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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 7/2012

01-07-2012 | Colorectal Cancer

Diagnostic Accuracy of MRI for Assessment of T Category, Lymph Node Metastases, and Circumferential Resection Margin Involvement in Patients with Rectal Cancer: A Systematic Review and Meta-analysis

Authors: Eisar Al-Sukhni, MD, Laurent Milot, MD, MSc, Mark Fruitman, MD, Joseph Beyene, PhD, J. Charles Victor, MSc, Selina Schmocker, BSc, Gina Brown, MD, Robin McLeod, MD, Erin Kennedy, MD, PhD

Published in: Annals of Surgical Oncology | Issue 7/2012

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Abstract

Background

Magnetic resonance imaging (MRI) is increasingly being used for rectal cancer staging. The purpose of this study was to determine the accuracy of phased array MRI for T category (T1–2 vs. T3–4), lymph node metastases, and circumferential resection margin (CRM) involvement in primary rectal cancer.

Methods

Medline, Embase, and Cochrane databases were searched using combinations of keywords relating to rectal cancer and MRI. Reference lists of included articles were also searched by hand. Inclusion criteria were: (1) original article published January 2000–March 2011, (2) use of phased array coil MRI, (3) histopathology used as reference standard, and (4) raw data available to create 2 × 2 contingency tables. Patients who underwent preoperative long-course radiotherapy or chemoradiotherapy were excluded. Two reviewers independently extracted data. Sensitivity, specificity, and diagnostic odds ratio were estimated for each outcome using hierarchical summary receiver–operating characteristics and bivariate random effects modeling.

Results

Twenty-one studies were included in the analysis. There was notable heterogeneity among studies. MRI specificity was significantly higher for CRM involvement [94%, 95% confidence interval (CI) 88–97] than for T category (75%, 95% CI 68–80) and lymph nodes (71%, 95% CI 59–81). There was no significant difference in sensitivity between the three elements as a result of wide overlapping CIs. Diagnostic odds ratio was significantly higher for CRM (56.1, 95% CI 15.3–205.8) than for lymph nodes (8.3, 95% CI 4.6–14.7) but did not differ significantly from T category (20.4, 95% CI 11.1–37.3).

