Jong Hoon Lee1, Hong Seok Jang2, Jun-Gi Kim3, Myung Ah Lee4, Dae Yong Kim5, Tae Hyun Kim5, Jae Hwan Oh5, Sung Chan Park5, Sun Young Kim5, Ji Yeon Baek5, Hee Chul Park6, Hee Cheol Kim7, Taek-Keun Nam8, Eui Kyu Chie9, Ji-Han Jung10, Seong Taek Oh11. 1. Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Republic of Korea; Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. 2. Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Republic of Korea. 3. Department of Colorectal Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Republic of Korea. 4. Department of Medical Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Republic of Korea. 5. Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Go-Yang, Republic of Korea. 6. Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 7. Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 8. Department of Radiation Oncology, Chonnam National University Hospital, Republic of Korea. 9. Department of Radiation Oncology, Seoul National University College of Medicine, Republic of Korea. 10. Department of Hospital Pathology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. 11. Department of Colorectal Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Republic of Korea. Electronic address: stoh@catholic.ac.kr.
Abstract
BACKGROUND AND PURPOSE: The reported overall accuracy of MRI in predicting the pathologic stage of nonirradiated rectal cancer is high. However, the role of MRI in restaging rectal tumors after neoadjuvant CRT is contentious. Thus, we evaluate the accuracy of restaging magnetic resonance imaging (MRI) for rectal cancer patients who receive preoperative chemoradiotherapy (CRT). METHODS AND MATERIALS: We analyzed 150 patients with locally advanced rectal cancer (T3-4N0-2) who had received preoperative CRT. Pre-CRT MRI was performed for local tumor and nodal staging. All patients underwent restaging MRI followed by total mesorectal excision after the end of radiotherapy. The primary endpoint of the present study was to estimate the accuracy of post-CRT MRI as compared with pathologic staging. RESULTS: Pathologic T classification matched the post-CRT MRI findings in 97 (64.7%) of 150 patients. 36 (24.0%) of 150 patients were overstaged in T classification, and the concordance degree was moderate (k=0.33, p<0.01). Pathologic N classification matched the post-CRI MRI findings in 85 (56.6%) of 150 patients. 54 (36.0%) of 150 patients were overstaged in N classification. 26 patients achieved downstaging (ycT0-2N0) on restaging MRI after CRT. 23 (88.5%) of 26 patients who had been downstaged on MRI after CRT were confirmed on the pathological staging, and the concordance degree was good (k=0.72, p<0.01). CONCLUSIONS: Restaging MRI has low accuracy for the prediction of the pathologic T and N classifications in rectal cancer patients who received preoperative CRT. The diagnostic accuracy of restaging MRI is relatively high in rectal cancer patients who achieved clinical downstaging after CRT.
BACKGROUND AND PURPOSE: The reported overall accuracy of MRI in predicting the pathologic stage of nonirradiated rectal cancer is high. However, the role of MRI in restaging rectal tumors after neoadjuvant CRT is contentious. Thus, we evaluate the accuracy of restaging magnetic resonance imaging (MRI) for rectal cancerpatients who receive preoperative chemoradiotherapy (CRT). METHODS AND MATERIALS: We analyzed 150 patients with locally advanced rectal cancer (T3-4N0-2) who had received preoperative CRT. Pre-CRT MRI was performed for local tumor and nodal staging. All patients underwent restaging MRI followed by total mesorectal excision after the end of radiotherapy. The primary endpoint of the present study was to estimate the accuracy of post-CRT MRI as compared with pathologic staging. RESULTS: Pathologic T classification matched the post-CRT MRI findings in 97 (64.7%) of 150 patients. 36 (24.0%) of 150 patients were overstaged in T classification, and the concordance degree was moderate (k=0.33, p<0.01). Pathologic N classification matched the post-CRI MRI findings in 85 (56.6%) of 150 patients. 54 (36.0%) of 150 patients were overstaged in N classification. 26 patients achieved downstaging (ycT0-2N0) on restaging MRI after CRT. 23 (88.5%) of 26 patients who had been downstaged on MRI after CRT were confirmed on the pathological staging, and the concordance degree was good (k=0.72, p<0.01). CONCLUSIONS: Restaging MRI has low accuracy for the prediction of the pathologic T and N classifications in rectal cancerpatients who received preoperative CRT. The diagnostic accuracy of restaging MRI is relatively high in rectal cancerpatients who achieved clinical downstaging after CRT.
Authors: Ramesh Paudyal; Yonggang Lu; Vaios Hatzoglou; Andre Moreira; Hilda E Stambuk; Jung Hun Oh; Kristen M Cunanan; David Aramburu Nunez; Yousef Mazaheri; Mithat Gonen; Alan Ho; James A Fagin; Richard J Wong; Ashok Shaha; R Michael Tuttle; Amita Shukla-Dave Journal: NMR Biomed Date: 2019-11-04 Impact factor: 4.044
Authors: Haihui Chen; Liting Shi; Ky Nam Bao Nguyen; Arta M Monjazeb; Karen E Matsukuma; Thomas W Loehfelm; Haixin Huang; Jianfeng Qiu; Yi Rong Journal: Adv Radiat Oncol Date: 2020-05-11