Abstract
Aim: To determine the diagnostic accuracy of baseline pre-operative MRI in detecting extramural vascular invasion in rectal tumors compared with histopathological reference standard. Materials and Methods: Patients presenting with rectal carcinoma at Salmaniya Medical Complex, Bahrain between 1 st January 2017 and 31 st December 2019 were retrospectively reviewed for the presence of extramural vascular invasion (EMVI) detected on pre-operative staging MRI and a 5-point EMVI score (0-4) was assigned. These findings were then correlated with histopathology reports that were labelled as either positive or negative for EMVI. Results: A total of 82 patients were included in this study. Out of these patients, 71 patients (86.5%) received pre-operative chemotherapy and radiotherapy. 11 patients (13.4%) did not receive any pre-operative chemotherapy or radiotherapy and proceeded directly to surgery. On MRI EMVI (mr-EMVI) was reported in 31 patients (37.8%) while on pathology it was seen in 26 patients (31.7%). Sensitivity, specificity and accuracy of mr-EMVI were 81.2%, 90% and 86.6%, respectively. It was noted that upon staging the tumor, the stage most frequently associated with EMVI was Stage T3c with 18 out of the 31 cases (58%) showing EMVI on MRI. The predominant location of the tumors showing mr-EMVI was in tumors located in mid rectum (90.3%; 28/31). Conclusion: Pre-operative baseline MRI for staging rectal tumors is a highly effective imaging modality to evaluate for the presence of EMVI which can have a significant effect on the management plan.
Highlights
Tumor staging plays a vital role in patient management and evaluating the prognosis of the disease
MATERIALS AND METHODS: Patients presenting with rectal carcinoma at Salmaniya Medical Complex, Bahrain between 1st January 2017 and 31st December 2019 were retrospectively reviewed for the presence of extramural vascular invasion (EMVI) detected on pre-operative staging Magnetic Resonance Imaging (MRI) and a 5-point EMVI score (0-4) was assigned
On MRI EMVI was reported in 31 (37.8%) patients, while on pathology it was noted in 26 patients (31.7%) (Figures 1 and 2)
Summary
Tumor staging plays a vital role in patient management and evaluating the prognosis of the disease. Rectal tumor staging is very important in deciding the appropriate management. Extramural vascular invasion (EMVI) of rectal tumors is defined as malignant cells present within the blood vessels located beyond the muscularis propria[3]. The presence of EMVI is a poor prognostic factor in rectal tumors. Talbot et al reported 5-year survival rate of merely 33 % in patients with tumor invading the extramural veins[3]. EMVI predicts distant tumor metastasis, and response to chemoradiotherapy[4]. The main purpose of this study was to determine the diagnostic accuracy of pre-operative rectal tumor staging MRI in the characterization of extramural vascular invasion in comparison with post-operative histopathological findings
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