Conclusions

MRI has good accuracy for both CRM and T category and should be considered for preoperative rectal cancer staging. In contrast, lymph node assessment is poor on MRI.
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Literature
1.
Frykholm GJ, Glimelius B, Pahlman L. Preoperative or postoperative irradiation in adenocarcinoma of the rectum: final treatment results of a randomized trial and an evaluation of late secondary effects. Dis Colon Rectum. 1992;36:564–72.CrossRef
2.
Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351:1731–40.PubMedCrossRef
3.
Augestad KM, Lindsetmo RO, Stulberg J, et al. International Rectal Cancer Study Group (IRCSG). International preoperative rectal cancer management: staging, neoadjuvant treatment, and impact of multidisciplinary teams. World J Surg. 2010;34:2689–700.PubMedCrossRef
4.
Kwok H, Bissett IP, Hill GL. Preoperative staging of rectal cancer. Int J Colorectal Dis. 2000;15:9–20.PubMedCrossRef
5.
Bipat S, Glas AS, Slors FJM, Zwinderman AH, Bossuyt PMM, 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.PubMedCrossRef
6.
Lahaye MJ, Engelen SME, Nelemans PJ, et al. Imaging for predicting the risk factors, the circumferential resection margin and nodal disease, of local recurrence in rectal cancer: a meta-analysis. Semin Ultrasound CT MR. 2005;26:259–68.PubMedCrossRef
7.
Purkayastha S, Tekkis PP, Athanasiou T, Tilney HS, Darzi AW, Heriot AG. Diagnostic precision of magnetic resonance imaging for preoperative prediction of the circumferential margin involvement in patients with rectal cancer. Colorect Dis. 2006;9:402–11.CrossRef
8.
Whiting P, Rutjes AWS, Reitsma JB, Bossuyt PMM, Kleijnen J. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol. 2003;3:25.PubMedCrossRef
9.
Whiting P, Harbord R, Kleijnen J. No role for quality scores in systematic reviews of diagnostic accuracy studies. BMC Med Res Methodol. 2005;5:19.PubMedCrossRef
10.
Leeflang MMG, Deeks JJ, Gatsonis C, Bossuyt PMM. Systematic reviews of diagnostic test accuracy. Ann Intern Med. 2008;149:889–97.PubMed
11.
Rutter CM, Gatsonis CA. A hierarchical regression approach to meta-analysis of diagnostic test accuracy evaluations. Stat Med. 2001;20:2865–84.PubMedCrossRef
12.
Reitsma JB, Glas AS, Rutjes AWS, Scholten RJPM, Bossuyt PMM, Zwinderman AH. Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. J Clin Epidemiol. 2005;58:982–990.PubMedCrossRef
13.
Branagan G, Chave H, Fuller C, McGee S, Finnis D. Can magnetic resonance imaging predict circumferential margins and TNM stage in rectal cancer? Dis Colon Rectum. 2004;47:1317–22.PubMedCrossRef
14.
Burton S, Brown G, Daniels I, et al. MRI identified prognostic features of tumors in distal sigmoid, rectosigmoid, and upper rectum: treatment with radiotherapy and chemotherapy. Int J Radiat Oncol Biol Phys. 2006;65:445–51.PubMedCrossRef
15.
Ferri M, Laghi A, Mingazzini P, et al. Pre-operative assessment of extramural invasion and sphincteral involvement in rectal cancer by magnetic resonance imaging with phased-array coil. Colorect Dis. 2005;7:387–93.CrossRef
16.
Gagliardi G, Bayar S, Smith R, Salem RR. Preoperative staging of rectal cancer using magnetic resonance imaging with external phase-arrayed coils. Arch Surg. 2002;137:447–51.PubMedCrossRef
17.
Halefoglu AM, Yildirim S, Avlanmis O, Sakiz D, Baykan A. Endorectal ultrasonography versus phased-array magnetic resonance imaging for preoperative staging of rectal cancer. World J Gastroenterol. 2008;14:3504–10.PubMedCrossRef
18.
Kim MJ, Lim JS, Oh YT, et al. Preoperative MRI of rectal cancer with and without rectal water filling: an intraindividual comparison. AJR Am J Roentgenol. 2004;182:1469–76.PubMed
19.
MERCURY Study Group. Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study. BMJ. 2006;333:779–84.CrossRef
20.
Oberholzer K, Junginger T, Kreitner KF, et al. Local staging of rectal carcinoma and assessment of the circumferential resection margin with high-resolution MRI using an integrated parallel acquisition technique. J Magn Reson Imaging. 2005;22:101–8.PubMedCrossRef
21.
Piippo U, Paakko E, Makinen M, Makela J. Local staging of rectal cancer using the black lumen magnetic resonance imaging technique. Scand J Surg. 2008;97:237–42.PubMed
22.
Rao SX, Zeng MS, Xu JM, et al. Assessment of T staging and mesorectal fascia status using high-resolution MRI in rectal cancer with rectal distention. World J Gastroenterol. 2007;13:4141–6.PubMed
23.
Strassburg J, Lewin A, Ludwig K, et al. Optimised surgery (so-called TME surgery) and high-resolution MRI in the planning of treatment of rectal carcinoma. Langenbecks Arch Surg. 2007;392:179–88.PubMedCrossRef
