Extramural Depth of Tumor Invasion at Thin-Section MR in Patients with Rectal Cancer: Results of the MERCURY Study

Fowler, Jeffrey M.; Beagley, C. E; Blomqvist, Lennart; Brown, Gina; Daniels, Ian R.; Heald, R. J.; Moran, Brendan; Norman, A.; Peppercorn, P D; Quirke, Philip; Sebag‐Montefiore, D.; Study, Mercury

doi:10.1148/radiol.2431051825

Cited by 420 publications

(78 citation statements)

References 32 publications

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“…In this study, we lack confirmation of radiological result with pathologic reference standard for the actual depth of extension (T3 sub-staging), but in our defense, a study revealed high agreement (92%) up to 0.5 mm for extramural tumor extension between radiologic and histopathologic diagnosis (11), and this is a reproducibility study rather than accuracy study. Therefore, it should not be criticized from that point of view.…”

Section: Limitations Of Our Studycontrasting

confidence: 54%

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Clinical Feasibility Assessment of T3 Sub-Stage in Rectal Cancer Using MRI

et al. 2018

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Background: MRI predicted distance of mesorectal extension (mrDME) in rectal cancer is one of the independent risk factors for recurrence and poor overall survival. In T3 rectal cancer, if no lymph node or distant metastasis is seen, the selection of optimum treatment is based on the distance of mesorectal extension. Therefore, it is very crucial to investigate the reproducibility of DME in T3 rectal cancer. Objectives: To investigate the reproducibility of the distance of mesorectal extension by tumor invasion in T3 stage rectal cancer by evaluating sub-stages T3a, T3b T3c and T3d individually versus T3a, T3b (T3ab) and T3c, T3d (T3cd) combined together using MRI. Methods: From July 2014 to December 2015, 188 patients with surgically and histologically confirmed T3 rectal cancer who underwent preoperative MRI were enrolled into this study. Two blinded radiologists evaluated the maximum distance of mesorectal extension (mrDME) in T2 weighted image in MRI. The study population was sub classified into T3a (< 1 mm), T3b (1 -5 mm), T3c (5 -15 mm) and T3d (> 15 mm) according to the distance of mesorectal extension by tumor invasion. The inter-observer and intra-observer data were then assessed using Kappa analysis (k); intraclass correlation coefficients (ICC) were also analyzed subsequently. Results: Difference in the value of inter/intra observer kappa (k), and inter/intra-observer intraclass coefficients (ICC) between the two groups was very distinct. In the individual group (T3a, T3b, T3c and T3d), the inter-observer and intra-observer (k) for the mrDME was 0.700 and 0.718 respectively; the inter-observer and intra-observer ICC was 0.772 and 0.786 respectively. In the combined group (T3ab and T3cd), the inter-observer and intra-observer kappa (k) for the mrDME was 0.819 and 0.883 respectively; the inter-observer and intra-observer ICC was 0.829 and 0.796 respectively. Conclusions: There was a distinct increase in the kappa (K) and intraclass coefficient (ICC) value in the combined group compared with the individual group. This high reproducibility result suggested that it is more reliable to measure T3ab and T3cd combined together than individually. This finding can play a crucial role in the management of rectal cancer and clinical decision making for non-expert radiologists in non-academic setting.

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Section: Limitations Of Our Studycontrasting

confidence: 54%

“…Recently, using 5 mm as a cutoff point to differentiate early and advanced T3 rectal cancer is highly acceptable. According to recent studies, patients with a DME more than 5 mm should be identified properly because they have a worse prognosis compared to patients with DME less than 5 mm (11).…”

Section: Introductionmentioning

confidence: 99%

Clinical Feasibility Assessment of T3 Sub-Stage in Rectal Cancer Using MRI

et al. 2018

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“…Axial images are also obtained before gadolinium administration. study, extramural depth of spread was predicted accurately with thin-section MRI (within 0.5 mm error compared to histopathologic extramural depth of spread) (31). Extramural vascular invasion (EMVI) is another prognostic factor in rectal cancer, which is associated with high risk of local and distant recurrence (32) and poor overall survival (33).…”

