Diagnostic accuracy of high-resolution MRI as a method to predict potentially safe endoscopic and surgical planes in patients with early rectal cancer

Balyasnikova, Svetlana; Read, James H.; Wotherspoon, Andrew; Rasheed, Shahnawaz; Tekkis, Paris; Tait, Diana; Cunningham, David; Brown, Gina

doi:10.1136/bmjgast-2017-000151

Cited by 30 publications

(27 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a study of 52 patients with T1–3 rectal cancer, preoperative nodal staging by MRI had an accuracy of 60 per cent, sensitivity of 57 per cent and specificity of 83 per cent. In another study that evaluated 65 early rectal cancers, the accuracy was 84 per cent, with a PPV of 71 per cent and NPV of 90 per cent for MRI‐based nodal staging. The present study confirmed the overstaging by MRI for nodal disease in this specific group of patients with early tumours, in which 56·3 per cent of cN1 tumours were pN0.…”

Section: Discussionmentioning

confidence: 99%

MRI cT1–2 rectal cancer staging accuracy: a population-based study

Detering

Oostendorp

Meyer

et al. 2020

British Journal of Surgery

View full text Add to dashboard Cite

Background Adequate MRI‐based staging of early rectal cancers is essential for decision‐making in an era of organ‐conserving treatment approaches. The aim of this population‐based study was to determine the accuracy of routine daily MRI staging of early rectal cancer, whether or not combined with endorectal ultrasonography (ERUS). Methods Patients with cT1–2 rectal cancer who underwent local excision or total mesorectal excision (TME) without downsizing (chemo)radiotherapy between 1 January 2011 and 31 December 2018 were selected from the Dutch ColoRectal Audit. The accuracy of imaging was expressed as sensitivity, specificity, and positive predictive value (PPV) and negative predictive value. Results Of 7382 registered patients with cT1–2 rectal cancer, 5539 were included (5288 MRI alone, 251 MRI and ERUS; 1059 cT1 and 4480 cT2). Among patients with pT1 tumours, 54·7 per cent (792 of 1448) were overstaged by MRI alone, and 31·0 per cent (36 of 116) by MRI and ERUS. Understaging of pT2 disease occurred in 8·2 per cent (197 of 2388) and 27·9 per cent (31 of 111) respectively. MRI alone overstaged pN0 in 17·3 per cent (570 of 3303) and the PPV for assignment of cN0 category was 76·3 per cent (2733 of 3583). Of 834 patients with pT1 N0 disease, potentially suitable for local excision, tumours in 253 patients (30·3 per cent) were staged correctly as cT1 N0, whereas 484 (58·0 per cent) and 97 (11·6 per cent) were overstaged as cT2 N0 and cT1–2 N1 respectively. Conclusion This Dutch population‐based analysis of patients who underwent local excision or TME surgery for cT1–2 rectal cancer based on preoperative MRI staging revealed substantial overstaging, indicating the weaknesses of MRI and missed opportunities for organ preservation strategies.

show abstract

Section: Discussionmentioning

confidence: 99%

MRI cT1–2 rectal cancer staging accuracy: a population-based study

Detering

Oostendorp

Meyer

et al. 2020

British Journal of Surgery

View full text Add to dashboard Cite

show abstract

“…Despite the application of pre-operative staging using high-resolution MRI (magnetic resonance imaging) and endo-rectal ultrasound (ERUS), unexpectedly involved lymph nodes and more invasive spread is sometimes encountered during histopathological analysis of the surgically-resected TME specimen. A study comparing pre-operative high-resolution MRI with histopathological assessment of TME specimen found MRI to have an accuracy of 84% in determining the lymph node status and an accuracy of 89% in distinguishing T1 sm1 and sm2 stage cancers from more invasive cancers [8]. If these cancers had been removed by local excision, in those where the MRI was not accurate the involved lymph nodes would have remained undiagnosed in the mesorectum.…”