24.
Taylor A, Slater A, Mapstone N, Taylor S, Halligan S. Staging rectal cancer: MRI compared to MDCT. Abdom Imaging. 2007;32:323–7.PubMedCrossRef
25.
Vliegen RFA, Beets GL, von Meyenfeldt MF, et al. Rectal cancer: MR imaging in local staging—is gadolinium-based contrast material helpful? Radiology. 2005;234:179–88.PubMedCrossRef
26.
Akasu T, Iinuma G, Takawa M, et al. Accuracy of high-resolution magnetic resonance imaging in preoperative staging of rectal cancer. Ann Surg Oncol. 2009;16:2787–94.PubMedCrossRef
27.
Kim YW, Cha SW, Pyo J, Kim NK. Factors related to preoperative assessment of the circumferential resection margin and the extent of mesorectal invasion by magnetic resonance imaging in rectal cancer: a prospective comparison study. World J Surg. 2009;33:1952–60.PubMedCrossRef
28.
Kim CK, Kim SH, Chun HK, et al. Preoperative staging of rectal cancer: accuracy of 3-tesla magnetic resonance imaging. Eur Radiol. 2006;16:972–80.PubMedCrossRef
29.
Kam MH, Wong DC, Stevenson ARL, Lai K, Phillips GE. Comparison of magnetic resonance imaging-fluorodeoxyglucose positron emission tomography fusion with pathological staging in rectal cancer. Br J Surg. 2010;97:266–8.PubMedCrossRef
30.
Kim H, Lim JS, Choi JY, et al. Rectal cancer: comparison of accuracy of local-regional staging with two- and three-dimensional preoperative 3-T MR imaging. Radiology. 2010;254:485–92.PubMedCrossRef
31.
Kim SH, Lee JM, Lee MW, Kim GH, Han JK, Choi BI. Diagnostic accuracy of 3.0-tesla rectal magnetic resonance imaging in preoperative local staging of primary rectal cancer. Invest Radiol. 2008;43:587–93.PubMedCrossRef
32.
Futterer JJ, Yakar D, Strijk SP, Barentsz JO. Preoperative 3 T MR imaging of rectal cancer: local staging accuracy using a two-dimensional and three-dimensional T2-weighted turbo spin echo sequence. Eur J Radiol. 2008;65:66–71.PubMedCrossRef
33.
MERCURY Study Group. Extramural depth of tumor invasion at thin-section MR in patients with rectal cancer: results of the MERCURY study. Radiology. 2007;243:132–9.CrossRef
34.
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.PubMedCrossRef
35.
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.PubMedCrossRef
36.
Engelen SM, Beets-Tan RG, Lahaye MJ, Kessels AG, Beets GL. Location of involved mesorectal and extramesorectal lymph nodes in patients with primary rectal cancer: preoperative assessment with MR imaging. Eur J Surg Oncol. 2008;34:776–81.PubMedCrossRef
37.
Taylor FGM, Quirke P, Heald RJ, et al. Preoperative high-resolution magnetic resonance imaging can identify good prognosis stage I, II, and III rectal cancer best managed by surgery alone: a prospective, multicenter, European study. Ann Surg. 2011;253:711–9.PubMedCrossRef
38.
Park SH. Degree of error of thin-section MR in measuring extramural depth of tumor invasion in patients with rectal cancer. Radiology. 2008;246:647–8.PubMedCrossRef
39.
Beets-Tan RGH, Beets GL, Vliegen RFA, et al. Accuracy of magnetic resonance imaging in prediction of tumor-free resection margin in rectal cancer surgery. Lancet. 2001;357:497–504.PubMedCrossRef
40.
Dent OF, Chapuis PH, Haboubi N, Bokey L. Magnetic resonance imaging cannot predict histological tumour involvement of a circumferential resection margin in rectal cancer. Colorectal Dis. 2011;13:974–83.PubMedCrossRef
41.
Glimelius B, Beets-Tan R, Blomqvist L, et al. Mesorectal fascia instead of circumferential resection margin in preoperative staging of rectal cancer. J Clin Oncol. 2011;2142–3.
42.
Brown G, Richards CJ, Bourne MW, et al. 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.PubMedCrossRef
43.
Kim JH, Beets GL, Kim MJ, et al. 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.PubMedCrossRef
44.
Matsuoka H, Nakamura A, Sugiyama M, et al. MRI diagnosis of mesorectal lymph node metastasis in patients with rectal carcinoma: what is the optimal criterion? Anticancer Res. 2004;24:4097–101.PubMed
Metadata
Title
Diagnostic Accuracy of MRI for Assessment of T Category, Lymph Node Metastases, and Circumferential Resection Margin Involvement in Patients with Rectal Cancer: A Systematic Review and Meta-analysis
Authors
Eisar Al-Sukhni, MD
Laurent Milot, MD, MSc
Mark Fruitman, MD
Joseph Beyene, PhD
J. Charles Victor, MSc
Selina Schmocker, BSc
Gina Brown, MD
Robin McLeod, MD
Erin Kennedy, MD, PhD
Publication date
01-07-2012
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 7/2012
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-011-2210-5

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