Top

Published in:

01-04-2016 | Original Scientific Report

Prediction of Lateral Pelvic Lymph-Node Metastasis in Low Rectal Cancer by Magnetic Resonance Imaging

Authors: Atsushi Ishibe, Mitsuyoshi Ota, Jun Watanabe, Yusuke Suwa, Shinsuke Suzuki, Amane Kanazawa, Kazuteru Watanabe, Yasushi Ichikawa, Chikara Kunisaki, Itaru Endo

Published in: World Journal of Surgery | Issue 4/2016

Abstract

Objective

This study was designed to evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) for lateral pelvic lymph-node metastasis.

Patients

Eighty-four patients with primary lower rectal cancer were examined by MRI and subsequently underwent radical surgery with lateral pelvic lymph-node dissection, without preoperative treatment. Lateral lymph-node metastases were assessed preoperatively by MRI, and the results were compared with the histopathological findings. The criterion for lateral lymph-node metastasis was any recognizable lymph node in the pelvic wall, regardless of diameter.

Result

Lateral pelvic lymph-node metastasis was diagnosed on preoperative MRI in 16 patients (19.9 %). The overall patient-based sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MRI were 75, 69.1, 36.4, 92.2, and 70.2 %, respectively. When a cut-off value of 10 mm was used for diagnosis, the corresponding values were 43.8, 98.5, 87.5, 88.1, and 88.1 %, respectively. The mean diameter of metastatic nodes (14.7 mm) was significantly larger than that of negative nodes (5.7 mm; P < 0.01).

Conclusion

MRI is an effective technique for predicting lateral pelvic node involvement and thus may facilitate preoperative decision-making in rectal cancer treatment. A cut-off value of 10 mm is useful for avoiding unnecessary lateral lymph-node dissection.

Heald RJ, Ryall RD (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1(8496):1479–1482CrossRefPubMed

Arbman G, Nilsson E, Hallbook O, Sjodahl R (1996) Local recurrence following total mesorectal excision for rectal cancer. Br J Surg 83(3):375–379CrossRefPubMed

van Gijn W, Marijnen CA, Nagtegaal ID et al (2011) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol 12(6):575–582CrossRefPubMed

Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351(17):1731–1740CrossRefPubMed

Takahashi T, Ueno M, Azekura K, Ohta H (2000) Lateral node dissection and total mesorectal excision for rectal cancer. Dis Colon Rectum 43(10 Suppl):S59–S68CrossRefPubMed

Moriya Y, Sugihara K, Akasu T, Fujita S (1997) Importance of extended lymphadenectomy with lateral node dissection for advanced lower rectal cancer. World J Surg 21(7):728–732. doi:10.1007/s002689900298 CrossRefPubMed

Ueno H, Mochizuki H, Hashiguchi Y et al (2007) Potential prognostic benefit of lateral pelvic node dissection for rectal cancer located below the peritoneal reflection. Ann Surg 245(1):80–87PubMedCentralCrossRefPubMed

Akasu T, Sugihara K, Moriya Y (2009) 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 16(10):2779–2786CrossRefPubMed

Mizukami Y, Ueda S, Mizumoto A et al (2011) Diffusion-weighted magnetic resonance imaging for detecting lymph node metastasis of rectal cancer. World J Surg 35(4):895–899. doi:10.1007/s00268-011-0986-x CrossRefPubMed

10.

LeBlanc JK (2007) Imaging and management of rectal cancer. Nat Clin Pract Gastroenterol Hepatol 4(12):665–676CrossRefPubMed

11.

Lahaye MJ, Engelen SM, Nelemans PJ et al (2005) 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 26(4):259–268CrossRefPubMed

12.

Goligher JCDH, Nixon HH (1984) Surgery of the anus, rectum and colon, 5th edn. Bailliere Tindall, London

13.

General rules for clinical and pathological studies on cancer of the colon, rectum and anus. Part I. Clinical classification. Japanese Research Society for Cancer of the Colon and Rectum. Jpn J Surg 13(6):557–573 (1983)

14.

Moriya Y, Hojo K, Sawada T, Koyama Y (1989) Significance of lateral node dissection for advanced rectal carcinoma at or below the peritoneal reflection. Dis Colon Rectum 32(4):307–315CrossRefPubMed

15.

Ueno M, Oya M, Azekura K, Yamaguchi T, Muto T (2005) Incidence and prognostic significance of lateral lymph node metastasis in patients with advanced low rectal cancer. Br J Surg 92(6):756–763CrossRefPubMed

16.

Hojo K, Koyama Y, Moriya Y (1982) Lymphatic spread and its prognostic value in patients with rectal cancer. Am J Surg 144(3):350–354CrossRefPubMed

17.

Lambregts DM, Beets GL, Maas M et al (2011) Accuracy of gadofosveset-enhanced MRI for nodal staging and restaging in rectal cancer. Ann Surg 253(3):539–545CrossRefPubMed

18.

Brown G, Radcliffe AG, Newcombe RG, Dallimore NS, Bourne MW, Williams GT (2003) Preoperative assessment of prognostic factors in rectal cancer using high-resolution magnetic resonance imaging. Br J Surg 90(3):355–364CrossRefPubMed

19.

Brown G, Richards CJ, Bourne MW et al (2003) Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison. Radiology 227(2):371–377CrossRefPubMed

20.

Gearhart SL, Frassica D, Rosen R, Choti M, Schulick R, Wahl R (2006) Improved staging with pretreatment positron emission tomography/computed tomography in low rectal cancer. Ann Surg Oncol 13(3):397–404CrossRefPubMed

21.

Heriot AG, Hicks RJ, Drummond EG et al (2004) Does positron emission tomography change management in primary rectal cancer? A prospective assessment. Dis Colon Rectum 47(4):451–458CrossRefPubMed

22.

Kusunoki M, Yanagi H, Kamikonya N et al (1994) Preoperative detection of local extension of carcinoma of the rectum using magnetic resonance imaging. J Am Coll Surg 179(6):653–656PubMed

23.

Indinnimeo M, Grasso RF, Cicchini C et al (1996) Endorectal magnetic resonance imaging in the preoperative staging of rectal tumors. Int Surg 81(4):419–422PubMed

Title: Prediction of Lateral Pelvic Lymph-Node Metastasis in Low Rectal Cancer by Magnetic Resonance Imaging
Authors: Atsushi Ishibe
Mitsuyoshi Ota
Jun Watanabe
Yusuke Suwa
Shinsuke Suzuki
Amane Kanazawa
Kazuteru Watanabe
Yasushi Ichikawa
Chikara Kunisaki
Itaru Endo
Publication date: 01-04-2016
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 4/2016
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-015-3299-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prediction of Lateral Pelvic Lymph-Node Metastasis in Low Rectal Cancer by Magnetic Resonance Imaging

Abstract

Objective

Patients

Result

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Patients

Result

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2016

Transduodenal Ampullectomy for the Treatment of Early-Stage Ampulla of Vater Cancer

Hepatic Artery Reconstruction with a Continuous Suture Method for Hepato-Biliary-Pancreatic Surgery

Clinical Usefulness of 5-FU Metabolic Enzymes as Predictive Markers of Response to Chemotherapy in Colorectal Cancer

Evolution of a Lung-Sparing Strategy with Sleeve Lobectomy and Induction Therapy for Non-small Cell Lung Cancer: 20-Year Experience at a Single Institution

Cost Effectiveness of a Fast-Track Protocol for Urgent Laparoscopic Cholecystectomies and Appendectomies

Prioritisation of Surgery in the National Health Strategic Plans of Africa: A Systematic Review