A Logistic Model Including Risk Factors for Lymph Node Metastasis Can Improve the Accuracy of Magnetic Resonance Imaging Diagnosis of Rectal Cancer

Ogawa, Shimpei; Itabashi, Michio; Hirosawa, Tomoichiro; Hashimoto, Takuzo; Bamba, Yoshiko; Kameoka, Shingo

doi:10.7314/apjcp.2015.16.2.707

Cited by 7 publications

(5 citation statements)

References 25 publications

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“…At present, the diagnostic ability of T staging, mesorectal fascia (MRF) invasion and extramural vascular invasion (EMVI) are widely recognized clinically and can be used as an important basis for the diagnosis and treatment of rectal cancer. 1 However, preoperative assessment of N staging that relies on MR criteria is not optimistic, 2 despite lymph node metastasis (LNM) being an important risk factor for disease-free survival and local recurrence. 3 The European Society for Medical Oncology (ESMO) guidelines 4 recommend that low-risk patients with T3N0 do not need preoperative neoadjuvant chemoradiotherapy (nCRT) and only need treatment with total mesorectal excision (TME).…”

Section: Introductionmentioning

confidence: 99%

Histogram Analysis of Diffusion-Weighted Magnetic Resonance Imaging as a Biomarker to Predict Lymph Node Metastasis in T3 Stage Rectal Carcinoma

Li¹,

Zhou²,

Wang³

et al. 2021

CMAR

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This study investigated the predictive value of apparent diffusion coefficient (ADC) histogram parameters of the primary tumor for regional lymph node metastasis (LNM) in pathological T3 stage rectal cancer. Patients and Methods: We retrospectively studied 175 patients with T3 stage rectal cancer who underwent preoperative MRI, including diffusion-weighted imaging, between January 2015 and October 2017. Based on pathological analysis of surgical specimens, 113 patients were classified into the LN− group and 62 in the LN+ group. We analyzed clinical data, radiological characteristics and histogram parameters derived from ADC maps. Then, receiver operating characteristic curve (ROC) analyses were generated to determine the best diagnostic performance. Results: The mean (p=0.002, cutoff=1.08×10 -3 s/mm 2 ), coefficient of variation (CV) (p=0.040, cutoff=0.249) of the ADC map, carbohydrate antigen 199, and N stage with magnetic resonance (mrN stage) were independent factors for LNM. Combining these factors yielded the best diagnostic performance, with the area under the ROC curve of 0.838, 72.9% sensitivity, 79.1% specificity, 65.2% positive predictive value, and 84.5% negative predictive value. Conclusion:With the mean >1.08×10 -3 s/mm 2 and CV <0.249, the ADC improved the diagnostic performance of LNM in T3 stage rectal cancer, which could assist surgeons with neoadjuvant chemoradiotherapy.

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Section: Introductionmentioning

confidence: 99%

Histogram Analysis of Diffusion-Weighted Magnetic Resonance Imaging as a Biomarker to Predict Lymph Node Metastasis in T3 Stage Rectal Carcinoma

Li¹,

Zhou²,

Wang³

et al. 2021

CMAR

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“…A model including clinical stage N, age, stage T, and body mass index proposed by Ogawa et al had a sensitivity, specificity, and AUC of predicting LN metastasis in rectal cancer patients of 0.723, 0.774, and 0.785, respectively 29 . The corresponding values in our study were 0.854, 0.847, and 0.903, respectively, suggesting that the diagnostic effectiveness of the current predictive model was higher than that of their model.…”

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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“…Recent studies indicated intensification of systemic therapy with neoadjuvant combination chemotherapy before standard treatment is feasible in poor-risk potentially operable rectal cancer with acceptable safety and promising long-term outcomes, for it can eradicate micrometastasis by implementation of a full systemic dose [ 22 , 23 ]. In term of metastatic LNs assessment, as the presence of microscopic metastases or inflammatory swelling of LNs, the preoperative metastatic LNs assessment remains a challenging problem for radiologists [ 19 ]. In our study, a short axis diameter of greater than 5mm, irregular borders or mixed signal intensity was used as the diagnostic criteria for metastatic LNs.…”

Section: Discussionmentioning

confidence: 99%

“…The MRI has been considered as the imaging modality of choice for the preoperative staging of rectal cancer; however, LNs staging is still challenging for MRI [ 17 , 18 ]. The diagnostic accuracy of MRI for assessing the LN metastasis varies from 57% to 85% [ 19 ]. On the other hand, the serum carcinoembryonic antigen (CEA) is known to be a widely available tumor marker for preoperative evaluation and postoperative detection of distant metastasis in patients with rectal cancer [ 20 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

Pretreatment magnetic resonance imaging of regional lymph nodes with carcinoembryonic antigen in prediction of synchronous distant metastasis in patients with rectal cancer

et al. 2016

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Distant metastasis in patients with rectal cancer remains a problem influencing prognosis. Prediction of synchronous distant metastasis is important for the choice of personalized treatment strategies and postoperative follow-up protocol. So far, there are few studies about the predictive value of MRI features combined with clinical characteristics for synchronous distant metastasis in rectal cancer, especially for the lesions developed within 6 months after surgery. We retrospectively reviewed the pretreatment clinical characteristics and magnetic resonance imaging (MRI) features of 271 patients from January 2010 to December 2011with pathologically confirmed rectal adenocarcinoma and tried to identify independent risk factors for synchronous distant metastasis. Forty-nine patients (18.1%) were confirmed to have synchronous distant metastasis. Multivariate logistic regression model demonstrated that the elevated carcinoembryonic antigen (CEA), positive MRI-predicted lymph nodes staging (mrN), and MRI-predicted mesorectal fascia (mrMRF) involvement were independent risk factors. The odd ratios were 12.2 for elevated CEA, 5.4 for mrN1 and 7.6 for mrN2, and 3.8 for mrMRF involvement, respectively. The accuracy and specificity for predicting synchronous distant metastasis by evaluating the positive mrN combined with elevated CEA were improved to 87.8% and 94.6%, respectively. The accuracy, sensitivity and specificity of positive mrN assessment were 86.1%, 71.4% and 91.7%, respectively using the histopathologic results as the reference standard. Altogether, our findings suggest that pretreatment positive mrN and elevated CEA are independent risk factors for synchronous distant metastasis in rectal cancer and combination of both could help to recognize the patients with high risk for structuring personalized treatment protocol.

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A Logistic Model Including Risk Factors for Lymph Node Metastasis Can Improve the Accuracy of Magnetic Resonance Imaging Diagnosis of Rectal Cancer

Abstract: Comprehensive Cancer Network., 2014). Establishment of an indication for neoadjuvant therapy requires evaluation of nodal staging and T stage and mesorectal fascia (MRF) involvement. If the symptoms are underestimated due to inaccurate nodal staging, the patient

Cited by 7 publications

References 25 publications

Histogram Analysis of Diffusion-Weighted Magnetic Resonance Imaging as a Biomarker to Predict Lymph Node Metastasis in T3 Stage Rectal Carcinoma

Histogram Analysis of Diffusion-Weighted Magnetic Resonance Imaging as a Biomarker to Predict Lymph Node Metastasis in T3 Stage Rectal Carcinoma

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

Pretreatment magnetic resonance imaging of regional lymph nodes with carcinoembryonic antigen in prediction of synchronous distant metastasis in patients with rectal cancer

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