Section: Accuracy Of Mrimentioning

confidence: 99%

MRI in local staging of rectal cancer: an update

Tapan

Ozbayrak²,

Tatlı³

2014

Diagn Interv Radiol

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Preoperative imaging for staging of rectal cancer has become an important aspect of current approach to rectal cancer management, because it helps to select suitable patients for neoadjuvant chemoradiotherapy and determine the appropriate surgical technique. Imaging modalities such as endoscopic ultrasonography, computed tomography, and magnetic resonance imaging (MRI) play an important role in assessing the depth of tumor penetration, lymph node involvement, mesorectal fascia and anal sphincter invasion, and presence of distant metastatic diseases. Currently, there is no consensus on a preferred imaging technique for preoperative staging of rectal cancer. However, high-resolution phased-array MRI is recommended as a standard imaging modality for preoperative local staging of rectal cancer, with excellent soft tissue contrast, multiplanar capability, and absence of ionizing radiation. This review will mainly focus on the role of MRI in preoperative local staging of rectal cancer and discuss recent advancements in MRI technique such as diffusion-weighted imaging and dynamic contrast-enhanced MRI. Colorectal cancer is the second most common cancer in women and the third most common cancer in men with 570 100 and 663 600 estimated new cases per year worldwide, respectively (1). Rectal cancer accounts for approximately 42% of colorectal cancers with 45 000 estimated new cases per year in the United States (2). Prognosis of rectal cancer is determined by depth of invasion, number of involved lymph nodes, and involvement of circumferential resection margin. Management of rectal cancer has evolved over the years with preoperative imaging playing an increasingly prominent role. Initial strategy of clinical diagnosis followed by surgery and postoperative chemotherapy had a high local recurrence rate (27%) and poor survival (48% 5-year survival) (3). Later studies showed that neoadjuvant chemoradiation improves survival and decreases local recurrence rates significantly (4). In addition, it reduces tumor size, facilitates curative resection (5), and may enable sphincter sparing surgery in cancers close to the anorectal junction (6). Neoadjuvant chemoradiotherapy is not indicated in stage I tumors (confined to rectal wall with no nodal involvement), but is recommended for stage II (extends beyond the rectal wall, no nodal involvement) and stage III tumors (regional lymph node involvement). Therefore, in order to avoid unnecessary chemoradiation in stage I cancers, a reliable imaging modality is crucial to precisely define depth of invasion and to identify lymph node involvement (7). Current approach in the management of rectal cancer includes preoperative staging with different imaging modalities followed by neoadjuvant chemoradiotherapy (for stage II/III cancers). This approach has lowered the local recurrence rate (11%) and improved survival (58% 5-year survival) (3).Preoperative imaging for rectal cancer staging is also useful to determine which surgical technique would be more appropriate: recently-developed lo...

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“…The extent of tumour spread from the muscularis propria is easily measured and has been underestimated for its value as a predictor of high-risk disease. It is quantifiable and readily reproducible on MRI [35], just as mesorectal fascial involvement is [36]. In addition to adverse prognostic factors, there are good prognostic markers such as a pushing border to the invasive front, a high normal lymph node yield, a dense lymphocytic infiltrate surrounding the tumour and a high tumour cell density accompanied by a low stroma content.…”

Section: Microscopic Featuresmentioning

confidence: 99%

Histopathological Work-Up of Resection Specimens, Local Excisions and Biopsies in Colorectal Cancer

Quirke

Palmer

Hutchins

et al. 2012

Dig Dis

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The pathological examination of material removed from patients with colorectal neoplasia is important. It provides a wide range of information on, for example, the quality and completeness of excision, the stage and biological aggressiveness, the need for further therapy, and response to therapy. Molecular testing adds valuable information on genetic risk and is required before treatment with anti-EGF-r antibodies. This article highlights the value derived from macroscopic inspection of surgical specimens, careful microscopy and excellent reporting according to national guidelines. Increasing use of a number of preoperative therapies and combinations in rectal cancer change the pathological features found and a standardised approach to the diagnosis of complete response is required. It touches upon the issues with frequent changes in TNM staging and the difficulties these changes are causing. The widespread introduction of bowel cancer screening is changing the stage of presentation of colorectal cancer leading to increasing numbers of local excisions and polyp cancers.

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Extramural Depth of Tumor Invasion at Thin-Section MR in Patients with Rectal Cancer: Results of the MERCURY Study

Abstract: Demonstration of accurate measurement of the depth of extramural tumor spread in the MERCURY Study enabled accurate preoperative prognostication.

Cited by 420 publications

References 32 publications

Clinical Feasibility Assessment of T3 Sub-Stage in Rectal Cancer Using MRI

Clinical Feasibility Assessment of T3 Sub-Stage in Rectal Cancer Using MRI

MRI in local staging of rectal cancer: an update

Histopathological Work-Up of Resection Specimens, Local Excisions and Biopsies in Colorectal Cancer

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