Can Ex Vivo Magnetic Resonance Imaging of Rectal Cancer Specimens Improve the Mesorectal Lymph Node Yield for Pathological Examination?

Stijns, Rutger C.H.; Philips, Bart W. J.; Wauters, C. A. P.; Wilt, Johannes de; Nagtegaal, Irıs D.; Scheenen, Tom W. J.

doi:10.1097/rli.0000000000000581

Cited by 9 publications

(20 citation statements)

References 44 publications

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“…Most of the non-matched structures measured less than 1 mm in size and were thus, as stated in the section Nodal structures not anatomically matched between staging MRI and histopathology , difficult to accurately classify using MRI. The findings are consistent with a recent study that showed that MRI visualises more lymph-node-like structures than even MRI-guided histopathology [ 34 ]. The MRI of the specimen in both our and the previously mentioned study was, however, acquired from formaldehyde fixated tissue, and to the best of our knowledge, there have been no reports on how this might alter MRI findings.…”

Section: Discussionsupporting

confidence: 92%

Rectal cancer: a methodological approach to matching PET/MRI to histopathology

et al. 2020

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Purpose To enable the evaluation of locoregional disease in the on-going RECTOPET (REctal Cancer Trial on PET/MRI/CT) study; a methodology to match mesorectal imaging findings to histopathology is presented, along with initial observations. Methods FDG-PET/MRI examinations were performed in twenty-four consecutively included patients with rectal adenocarcinoma. In nine patients, of whom five received neoadjuvant treatment, a postoperative MRI of the surgical specimen was performed. The pathological cut-out was performed according to clinical routine with the addition of photo documentation of each slice of the surgical specimen, meticulously marking the location, size, and type of pathology of each mesorectal finding. This allowed matching individual nodal structures from preoperative MRI, via the specimen MRI, to histopathology. Results Preoperative MRI identified 197 mesorectal nodal structures, of which 92 (47%) could be anatomically matched to histopathology. Of the matched nodal structures identified in both MRI and histopathology, 25% were found to be malignant. These malignant structures consisted of lymph nodes (43%), tumour deposits (48%), and extramural venous invasion (9%). One hundred eleven nodal structures (55%) could not be matched anatomically. Of these, 97 (87%) were benign lymph nodes, and 14 (13%) were malignant nodal structures. Five were malignant lymph nodes, and nine were tumour deposits, all of which had a short axis diameter < 5 mm. Conclusions We designed a method able to anatomically match and study the characteristics of individual mesorectal nodal structures, enabling further research on the impact of each imaging modality. Initial observations suggest that small malignant nodal structures assessed as lymph nodes in MRI often comprise other forms of mesorectal tumour spread. Trial registration Clinical Trials Identifier:NCT03846882.

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Section: Discussionsupporting

confidence: 92%

Rectal cancer: a methodological approach to matching PET/MRI to histopathology

et al. 2020

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“…Using our described work ow with 7T ex vivo MRI as an intermediate step to guide histopathological work-up, new techniques can be validated on a node-to-node level with histopathology. The detailed 7T ex vivo MRI of the resection specimen aids in nding the smallest lymph nodes that otherwise might be missed with routine pathological evaluation[12], supporting the validation of in vivo imaging techniques.ConclusionA technically feasible method was developed to correlate lymph nodes identi ed on USPIO-enhanced MRI for the detection of lymph nodes metastases with histopathology of the same nodes as gold standard. This work ow was suitable in various anatomical regions.…”

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confidence: 74%

“…Based on lymph node size and appearance, and their location in relation to anatomical landmarks, these in vivo nodes were correlated to the ex vivo MRI images. Subsequently, the lymphadenectomy specimen was dissected at the Department of Pathology with the 3D ex vivo MR images presented on-screen to guide the pathologist [12]. The matched lymph nodes were located in the specimen, taken out, and separately enclosed in a tissue cassette.…”

Section: Mri Guided Pathology and Node-to-node Correlationmentioning

confidence: 99%

Validation of in vivo nodal staging of solid malignancies with USPIO-enhanced MRI: a workflow protocol

