Marit E van der Sande1, Geerard L Beets2, Britt Jp Hupkens3, Stéphanie O Breukink4, Jarno Melenhorst5, Frans Ch Bakers6, Doenja Mj Lambregts7, Heike I Grabsch8, Regina Gh Beets-Tan9, Monique Maas10. 1. Netherlands Cancer Institute, Department of Surgery, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands. Electronic address: m.vd.sande@nki.nl. 2. Netherlands Cancer Institute, Department of Surgery, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands; GROW School for Oncology and Developmental Biology, Universiteitssingel 40, 6229 ER, Maastricht, the Netherlands. Electronic address: g.beets@nki.nl. 3. Maastricht University Medical Center+, Department of Surgery, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands; Maastricht University Medical Center+, Department of Radiology, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands. Electronic address: britthupkens@gmail.com. 4. Maastricht University Medical Center+, Department of Surgery, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands. Electronic address: s.breukink@mumc.nl. 5. Maastricht University Medical Center+, Department of Surgery, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands. Electronic address: jarno.melenhorst@mumc.nl. 6. Maastricht University Medical Center+, Department of Radiology, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands. Electronic address: fch.bakers@mumc.nl. 7. Netherlands Cancer Institute, Department of Radiology, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands. Electronic address: d.lambregts@nki.nl. 8. GROW School for Oncology and Developmental Biology, Universiteitssingel 40, 6229 ER, Maastricht, the Netherlands; Maastricht University Medical Center+, Department of Pathology, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands; Leeds Institute of Medical Research at St. James's, University of Leeds, Pathology and Data Analytics, Beckett Street, Leeds, United Kingdom. Electronic address: h.grabsch@maastrichtuniversity.nl. 9. GROW School for Oncology and Developmental Biology, Universiteitssingel 40, 6229 ER, Maastricht, the Netherlands; Netherlands Cancer Institute, Department of Radiology, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands. Electronic address: r.beets-tan@nki.nl. 10. Netherlands Cancer Institute, Department of Radiology, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands. Electronic address: moniquemaas@live.nl.
Abstract
PURPOSE: To evaluate what features on restaging MRI and endoscopy led to a false clinical diagnosis of residual tumour in patients with a pathological complete response after rectal cancer surgery. METHODS: Patients with an unrecognized complete response after (chemo)radiotherapy were selected in a tertiary referral centre for rectal cancer treatment. An unrecognized complete response was defined as a clinical incomplete response at MRI and/or endoscopy with a pathological complete response of the primary tumour after surgery. The morphology of the tumour bed and the lymph nodes were evaluated on post-CRT T2-weighted MRI (T2-MRI) and diffusion weighted imaging (DWI). Post-CRT endoscopy images were evaluated for residual mucosal abnormalities. MRI and endoscopy features were correlated with histopathology. RESULTS: Thirty-six patients with an unrecognized complete response were included. Mucosal abnormalities were present at restaging endoscopy in 84%, mixed signal intensity on T2-MRI in 53%, an irregular aspect of the former tumour location on T2-MRI in 69%, diffusion restriction on DWI in 51% and suspicious lymph nodes in 25%. CONCLUSIONS: Overstaging of residual tumour after (chemo)radiotherapy in rectal cancer is mainly due to residual mucosal abnormalities at endoscopy, mixed signal intensity or irregular fibrosis at T2-MRI, diffusion restriction at DWI and residual suspicious lymph nodes. Presence of these features is not definitely associated with residual tumour and in selected cases an extended waiting interval can be considered.
PURPOSE: To evaluate what features on restaging MRI and endoscopy led to a false clinical diagnosis of residual tumour in patients with a pathological complete response after rectal cancer surgery. METHODS:Patients with an unrecognized complete response after (chemo)radiotherapy were selected in a tertiary referral centre for rectal cancer treatment. An unrecognized complete response was defined as a clinical incomplete response at MRI and/or endoscopy with a pathological complete response of the primary tumour after surgery. The morphology of the tumour bed and the lymph nodes were evaluated on post-CRT T2-weighted MRI (T2-MRI) and diffusion weighted imaging (DWI). Post-CRT endoscopy images were evaluated for residual mucosal abnormalities. MRI and endoscopy features were correlated with histopathology. RESULTS: Thirty-six patients with an unrecognized complete response were included. Mucosal abnormalities were present at restaging endoscopy in 84%, mixed signal intensity on T2-MRI in 53%, an irregular aspect of the former tumour location on T2-MRI in 69%, diffusion restriction on DWI in 51% and suspicious lymph nodes in 25%. CONCLUSIONS: Overstaging of residual tumour after (chemo)radiotherapy in rectal cancer is mainly due to residual mucosal abnormalities at endoscopy, mixed signal intensity or irregular fibrosis at T2-MRI, diffusion restriction at DWI and residual suspicious lymph nodes. Presence of these features is not definitely associated with residual tumour and in selected cases an extended waiting interval can be considered.
Authors: Jonathan B Yuval; Hannah M Thompson; Canan Firat; Floris S Verheij; Maria Widmar; Iris H Wei; Emmanouil Pappou; J Joshua Smith; Martin R Weiser; Philip B Paty; Garrett M Nash; Jinru Shia; Marc J Gollub; Julio Garcia-Aguilar Journal: Dis Colon Rectum Date: 2022-04-01 Impact factor: 4.585
Authors: Daan Linders; Marion Deken; Maxime van der Valk; Willemieke Tummers; Shadhvi Bhairosingh; Dennis Schaap; Gesina van Lijnschoten; Elham Zonoobi; Peter Kuppen; Cornelis van de Velde; Alexander Vahrmeijer; Arantza Farina Sarasqueta; Cornelis Sier; Denise Hilling Journal: Diagnostics (Basel) Date: 2021-03-14
Authors: Anuradha Chandramohan; Umar M Siddiqi; Rohin Mittal; Anu Eapen; Mark R Jesudason; Thomas S Ram; Ashish Singh; Dipti Masih Journal: Eur J Radiol Open Date: 2020-02-25
Authors: Fernando López-Campos; Margarita Martín-Martín; Roberto Fornell-Pérez; Juan Carlos García-Pérez; Javier Die-Trill; Raquel Fuentes-Mateos; Sergio López-Durán; José Domínguez-Rullán; Reyes Ferreiro; Alejandro Riquelme-Oliveira; Asunción Hervás-Morón; Felipe Couñago Journal: World J Gastroenterol Date: 2020-08-07 Impact factor: 5.742