Quality of preoperative pelvic computed tomography (CT) and magnetic resonance imaging (MRI) for rectal cancer in a region in Ontario: A retrospective population‐based study

Bogach, Jessica; Tsai, Scott S. H.; Zbuk, Kevin; Wong, Raimond; Grubac, Vanja; Coates, Angela; Pond, Gregory R.; Šimunović, Marko

doi:10.1002/jso.25000

Cited by 14 publications

(8 citation statements)

References 11 publications

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“…However, the benefit of these surveillance strategies has not been established. In particular, baseline radiological oncological staging of lymph nodes in colorectal cancer is hampered by moderate sensitivity and specificity of approximately 75 % [29][30][31][32][33][34][35][36], and there exists no literature on the benefits of sequential imaging over time.…”

Section: Discussionmentioning

confidence: 99%

High practice variation in risk stratification, baseline oncological staging, and follow-up strategies for T1 colorectal cancers in the Netherlands

et al. 2020

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Background and study aims Based on pathology, locally resected T1 colorectal cancer (T1-CRC) can be classified as having low- or high-risk for irradicality and/or lymph node metastasis, the latter requiring adjuvant surgery. Reporting and application of pathological high-risk criteria is likely variable, with inherited variation regarding baseline oncological staging, treatment and surveillance. Methods We assessed practice variation using an online survey among gastroenterologists and surgeons participating in the Dutch T1-CRC Working Group. Results Of the 130 invited physicians, 53 % participated. Regarding high-risk T1-CRC criteria, lymphangio-invasion is used by 100 %, positive or indeterminable margins by 93 %, poor differentiation by 90 %, tumor-free margin ≤ 1 mm by 78 %, tumor budding by 57 % and submucosal invasion > 1000 µm by 47 %. Fifty-two percent of the respondents do not perform baseline staging in locally resected low-risk T1-CRC. In case of unoperated high-risk patients, we recorded 61 different surveillance strategies in 63 participants, using 19 different combinations of diagnostic tests. Endoscopy is used in all schedules. Mean follow-up time is 36 months for endoscopy, 26 months for rectal MRI and 30 months for abdominal CT (all varying 3–60 months). Conclusion We found variable use of pathological high-risk T1-CRC criteria, creating risk for misclassification as low-risk T1-CRC. This has serious implications, as most participants will not proceed to oncological staging in low-risk patients and adjuvant surgery nor radiological surveillance is considered. On the other hand, oncological surveillance in patients with a locally resected high-risk T1-CRC who do not wish adjuvant surgery is highly variable emphasizing the need for a uniform surveillance protocol.

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Section: Discussionmentioning

confidence: 99%

High practice variation in risk stratification, baseline oncological staging, and follow-up strategies for T1 colorectal cancers in the Netherlands

et al. 2020

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“…Transanal local excision is indicated for noncircumferential villous adenomas and well to moderately differentiated cTis and cT1 carcinomas [ 4 ] without evidence of LN invasion, smaller than 3 cm in diameter, located between 8 to 10 cm from the anal margin and occupying less than 1/3 of the circumference of the rectum lumen, that can be accessed transanally for complete transanal excision [ 35 ], either by conventional techniques or by transanal endoscopic microsurgery (TEM) or transanal minimally invasive surgery (TAMIS), which is considered the standard procedure for this type of resection with 10-year overall survival rates of greater than 75% disease-free survival [ 22 , 36 - 40 ].…”

Section: Surgical Managementmentioning

confidence: 99%

“…In the past, the only method to evaluate the extent of rectal cancer at the distal rectum was a digital rectal exam. However, the implementation of abdominal computed tomography (CT) scan showed clear images of the local spread of distal rectal cancer, where the exact relation between the tumor and surrounding organ used to be unclear [ 4 ]. The endorectal ultrasonographic evaluation was later available, easy to use, and helpful to assess the depth of invasion [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Surgical Treatment of Low-Lying Rectal Cancer: Updates

