Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 10/2009

01-10-2009 | Colorectal Cancer

Accuracy of High-Resolution Magnetic Resonance Imaging in Preoperative Staging of Rectal Cancer

Authors: Takayuki Akasu, MD, Gen Iinuma, MD, Masashi Takawa, MD, Seiichiro Yamamoto, MD, Yukio Muramatsu, MD, Noriyuki Moriyama, MD

Published in: Annals of Surgical Oncology | Issue 10/2009

Login to get access

Abstract

Background

To achieve better prognosis and quality of life for patients with rectal cancer, extent of surgery and neoadjuvant chemoradiotherapy should accurately reflect disease extent. The aim of this study was to evaluate accuracy of high-resolution magnetic resonance imaging (HRMRI) for preoperative staging of rectal cancer.

Methods

Between 2001 and 2003, 104 patients with primary rectal cancer were examined with HRMRI and underwent radical surgery. Transmural invasion depth and lymph node metastasis were assessed prospectively and classified according to the American Joint Committee on Cancer (AJCC) tumor–node–metastasis (TNM) system by both HRMRI and histopathology, and results were compared. Criteria for mesorectal and lateral pelvic lymph node involvement were short-axis diameters of ≥5 mm and ≥4 mm, respectively.

Results

There were 15 pT1, 25 pT2, 50 pT3, and 14 pT4 tumors. Overall accuracy rate for transmural invasion depth was 84%. The mesorectal fascia could be visualized in 98% of patients. Twenty-three patients had mesorectal fascia involvement and the overall accuracy rate was 96% (sensitivity, 96%; specificity, 96%). Fifty-three patients had mesorectal lymph node metastasis and the overall accuracy rate was 74% (sensitivity, 83%; specificity, 64%). Lateral pelvic lymph node metastasis was observed in 15 patients and the overall accuracy rate was 87% (sensitivity, 87%; specificity, 87%).

