Emre Altinmakas1,2, Hakan Dogan1, Orhun Cig Taskin3, Emre Ozoran4, Dursun Bugra4, Volkan Adsay3, Emre Balik4, Bengi Gurses5. 1. Department of Radiology, Koç University School of Medicine, 34010, Istanbul, Turkey. 2. Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 3. Department of Pathology, Koç University School of Medicine, Istanbul, Turkey. 4. Department of General Surgery, Koç University School of Medicine, Istanbul, Turkey. 5. Department of Radiology, Koç University School of Medicine, 34010, Istanbul, Turkey. bgurses@kuh.ku.edu.tr.
Abstract
PURPOSE: To assess whether size, diameter, and large vein involvement of MR-detected extramural venous invasion (MR-EMVI) have an impact on neoadjuvant therapy response in rectal adenocarcinoma. METHODS: 57 patients with locally advanced rectal adenocarcinoma scanned with MRI before and after neoadjuvant therapy were included. Two abdominal radiologists evaluated the images with special emphasis on EMVI, on initial staging and after neoadjuvant treatment. The sensitivity and specificity of MRI for detection of rest EMVI were determined. The association of various MR-EMVI characteristics including number, size, and main vein involvement with treatment response was investigated. In subjects with discordance of radiology and pathology, elastin stain was performed, and images and slides were re-evaluated on site with a multidisciplinary approach. RESULTS: At initial evaluation, 17 patients were MR-EMVI negative (29.8%) and 40 were MR-EMVI positive (70.2%). Complete/near-complete responders had less number (mean 1.45) and smaller diameter of MR-EMVI (mean 1.8 mm), when compared with partial responders (2.54 and 3.3 mm; p < 0.005). The sensitivity of MRI for rest EMVI detection was high, specificity was moderate, and in one patient elastin stain changed the final decision. In five patients with rest MR-EMVI positivity, carcinoma histopathologically had a distinctive serpiginous perivascular spread, growing along the track of vascular bundle, although it did not appear in intravascular spaces. CONCLUSION: This study demonstrates that not only the presence, but also size and number of EMVI that may be significant clinically and thus these parameters also ought to be incorporated to the MRI evaluation and prognostication of treatment response. From pathology perspective, tumors growing alongside major vessels may also reflect EMVI even if they are not demonstrably "intravascular."
PURPOSE: To assess whether size, diameter, and large vein involvement of MR-detected extramural venous invasion (MR-EMVI) have an impact on neoadjuvant therapy response in rectal adenocarcinoma. METHODS: 57 patients with locally advanced rectal adenocarcinoma scanned with MRI before and after neoadjuvant therapy were included. Two abdominal radiologists evaluated the images with special emphasis on EMVI, on initial staging and after neoadjuvant treatment. The sensitivity and specificity of MRI for detection of rest EMVI were determined. The association of various MR-EMVI characteristics including number, size, and main vein involvement with treatment response was investigated. In subjects with discordance of radiology and pathology, elastin stain was performed, and images and slides were re-evaluated on site with a multidisciplinary approach. RESULTS: At initial evaluation, 17 patients were MR-EMVI negative (29.8%) and 40 were MR-EMVI positive (70.2%). Complete/near-complete responders had less number (mean 1.45) and smaller diameter of MR-EMVI (mean 1.8 mm), when compared with partial responders (2.54 and 3.3 mm; p < 0.005). The sensitivity of MRI for rest EMVI detection was high, specificity was moderate, and in one patient elastin stain changed the final decision. In five patients with rest MR-EMVI positivity, carcinoma histopathologically had a distinctive serpiginous perivascular spread, growing along the track of vascular bundle, although it did not appear in intravascular spaces. CONCLUSION: This study demonstrates that not only the presence, but also size and number of EMVI that may be significant clinically and thus these parameters also ought to be incorporated to the MRI evaluation and prognostication of treatment response. From pathology perspective, tumors growing alongside major vessels may also reflect EMVI even if they are not demonstrably "intravascular."
Authors: Min Soo Cho; Youn Young Park; Jiho Yoon; Seung Yoon Yang; Seung Hyuk Baik; Kang Young Lee; Ik Yong Kim; Nam Kyu Kim Journal: J Surg Oncol Date: 2018-05-22 Impact factor: 3.454
Authors: Roy F A Vliegen; Geerard L Beets; Maarten F von Meyenfeldt; Alfons G H Kessels; Etienne E M T Lemaire; Jos M A van Engelshoven; Regina G H Beets-Tan Journal: Radiology Date: 2004-11-18 Impact factor: 11.105
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Authors: Muhammed R S Siddiqui; Constantinos Simillis; Chris Hunter; Manish Chand; Jemma Bhoday; Aurelie Garant; Te Vuong; Giovanni Artho; Shahnawaz Rasheed; Paris Tekkis; Al-Mutaz Abulafi; Gina Brown Journal: Br J Cancer Date: 2017-04-27 Impact factor: 7.640