Varela

Kim

2021

Ann Coloproctol

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Despite innovative advancements, distally located rectal cancer remains a critical disease of challenging management. The crucial location of the tumor predisposes it to a circumferential resection margin (CRM) that tends to involve the anal sphincter complex and surrounding organs, with a high incidence of delayed anastomotic complications and the risk of the pelvic sidewall or rarely inguinal lymph node metastases. In this regard, colorectal surgeons should be aware of other issues beyond total mesorectal excision (TME) performance. For decades, the concept of extralevator abdominoperineal resection to avoid compromised CRM has been introduced. However, the complexity of deep pelvic dissection with poor visualization in low-lying rectal cancer has led to transanal TME. In contrast, neoadjuvant chemoradiotherapy (NCRT) has allowed for the execution of more sphincter-saving procedures without oncologic compromise. Significant tumor regression after NCRT and complete pathologic response also permit applying the watch-and-wait protocol in some cases, now with more solid evidence. This review article will introduce the current surgical treatment options, their indication and technical details, and recent oncologic and functional outcomes. Lastly, the novel characteristics of distal rectal cancer, such as pelvic sidewall and inguinal lymph node metastases, will be discussed along with its tailored and individualized treatment approach.

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“…The characteristics of the studies are presented in Table 1. The reference standards were divided into the following five categories according to different morphological criteria: (A) a short-axis diameter of 5 mm (22-34), (B) morphological standard, including an irregular border and mixed-signal intensity within the lymph node (35)(36)(37)(38)(39)(40), (C) a short-axis diameter of 5 mm with the morphological standard (11,(41)(42)(43)(44)(45)(46)(47)(48), (D) a short-axis diameter of 8 mm with the morphological standard (49)(50)(51)(52), and (E) a short-axis diameter of 10 mm with the morphological standard (11,45,53,54). In all of the included articles, 36 indirectly evaluated the lymph node stage of patients through histopathology and 5 (9,41,42,55,56) identified the node-by-node correspondence between lymph node MRI scans and histopathologic results.…”

Section: Description Of Included Studiesmentioning

confidence: 99%

Magnetic Resonance Imaging Evaluation of the Accuracy of Various Lymph Node Staging Criteria in Rectal Cancer: A Systematic Review and Meta-Analysis

et al. 2021

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BackgroundMagnetic resonance imaging (MRI)-based lymph node staging remains a significant challenge in the treatment of rectal cancer. Pretreatment evaluation of lymph node metastasis guides the formulation of treatment plans. This systematic review aimed to evaluate the diagnostic performance of MRI in lymph node staging using various morphological criteria.MethodsA systematic search of the EMBASE, Medline, and Cochrane databases was performed. Original articles published between 2000 and January 2021 that used MRI for lymph node staging in rectal cancer were eligible. The included studies were assessed using the QUADAS-2 tool. A bivariate random-effects model was used to conduct a meta-analysis of diagnostic test accuracy.ResultsThirty-seven studies were eligible for this meta-analysis. The pooled sensitivity, specificity, and diagnostic odds ratio of preoperative MRI for the lymph node stage were 0.73 (95% confidence interval [CI], 0.68–0.77), 0.74 (95% CI, 0.68–0.80), and 7.85 (95% CI, 5.78–10.66), respectively. Criteria for positive mesorectal lymph node metastasis included (A) a short-axis diameter of 5 mm, (B) morphological standard, including an irregular border and mixed-signal intensity within the lymph node, (C) a short-axis diameter of 5 mm with the morphological standard, (D) a short-axis diameter of 8 mm with the morphological standard, and (E) a short-axis diameter of 10 mm with the morphological standard. The pooled sensitivity/specificity for these criteria were 75%/64%, 81%/67%, 74%/79%, 72%/66%, and 62%/91%, respectively. There was no significant difference among the criteria in sensitivity/specificity. The area under the receiver operating characteristic (ROC) curve values of the fitted summary ROC indicated a diagnostic accuracy rate of 0.75–0.81.ConclusionMRI scans have minimal accuracy as a reference index for pretreatment staging of various lymph node staging criteria in rectal cancer. Multiple types of evidence should be used in clinical decision-making.

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Quality of preoperative pelvic computed tomography (CT) and magnetic resonance imaging (MRI) for rectal cancer in a region in Ontario: A retrospective population‐based study

Abstract: In this region of Ontario, pre-operative MRI was underutilized, CT reporting of MRF status was low, and when reported sensitivity and specificity of T- and N-category were similar for CT and MRI.

Cited by 14 publications

References 11 publications

High practice variation in risk stratification, baseline oncological staging, and follow-up strategies for T1 colorectal cancers in the Netherlands

High practice variation in risk stratification, baseline oncological staging, and follow-up strategies for T1 colorectal cancers in the Netherlands

Surgical Treatment of Low-Lying Rectal Cancer: Updates

Magnetic Resonance Imaging Evaluation of the Accuracy of Various Lymph Node Staging Criteria in Rectal Cancer: A Systematic Review and Meta-Analysis

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