Conclusions

HRMRI was moderately accurate for prediction of mesorectal lymph node metastasis and highly accurate regarding transmural invasion depth, and mesorectal fascia and lateral pelvic node involvement. Therefore, HRMRI appears useful for preoperative decision-making in rectal cancer treatment.
Literature
1.
Havenga K, DeRuiter MC, Enker WE, Welvaart K. Anatomical basis of autonomic nerve-preserving total mesorectal excision for rectal cancer. Br J Surg. 1996;83:384–8.CrossRefPubMed
2.
Kapiteijn E, Marijnen CAM, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 2001;345:638–46.CrossRefPubMed
3.
Improved survival with preoperative radiotherapy in resectable rectal cancer, Swedish Rectal Cancer Trial. N Engl J Med. 1997;336:980–7.
4.
Akasu T, Kondo H, Moriya Y, et al. Endorectal ultrasonography and treatment of early stage rectal cancer. World J Surg. 2000;24:1061–8.CrossRefPubMed
5.
Zaheer S, Pemberton JH, Farouk R, Dozois RR, Wolff BG, Ilstrup D. Surgical treatment of adenocarcinoma of the rectum. Ann Surg. 1998;227:800–11.CrossRefPubMed
6.
Peeters KC, van de Velde CJ, Leer JW, et al. Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients—a Dutch Colorectal Cancer Group Study. J Clin Oncol. 2005;23:6199–206.CrossRefPubMed
7.
Pollack J, Holm T, Cedermark B, Holmstrom B, Mellgren A. Long-term effect of preoperative radiation therapy on anorectal function. Dis Colon Rectum. 2006;49:345–52.CrossRefPubMed
8.
Marijnen CA, van de Velde CJ, Putter H, et al. Impact of short-term preoperative radiotherapy on health-related quality of life and sexual functioning in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol. 2005;23:1847–58.CrossRefPubMed
9.
Heriot AG, Tekkis PP, Fazio VW, Neary P, Lavery IC. Adjuvant radiotherapy is associated with increased sexual dysfunction in male patients undergoing resection for rectal cancer: a predictive model. Ann Surg. 2005;242:502–11.PubMed
10.
Bipat S, Glas AS, Slors FJ, Zwinderman AH, Bossuyt PM, Stoker J. Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging—a meta-analysis. Radiology. 2004;232:773–83.CrossRefPubMed
11.
Brown G, Richards CJ, Newcombe RG, et al. Rectal carcinoma: thin-section MR imaging for staging in 28 patients. Radiology. 1999;211:215–22.PubMed
12.
Beets-Tan RG, Beets GL, Vliegen RF, et al. Accuracy of magnetic resonance imaging in prediction of tumour-free resection margin in rectal cancer surgery. Lancet. 2001;357:497–504.CrossRefPubMed
13.
Brown G, Richards CJ, Bourne MW, Newcombe RG, Radcliffe AG, Dallimore NS, Williams GT. Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison. Radiology. 2003;227:371–7.CrossRefPubMed
14.
Akasu T, Iinuma G, Fujita T, et al. Thin-section MRI with a phased-array coil for preoperative evaluation of pelvic anatomy and tumor extent in patients with rectal cancer. AJR Am J Roentgenol. 2005;184:531–8.PubMed
15.
Greene FL, Page DL, Fleming ID, et al., editors. American Joint Committee on cancer staging manual. 6th ed. Philadelphia: Springer; 2002.
16.
MacFarlane JK, Ryall RD, Heald RJ. Mesorectal excision for rectal cancer. Lancet. 1993; 341:457–60.CrossRefPubMed
17.
Nelson H, Petrelli N, Carlin A, et al. Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst. 2001;93:583–96.CrossRefPubMed
18.
Akasu T, Moriya Y. Abdominopelvic lymphadenectomy with autonomic nerve preservation for carcinoma of the rectum: Japanese experience. In: Wanebo HJ, editor. Surgery for gastrointestinal cancer: a multidisciplinary approach. Philadelphia: Lippincott-Raven; 1997. p. 667–80.
19.
Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960;20:37–46.CrossRef
20.
Cohen J. Weighted kappa: nominal scale agreement with provision for scaled disagreement or partial credit. Psychol Bull. 1968;70:213–30.CrossRefPubMed
21.
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.CrossRefPubMed
22.
Birbeck KF, Macklin CP, Tiffin NJ, et al. Rates of circumferential resection margin involvement vary between surgeons and predict outcomes in rectal cancer surgery. Ann Surg. 2002;235:449–57.CrossRefPubMed
23.
Wibe A, Rendedal PR, Svensson E, et al. Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer. Br J Surg. 2002;89:327–34.CrossRefPubMed
24.
MERCURY Study Group (2006) Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study. BMJ. 333:779–82. Epub 2006 Sep 19.CrossRef
25.
Brown G, Radcliffe AG, Newcombe RG, Dallimore NS, Bourne MW, Williams GT. Preoperative assessment of prognostic factors in rectal cancer using high-resolution magnetic resonance imaging. Br J Surg. 2003;90:355–64.CrossRefPubMed
26.
Kim CK, Kim SH, Choi D, Kim MJ, Chun HK, Lee SJ, et al. Comparison between 3-T magnetic resonance imaging and multi-detector row computed tomography for the preoperative evaluation of rectal cancer. J Comput Assist Tomogr. 2007;31:853–59.CrossRefPubMed
27.
Ueno H, Mochizuki H, Hashiguchi Y, et al. Potential prognostic benefit of lateral pelvic node dissection for rectal cancer located below the peritoneal reflection. Ann Surg. 2007;245:80–7.CrossRefPubMed
28.
Sugihara K, Kobayashi H, Kato T, et al. Indication and benefit of pelvic sidewall dissection for rectal cancer. Dis Colon Rectum. 2006;49:1663–72.CrossRefPubMed
29.
Syk E, Torkzad MR, Blomqvist L, Ljungqvist O, Glimelius B. Radiological findings do not support lateral residual tumour as a major cause of local recurrence of rectal cancer. Br J Surg. 2006;93:113–9.CrossRefPubMed
30.
Kim TH, Jeong SY, Choi DH, et al. Lateral lymph node metastasis is a major cause of locoregional recurrence in rectal cancer treated with preoperative chemoradiotherapy and curative resection. Ann Surg Oncol. 2008;15:729–37.CrossRefPubMed
31.
Akasu T, Sugihara K, Moriya Y. Male urinary and sexual functions after mesorectal excision alone or in combination with extended lateral pelvic lymph node dissection for rectal cancer. Ann Surg Oncol. DOI:10.​1245/​s10434-009-0546-x.
32.
Kim JH, Beets GL, Kim MJ, Kessels AG, Beets-Tan RG. High-resolution MR imaging for nodal staging in rectal cancer: are there any criteria in addition to the size? Eur J Radiol. 2004;52:78–83.CrossRefPubMed
33.
Koh DM, Brown G, Temple L, et al. Rectal cancer: mesorectal lymph nodes at MR imaging with USPIO versus histopathologic findings—initial observations. Radiology. 2004; 231:91–9.CrossRefPubMed
34.
Lahaye MJ, Engelen SM, Kessels AG, et al. USPIO-enhanced MR imaging for nodal staging in patients with primary rectal cancer: predictive criteria. Radiology. 2008;246:804–11. Epub 2008 Jan 14.CrossRefPubMed
Metadata
Title
Accuracy of High-Resolution Magnetic Resonance Imaging in Preoperative Staging of Rectal Cancer
Authors
Takayuki Akasu, MD
Gen Iinuma, MD
Masashi Takawa, MD
Seiichiro Yamamoto, MD
Yukio Muramatsu, MD
Noriyuki Moriyama, MD
Publication date
01-10-2009
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 10/2009
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-009-0613-3

Other articles of this Issue 10/2009

Annals of Surgical Oncology 10/2009 Go to the issue

Breast Oncology

Presenting Features of Breast Cancer Differ by Molecular Subtype

Healthcare Policy and Outcomes

Multidisciplinary Cancer Conferences: Identifying Opportunities to Promote Implementation

Translational Research and Biomarkers

Prognostic Significance of Vascular Endothelial Growth Factor in Squamous Cell Carcinomas of the Tonsil in Relation to Human Papillomavirus Status and Epidermal Growth Factor Receptor

Pediatric Oncology

CT-Guided Radiofrequency Ablation of Pediatric Osteoid Osteoma Utilizing a Water-Cooled Tip

Gastrointestinal Oncology

Male Urinary and Sexual Functions After Mesorectal Excision Alone or in Combination with Extended Lateral Pelvic Lymph Node Dissection for Rectal Cancer

Melanomas

Biological Factors, Tumor Growth Kinetics, and Survival After Metastasectomy for Pulmonary Melanoma