-free survival (DFS) (HR: 2.058, 95% CI: 1.034-4.096,

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Section: Discussionsupporting

confidence: 88%

Prognostic value of CEA and CA19-9 in patients with local advanced rectal cancer receiving neoadjuvant chemoradiotherapy, radical surgery and postoperative chemotherapy

Shan¹,

Gu²,

Shi³

et al. 2021

Transl Cancer Res TCR

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show abstract

“…27 Similarly, Faletti et al's research has shown that the prediction of metastatic LNs is improved by considering dimension, morphology and signal characteristics, and they emphasized the ability of ADC to identify a high probability of malignant nodes in the diagnostic process. 28 Because the current study was a retrospective study, we cannot match the LNs on MRI with the metastatic LNs reported in pathology one-by-one. Therefore, we gave up measuring the ADC of LNs individually.…”

Section: Discussionmentioning

confidence: 99%

Prediction Model Combining Clinical and MR Data for Diagnosis of Lymph Node Metastasis in Patients With Rectal Cancer

Zhao

Guo

et al. 2020

Magnetic Resonance Imaging

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Background Determining the status of lymph node (LN) metastasis in rectal cancer patients preoperatively is crucial for the treatment option. However, the diagnostic accuracy of current imaging methods is low. Purpose To develop and test a model for predicting metastatic LNs of rectal cancer patients based on clinical data and MR images to improve the diagnosis of metastatic LNs. Study type Retrospective. Subjects In all, 341 patients with histologically confirmed rectal cancer were divided into one training set (120 cases) and three validation sets (69, 103, 49 cases). Field strength/sequence 3.0T, axial and sagittal T2‐weighted turbo spin echo and diffusion‐weighted imaging (b = 0 s/mm2, 800 s/mm2) Assessment In the training dataset, univariate logistic regression was used to identify the clinical factors (age, gender, and tumor markers) and MR data that correlated with LN metastasis. Then we developed a prediction model with these factors by multiple logistic regression analysis. The accuracy of the model was verified using three validation sets and compared with the traditional MRI method. Statistical tests Univariate and multivariate logistic regression. The area under the curve (AUC) value was used to quantify the diagnostic accuracy of the model. Results Eight factors (CEA, CA199, ADCmean, mriT stage, mriN stage, CRM, EMVI, and differentiation degree) were significantly associated with LN metastasis in rectal cancer patients (P<0.1). In the training set (120) and the three validation sets (69, 103, 49), the AUC values of the model were much higher than the diagnosis by MR alone (training set, 0.902 vs. 0.580; first validation set, 0.789 vs. 0.743; second validation set, 0.774 vs. 0.573; third validation set, 0.761 vs. 0.524). Data Conclusion For the diagnosis of metastatic LNs in rectal cancer patients, our proposed logistic regression model, combining clinical and MR data, demonstrated higher diagnostic efficiency than MRI alone. Level of Evidence 4 Technical Efficacy Stage 2

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“…Currently, the main challenge for radiologists is the metastatic LNs with smaller short diameter, because there is much overlap between their morphologic appearance and that of nonmetastatic LNs in practice. Faletti et al found short diameter of LN ≥8 mm can obtain the best diagnostic accuracy, 19 and short diameter > 9 mm LNs are considered as metastatic LNs. 7,19 Thus, we excluded patients with the largest LN short diameter greater than 9 mm in our study.…”

Section: Discussionmentioning

confidence: 99%

“…Faletti et al found short diameter of LN ≥8 mm can obtain the best diagnostic accuracy, 19 and short diameter > 9 mm LNs are considered as metastatic LNs. 7,19 Thus, we excluded patients with the largest LN short diameter greater than 9 mm in our study. Similar to the mechanism of primary tumorigenesis, metastasis is a multistep, multifactor complex process.…”

Section: Discussionmentioning

confidence: 99%

A Nomogram of Combining IVIM‐DWI and MRI Radiomics From the Primary Lesion of Rectal Adenocarcinoma to Assess Nonenlarged Lymph Node Metastasis Preoperatively

Jia

Jiang

Zhang

et al. 2022

Magnetic Resonance Imaging

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Background: Lymph node (LN) staging plays an important role in treatment decision-making. Current problem is that preoperative detection of LN involvement is always highly challenging for radiologists. Purpose: To explore the value of the nomogram model combining intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) and radiomics features from the primary lesion of rectal adenocarcinoma in assessing the non-enlarged lymph node metastasis (N-LNM) preoperatively. Study Type: Retrospective. Population: A total of 126 patients (43% female) comprising a training group (n = 87) and a validation group (n = 39) with pathologically confirmed rectal adenocarcinoma. Field Strength/Sequence: A 3.0 Tesla (T); T 2 Àweighted imaging (T 2 WI) with fast spin-echo (FSE) sequence; IVIM-DWI spin-echo echo-planar imaging sequence. Assessment: Based on pathological analysis of the surgical specimen, patients were classified into negative LN (LNÀ) and positive LN (LN+) groups. Apparent diffusion coefficient (ADC), diffusion coefficient (D), pseudo diffusion coefficient (D*) and microvascular volume fraction (f) values of primary lesion of rectal adenocarcinoma were measured. Three-dimensional (3D) radiomics features were measured on T 2 WI and IVIM-DWI. A nomogram model including IVIM-DWI and radiomics features was developed. Statistical Tests: General_univariate_analysis and multivariate logistic regression were used for radiomics features selection. The performance of the nomogram was assessed by the receiver operating characteristic (ROC) curve, calibration, and decision curve analysis (DCA). Results: The LN+ group had a significantly lower D* value ([13.20 AE 13.66 vs. 23.25 AE 18.71] Â 10 À3 mm 2 /sec) and a higher f value (0.43 AE 0.12 vs. 0.34 AE 0.10) than the LNÀ group in the training cohort. The nomogram model combined D*, f, and radiomics features had a better evaluated performance (AUC = 0.864) than any other model in the training cohort. Date Conclusion:The nomogram model including IVIM-DWI and MRI radiomics features in the primary lesion of rectal adenocarcinoma was associated with the N-LNM.

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Preoperative staging of rectal cancer using magnetic resonance imaging: comparison with pathological staging

Cited by 14 publications

References 0 publications

Prognostic value of CEA and CA19-9 in patients with local advanced rectal cancer receiving neoadjuvant chemoradiotherapy, radical surgery and postoperative chemotherapy

Prognostic value of CEA and CA19-9 in patients with local advanced rectal cancer receiving neoadjuvant chemoradiotherapy, radical surgery and postoperative chemotherapy

Prediction Model Combining Clinical and MR Data for Diagnosis of Lymph Node Metastasis in Patients With Rectal Cancer

A Nomogram of Combining IVIM‐DWI and MRI Radiomics From the Primary Lesion of Rectal Adenocarcinoma to Assess Nonenlarged Lymph Node Metastasis Preoperatively

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