Driessen¹,

Gouw²,

Stijns³

et al. 2020

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BackgroundIn various cancer types, the first step towards extended metastatic disease is the presence of lymph node metastases. Imaging methods with sufficient diagnostic accuracy are required to personalize treatment. Lymph node metastases can be detected with ultrasmall superparamagnetic iron oxide (USPIO)-enhanced magnetic resonance imaging (MRI), but this method needs validation. Here, a workflow is presented which is designed to compare MRI-visible lymph nodes on a node-to-node basis with histopathology. MethodsIn patients with prostate, rectal, periampullary, esophageal, and head-and-neck cancer, in vivo USPIO-enhanced MRI was performed to detect lymph nodes suspicious for harboring metastases. After lymphadenectomy, but before histopathological assessment, a 7 Tesla (T) preclinical ex vivo MRI of the surgical specimen was performed, and in vivo MR-images were radiologically matched to ex vivo MR images. Lymph nodes were annotated on the ex vivo MRI for an MR-guided pathological examination of the specimens. ResultsMatching lymph nodes of ex vivo MRI to pathology was feasible in all cancer types. The annotated ex vivo MR images enabled a comparison between USPIO-enhanced in vivo MRI and histopathology which allowed for analyses on nodal, or at least on nodal station level.ConclusionsA workflow was developed to validate in vivo USPIO-enhanced MRI with histopathology. Guiding the pathologist towards lymph nodes in the resection specimens during histopathological work-up allowed analysis at nodal level, or at least nodal station level of in vivo suspicious lymph nodes with corresponding histopathology, providing direct information for validation of in vivo USPIO-enhanced MRI detected lymph nodes. Trial registrationVALINODE data is collected from patients undergoing USPIO-enhanced MRI in the clinical setting. Therefore, the trial has not been registered in an online trial register. 7TNANO1 is registered at Clinicaltrials.gov: NCT02751606, April 26 2016 (https://clinicaltrials.gov/ct2/show/NCT02751606). NANO-PANC is registered at Clinicaltrials.gov: NCT04311047, March 17 2020 (https://www.clinicaltrials.gov/ct2/show/NCT04311047). PRECIES is registered in the Dutch Trial Register: NTR6072, August 5 2016 (https://www.trialregister.nl/trial/5797). USPIO-NECK is registered at Clinicaltrials.gov: NCT03817307, January 25 2019 (https://clinicaltrials.gov/ct2/show/NCT03817307).

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“…With standard pathology methods less lymph nodes or lymph node like structures were detected with pathology compared to ultra-high field MRI, even MRI guided. No other water containing structures were revealed as explanation for the water containing spherical structures within the lipid tissue as assessed by MRI [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…Ex-vivo research has been showing promising results in mesorectal lymph node assessment at 7T. Many lymph nodes or lymph node like structures were found on ex vivo 7T MRI, with a small mean size [23].…”

Section: Ultra-high Magnetic Field Imagingmentioning

confidence: 99%

Magnetic resonance imaging at ultra-high magnetic field strength: An in vivo assessment of number, size and distribution of pelvic lymph nodes

et al. 2020

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The definition of an in vivo nodal anatomical baseline is crucial for validation of representative lymph node dissections and accompanying pathology reports of pelvic cancers, as well as for assessing a potential therapeutic effect of extended lymph node dissections. Therefore the number, size and distribution of lymph nodes in the pelvis were assessed with highresolution, large field-of-view, 7 Tesla (T) magnetic resonance imaging (MRI) with frequency-selective excitation. Materials and methods We used 7 T MRI for homogeneous pelvic imaging in 11 young healthy volunteers. Frequency-selective imaging of water and lipids was performed to detect nodal structures in the pelvis. Number and size of detected nodes was measured and size distribution per region was assessed. An average volunteer-normalized nodal size distribution was determined. Results In total, 564 lymph nodes were detected in six pelvic regions. Mean number was 51.3 with a wide range of 19-91 lymph nodes per volunteer. Mean diameter was 2.3 mm with a range of 1 to 7 mm. 69% Was 2 mm or smaller. The overall size distribution was very similar to the average volunteer-normalized nodal size distribution. Conclusions The amount of in vivo visible lymph nodes varies largely between subjects, whereas the normalized size distribution of nodes does not. The presence of many small lymph nodes

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Can Ex Vivo Magnetic Resonance Imaging of Rectal Cancer Specimens Improve the Mesorectal Lymph Node Yield for Pathological Examination?

Abstract: Supplemental digital content is available in the text.

Cited by 9 publications

References 44 publications

Rectal cancer: a methodological approach to matching PET/MRI to histopathology

Rectal cancer: a methodological approach to matching PET/MRI to histopathology

Validation of in vivo nodal staging of solid malignancies with USPIO-enhanced MRI: a workflow protocol

Magnetic resonance imaging at ultra-high magnetic field strength: An in vivo assessment of number, size and distribution of pelvic lymph nodes

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