Top

Published in:

01-09-2004 | Original Contributions

Can Magnetic Resonance Imaging Predict Circumferential Margins and TNM Stage in Rectal Cancer?

Authors: Graham Branagan, M.S., F.R.C.S., Helen Chave, D.M., F.R.C.S., Clare Fuller, M.B., B.Ch., F.R.C.Path., Shaun McGee, M.R.C.P., F.R.C.R., Derek Finnis, F.R.C.S.(Engl.), F.R.C.S.(Can.)

Published in: Diseases of the Colon & Rectum | Issue 9/2004

INTRODUCTION:

This study was designed to assess whether preoperative magnetic resonance imaging scans were able to predict 1) pathologic tumor and node stage, and 2) those patients with a pathologically clear circumferential resection margin.

METHODS:

Patients with histologically proven carcinoma of the rectum were staged preoperatively using magnetic resonance imaging. Histologic specimens from patients undergoing mesorectal excision were reported according to the Royal College of Pathologists minimum dataset. Agreement between radiologic staging of tumor, local lymph nodes and circumferential resection margin involvement, and pathologic reporting was assessed by means of the Kappa statistic.

RESULTS:

After exclusions (10 radiotherapy, 3 failed scans, 10 no surgery, 9 local surgery), 40 patients remained. Magnetic resonance imaging correctly staged the tumor in 20 patients, understaged in 12, and overstaged in 8. Statistically, there was poor correlation between pathologic and radiologic tumor staging (Kappa, 0.18; 95 percent confidence interval, −0.13 to 0.42). Magnetic resonance imaging correctly staged node status in 27 patients, overstaged in 9, and understaged in 4. Statistically, there was poor correlation between pathologic and radiologic node staging (Kappa, 0.38; 95 percent confidence interval, 0.08–0.64). Magnetic resonance imaging correctly reported the status of the circumferential resection margin in 39 patients and understaged 1. Statistically, there was good correlation between pathologic and radiologic reporting of circumferential resection margin involvement (Kappa, 0.66; 95 percent confidence interval, 0.03–1).

CONCLUSIONS:

Preoperative magnetic resonance imaging scans provide poor predictive data as to subsequent pathologic tumor and node stage. Preoperative magnetic resonance imaging does produce reliable prediction of clear circumferential resection margins and provides valuable information in assessing whether patients can proceed to surgery without the need for preoperative radiotherapy.

Haas-Kock, DF, Baeten, CG, Jager, JJ, et al. 1996Prognostic significance of radial margins of clearance in rectal cancerBr J Surg837815PubMed

Adam, IJ, Mohamdee, MO, Martin, IG, et al. 1994Role of circumferential margin involvement in the local recurrence of rectal cancerLancet34470711CrossRefPubMed

Quirke, P, Durdey, P, Dixon, MF, Williams, NS 1986Local recurrence of rectal adenocarcinoma due to inadequate surgical resection: histopathological study of lateral tumour spread and surgical excisionLancet29969CrossRefPubMed

Heald, RJ, Ryall, RD 1986Recurrence and survival after total mesorectal excision for rectal cancerLancet1147982CrossRefPubMed

Macfarlane, JK, Ryall, RD, Heald, RJ 1993Mesorectal excision for rectal cancerLancet34145760CrossRefPubMed

Havenga, K, Enker, WE, Norstein, J, et al. 1999Improved survival and local control after total mesorectal excision or D3 lymphadenectomy in the treatment of primary rectal cancer: an international analysis of 1411 patientsEur J Surg Oncol2536874CrossRefPubMed

Bjerkeset, T, Dahl, O 1980Irradiation and surgery for primarily inoperable rectal adenocarcinomaDis Colon Rectum23298303PubMed

Dosoretz, D, Gunderson, L, Hedberg, S, et al. 1983Preoperative irradiation for unresectable rectal and rectosigmoid carcinomasCancer528148PubMed

Frykholm, G, Glimelius, B, Pahlman, L 1989Preoperative irradiation with and without chemotherapy (MFL) in the treatment of primarily nonresectable adenocarcinoma of the rectum, results from two consecutive studiesEur J Cancer Clin Oncol25153541PubMed

10.