Section: Introductionmentioning

confidence: 99%

Adjuvant radiotherapy after local excision of rectal cancer

Jones

Cunningham

2019

Acta Oncologica

View full text Add to dashboard Cite

Background: Local excision is now accepted as a standard treatment option for certain patients with early rectal cancer. However, there is a higher risk of local recurrence than after radical surgery with total mesorectal excision. Adjuvant radiotherapy after local excision may reduce this excess risk, and yet retain the benefits of local excision, with rectal preservation. Methods: A review of the literature pertaining to the use of adjuvant radiotherapy after local excision of rectal cancer and a discussion of current practice. Results: We first considered local excision as a treatment option for early rectal cancer, looking at technical developments and the risks and benefits of organ preservation, in particular, the advantages for quality of life and the risk of leaving residual disease which may result in local recurrence. We then looked at reported outcomes for studies using adjuvant radiotherapy after local excision. Few of the studies routinely used modern endoscopic methods of local excision and only the recent used chemoradiation. Local recurrence rates after adjuvant radiotherapy have improved over time, with rates of around 3.5% in the recent studies. Adverse effects of adjuvant radiotherapy are not commonly described, but generally, they are relatively mild when described. We then discussed current practice regarding adjuvant radiotherapy, including pathological criteria, discussion of local recurrence risk with the patient and the importance of a surveillance regime to detect any recurrence at an early stage. Conclusion: We conclude that the current state of knowledge regarding adjuvant radiotherapy after local excision suggests a potential role in decreasing the risk of local recurrence but further studies are required to better define this effect, clarify which patients will gain the most benefit from this pathway, and identify those who should avoid exposure to the risks of radiotherapy. ARTICLE HISTORY

show abstract

“…Recent studies have shown that radiomics is important in identifying tumor heterogeneity in several kinds of tumors [5][6][7][8][9], which may serve as a complementary tool for the preoperative tumor staging in rectal cancer [10][11][12][13]. The patients with rectal cancer required a comprehensive staging evaluation for guiding decisions regarding choice of treatment with an aim to avoid undertreatment and minimize overtreatment.…”

Section: Discussionmentioning

confidence: 99%

“…Radiomics has been used to evaluate several kinds of tumors in previous studies and is being increasingly implemented [5][6][7][8][9]. MRI-based radiomics model has been employed in distinguishing cancer from benign tissue and reflecting the histological characteristics of rectal cancer [10][11][12][13]. Therefore, the purpose of the present study was to investigate the significance of an MRI-based radiomics model derived from high-resolution T2WI in identifying specific pathological features of rectal cancer and build a set of prediction radiomics models.…”

Section: Introductionmentioning

confidence: 99%

MRI-based Radiomics of Rectal Cancer: Preoperative Assessment of the Pathological Features

Shen

Jia³

et al. 2019

Preprint

View full text Add to dashboard Cite

[EXSCINDED] Abstract Background This study aimed to evaluate the significance of MRI-based radiomics model derived from high-resolution T2-weighted images (T2WIs) in predicting tumor pathological features of rectal cancer.Methods A total of 152 patients with rectal cancer who underwent surgery without any neoadjuvant therapy between March 2017 and September 2018 were included retrospectively. The patients were scanned using a 3-tesla magnetic resonance imaging, and high-resolution T2WIs were obtained. Lesions were delineated, and 1029 radiomics features were extracted. Least absolute shrinkage and selection operator was used to select features, and multilayer perceptron (MLP), logistic regression, support vector machine (SVM), decision tree, random forest (RF), and K-nearest neighbor were trained using fivefold cross-validation to build a prediction model. The diagnostic performance of the prediction models was assessed using the receiver operating characteristic curves.Results A total of 1029 features were extracted, and 15, 11, and 11 features were selected to predict the degree of differentiation, T stage, and N stage, respectively. The best performance of the radiomics model for the degree of differentiation, T stage, and N stage was obtained by SVM [area under the curve (AUC), 0.862; 95% confidence interval (CI), 0.750–0.967; sensitivity, 83.3%; specificity, 85.0%], MLP (AUC, 0.809; 95% CI, 0.690–0.905; sensitivity, 76.2%; specificity, 74.1%), and RF (AUC, 0.809; 95% CI, 0.690–0.905; sensitivity, 76.2%; specificity, 74.1%).Conclusion This study demonstrated that the high-resolution T2WI–based radiomics model could serve as pretreatment biomarkers in predicting pathological features of rectal cancer.

show abstract

Diagnostic accuracy of high-resolution MRI as a method to predict potentially safe endoscopic and surgical planes in patients with early rectal cancer

Cited by 30 publications

References 21 publications

MRI cT1–2 rectal cancer staging accuracy: a population-based study

MRI cT1–2 rectal cancer staging accuracy: a population-based study

Adjuvant radiotherapy after local excision of rectal cancer

MRI-based Radiomics of Rectal Cancer: Preoperative Assessment of the Pathological Features

Contact Info

Product

Resources

About