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International Journal of Colorectal Disease
Published in: International Journal of Colorectal Disease 6/2016

Open Access 01-06-2016 | Original Article

Nodal staging in rectal cancer: why is restaging after chemoradiation more accurate than primary nodal staging?

Authors: Luc A. Heijnen, Monique Maas, Regina G. Beets-Tan, Myrthe Berkhof, Doenja M. Lambregts, Patty J. Nelemans, Robert Riedl, Geerard L. Beets

Published in: International Journal of Colorectal Disease | Issue 6/2016

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Abstract

Purpose

This study aims to explore the influence of chemoradiation treatment (CRT) on rectal cancer nodes and to generate hypotheses why nodal restaging post-CRT is more accurate than at primary staging.

Methods

Thirty-nine patients with locally advanced rectal cancer underwent MRI pre- and post-CRT. All visible mesorectal nodes were measured on a 3D T1-weighted gradient echo (3D T1W GRE) sequence with 1-mm3 voxels and matched between pre- and post-CRT-MRI and with histology by lesion-by-lesion matching. Change in number and size of nodes was compared between pre- and post-CRT-MRI. ROC curves were constructed to assess diagnostic performance of size.

Results

Eight hundred ninety-five nodes were found pre-CRT: 44 % disappeared and 40 % became smaller post-CRT. Disappearing nodes were initially significantly smaller than nodes that remained visible post-CRT: 2.9 mm vs. 3.8 mm. cN+ stage was predicted in 97 % pre-CRT and 36 % of patients had ypN+ post-CRT. ypN+ patients had significantly larger nodes than ypN0 patients both pre- and post-CRT. Optimal size cutoff for post-CRT ypN stage prediction was 2.5 mm (area under the curve (AUC) of 0.78) at MRI.

Conclusions

After CRT, most lymph nodes become smaller, and many disappear. Size predicts disappearance and node positivity. Together with a low prevalence of ypN+, this can explain the higher accuracy of nodal staging after CRT than in a primary staging setting, possibly of use when considering organ-preserving strategies after CRT.
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Metadata
Title
Nodal staging in rectal cancer: why is restaging after chemoradiation more accurate than primary nodal staging?
Authors
Luc A. Heijnen
Monique Maas
Regina G. Beets-Tan
Myrthe Berkhof
Doenja M. Lambregts
Patty J. Nelemans
Robert Riedl
Geerard L. Beets
Publication date
01-06-2016
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Colorectal Disease / Issue 6/2016
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-016-2576-8

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