Abstract
BackgroundPreoperative T staging of lower rectal cancer is an important criterion for selecting intersphincteric resection (ISR) or abdominoperineal resection (APR) as well as selecting neoadjuvant therapy. The aim of this study was to evaluate the accuracy of preoperative T staging using CT colonography (CTC) with multiplanar reconstruction (MPR), in which with the newest workstation the images can be analyzed with a slice thickness of 0.5 mm.MethodsBetween 2011 and 2013, 45 consecutive patients with very low rectal adenocarcinoma underwent CTC with MPR. The accuracy of preoperative T staging using CTC with MPR was evaluated. The accuracy of preoperative T staging using MRI in the same patient population (34 of 45 patients) was also examined.ResultsOverall accuracy of T staging was 89% (41/45) for CTC with MPR and 71% (24/34) for MRI. CTC with MPR was particularly sensitive for pT2 tumors (82%; 14/17), whereas MRI tended to overstage pT2 tumors and its sensitivity for pT2 was 53% (8/15).ConclusionsCTC with MPR, with an arbitrary selection, could be aligned to the tumor axis and better demonstrated tumor margins consecutively including the deepest section of the tumor. The accuracy of T2 and T3 staging using CTC with MPR seemed to surpass that of MRI, suggesting a potential role of CTC with MPR in preoperative T staging for very low rectal cancer.
Highlights
Preoperative T staging of lower rectal cancer is an important criterion for selecting intersphincteric resection (ISR) or abdominoperineal resection (APR) as well as selecting neoadjuvant therapy
Kobayashi et al [8] reported that the overall accuracy of T staging using multi-detector row computed tomography (CT) (MDCT) with multiplanar reconstruction (MPR) was 61% (44/72) in 72 patients with rectal cancer, with the accuracy for pT2 tumors being the lowest (4/18) [8], suggesting that the biggest challenge lies in distinguishing T2 from T3 preoperatively
We evaluated the accuracy of preoperative T staging using CT colonography (CTC) with MPR in those 45 patients with very low rectal cancer
Summary
Preoperative T staging of lower rectal cancer is an important criterion for selecting intersphincteric resection (ISR) or abdominoperineal resection (APR) as well as selecting neoadjuvant therapy. Preoperative local staging using MDCT with multiplanar reconstruction (MPR) has recently been reported [8, 9]. Ahmetoglu et al [9] reported an 86% overall accuracy of T staging using MDCT with MPR in 37 patients with rectal cancer. Kobayashi et al [8] reported that the overall accuracy of T staging using MDCT with MPR was 61% (44/72) in 72 patients with rectal cancer, with the accuracy for pT2 tumors being the lowest (4/18) [8], suggesting that the biggest challenge lies in distinguishing T2 from T3 preoperatively.
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