Pahlman, L, Glimelius, B, Ginman, C, Graffman, S, Adalsteinsson, B 1985Preoperative irradiation of primarily non-resectable adenocarcinoma of the rectum and rectosigmoidActa Radiol Oncol24359PubMed

11.

Frykholm, GJ, Glimelius, B, Pahlman, L 1993Preoperative or postoperative irradiation in adenocarcinoma of the rectum: final treatment results of a randomized trial and an evaluation of late secondary effectsDis Colon Rectum3656472PubMed

12.

Rifkin, MD, Ehrlich, SM, Marks, G 1989Staging of rectal carcinoma: prospective comparison of endorectal US and CTRadiology17031922PubMed

13.

Meyenberger, C, Huch Boni, RA, Bertschinger, P, Zala, GF, Klotz, HP, Krestin, GP 1995Endoscopic ultrasound and endorectal magnetic resonance imaging: a prospective, comparative study for preoperative staging and follow-up of rectal cancerEndoscopy2746979PubMed

14.

Lindmark, G, Elvin, A, Pahlman, L, Glimelius, B 1992The value of preoperative endosonography in preoperative staging of rectal cancerInt J Colorectal Dis71626PubMed

15.

Beets-Tan, RG, Beets, GL, Vliegen, RF, et al. 2001Accuracy of magnetic resonance imaging in prediction of tumour-free resection margin in rectal cancer surgeryLancet357497504PubMed

16.

Brown, G, Richards, CJ, Newcombe, RG, et al. 1999Rectal carcinoma: thin-section MR imaging for staging in 28 patientsRadiology21121522PubMed

17.

Kim, NK, Kim, MJ, Park, JK, Park, SI, Min, JS 2000Preoperative staging of rectal cancer with MRI: accuracy and clinical usefulnessAnn Surg Oncol77327PubMed

18.

Collie, M, Lyttle, JA, Apthorp, L 2002Comparison of MRI and pathological staging of rectal tumoursColorectal Disease47

19.

Nagtegaal, ID, Marijnen, CA, Klein Kranebarg, E, Velde, CJ, Krieken, JH 2002Circumferential margin involvement is still an important predictor of local recurrence in rectal carcinoma: not one millimeter but two millimeters is the limitAm J Surg Pathol263507CrossRefPubMed

Title: Can Magnetic Resonance Imaging Predict Circumferential Margins and TNM Stage in Rectal Cancer?
Authors: Graham Branagan, M.S., F.R.C.S.
Helen Chave, D.M., F.R.C.S.
Clare Fuller, M.B., B.Ch., F.R.C.Path.
Shaun McGee, M.R.C.P., F.R.C.R.
Derek Finnis, F.R.C.S.(Engl.), F.R.C.S.(Can.)
Publication date: 01-09-2004
Publisher: Springer-Verlag
Published in: Diseases of the Colon & Rectum / Issue 9/2004
Print ISSN: 0012-3706
Electronic ISSN: 1530-0358
DOI: https://doi.org/10.1007/s10350-004-0594-z

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Can Magnetic Resonance Imaging Predict Circumferential Margins and TNM Stage in Rectal Cancer?

INTRODUCTION:

METHODS:

RESULTS:

CONCLUSIONS:

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

INTRODUCTION:

METHODS:

RESULTS:

CONCLUSIONS:

Please log in to get access to this content

Other articles of this Issue 9/2004

Predicting Proximal Advanced Neoplasms at Screening Sigmoidoscopy

Concurrent vs. Staged Colectomy and Hepatectomy for Primary Colorectal Cancer With Synchronous Hepatic Metastases

Oncologic and Functional Results of Total Mesorectal Excision and Autonomic Nerve-Preserving Operation for Advanced Lower Rectal Cancer

Physiologic Effects of Bowel Preparation

SELF-ASSESSMENT QUIZ: ANSWERS, CRITIQUES, AND REFERENCES

Long-Term Results of Balloon Catheter Dilation of Lower Gastrointestinal Tract Stenoses