Preoperative Staging Of Rectal Carcinoma Research Articles

Role of MRI in diagnosis and preoperative staging of rectal carcinoma

Role of MRI in diagnosis and preoperative staging of rectal carcinoma

Preoperative MRI evaluation of mesorectum in cases of rectal carcinoma

Objectives The aim of this study was to evaluate the accuracy of MRI in preoperative staging, in the prediction of negative circumferential resection margin (CRM), and in the planning of surgical management for rectal carcinoma. Background Rectal cancer constitutes about one-third of all gastrointestinal tumors. Preoperative imaging for staging of rectal cancer has become an important aspect of the current approach to rectal cancer management because it helps to select suitable patients for neoadjuvant chemoradiotherapy and determine the appropriate surgical technique. The purpose of this study was to assess the accuracy of MRI in the preoperative staging of rectal carcinoma, in the prediction of negative CRM, and for planning its surgical management. To this end we aimed to study its efficacy in preoperative local staging of rectal carcinoma (T and N stages), in evaluating mesorectal fat and fascia involvement, and in the prediction of negative CRM. Patients and methods Thirty-seven patients with pathologically proven rectal carcinoma underwent pelvic MRI on a 1.5 T magnet with pelvic phased array coil with transrectal gel administration. The MRI protocol was adhered to. All cases were operated upon and their postoperative specimens were compared with preoperative MRI results. Results Comparable to histopathological examination, MRI correctly diagnosed in 34 out of 37 patients in different T stages (accuracy 91.9%) and in 32 out of 37 patients in different N stages (accuracy 86.5%). Accuracy in the evaluation of mesorectal fat invasion was 97.3%, that in the evaluation of mesorectal fascia invasion was 94.5%, and that in the evaluation of CRM was 97.3%. Conclusion MRI of rectal cancer is accurate for preoperative staging, evaluation of mesorectal fat and fascia, prediction of negative CRM, and evaluation of lymph node involvement.

Utility of high resolution MRI for pre-operative staging of rectal carcinoma, involvement of the mesorectal fascia and circumferential resection margin

Aim of the workTo assess utility of high resolution MRI for preoperative staging of rectal carcinoma, mesorectal fascia involvement and circumferential resection margin. Subjects and methodsThis prospective study included 40 patients (their mean age was 54.2years). All patients were proved pathologically to have cancer rectum located about 15cm from the external anal verge. MRI using high resolution sequences was done to all patients, then surgery was done, and MRI findings were correlated with pathological and surgical outcome. ResultsTwenty-five tumors were located in the upper rectum (62.5%), 7 in the mid rectum (17.5%), and 8 in the distal rectum (20%). MRI based T staging showed sensitivity, specificity, PPV and NPV of 95.8%, 87.5%,92% and 93.3% respectively with weighted kappa 0.84 and P_value 0.000. The sensitivity, specificity, PPV and NPV of MRI based assessment of circumferential resection margin (CRM) were 90.0%, 96.7%, 90% and 96.7% respectively with weighted kappa 0.86 and P_value 0.000. The accuracy, sensitivity, specificity, PPV and NPV of nodal staging by MRI were 85%, 73.3%, 92%, 84.6% and 96.7% respectively. ConclusionPreoperative MRI utilizing high resolution sequences is an accurate modality for pre-operative grading of rectal carcinoma, delineation of affection of the mesorectal fascia and circumferential resection margin which are the main factors affecting the outcome of surgery thus helping to categorize patients who can go directly for surgery from patients who may go for neo-adjuvant therapy to avoid overtreatment.

Learning curve of endorectal ultrasonography in preoperative staging of rectal carcinoma.

Accurate preoperative staging of rectal carcinoma is essential for optimal treatment. This study was designed to evaluate the accuracy and learning curve of endorectal ultrasonography (ERUS) in the preoperative staging of rectal carcinoma. We retrospectively analyzed the records of patients with rectal carcinoma who underwent preoperative ERUS followed by curative surgery at the Shanxi Province Tumor Hospital between January, 2007 and March, 2010. The patients were divided into three groups, namely A, B and C, depending on whether the examination was performed between January and December, 2007, between January and December, 2008 or between January, 2009 and March, 2010, respectively. Five physicians with no prior experience in ERUS performed the examinations. We compared the ERUS staging with the pathological findings using the tumor-node-metastasis (TNM) classification. The accuracy of ERUS in T and N staging after each additional consecutive 20 patients was calculated for physicians D, E and F. A total of 319 patients underwent ERUS prior to surgery. There were 38 patients in group A, 135 in group B and 146 in group C. Two of the five physicians performed only 47 of the 319 examinations, whereas the remaining 272 patients were examined by physicians D (n=162), E (n=64) and F (n=46). The overall accuracy in assessing the extent of rectal wall invasion (T) was 67%, with 16% of the cases overstaged and 17% understaged and the accuracy in assessing nodal involvement (N) was 66%, with 11% of the cases overstaged and 23% understaged. The total T and N staging accuracy of physicians D, E and F was 75 and 72%; 59 and 59%; and 50 and 52%, respectively. For physicians D, E and F, the accuracy of T and N staging after each additional 20 patients was calculated and the curve of the accuracy reached a plateau after physician D completed 80 cases. Therefore, ERUS is a valuable tool for assessing the depth of tumor invasion and it appears that after ~80 cases a physician may be considered able to apply it efficiently.

Diagnostic value of double contrast-enhanced ultrasonography in preoperative staging of rectal carcinoma

Objective To evaluate the preoperative T staging value of rectal carcinoma by using double contrast-enhanced ultrasonography (DCUS).Methods 71 patients with rectal carcinoma were examined by ultrasound after infusing contrast agent and bolus injection of SonoVue preoperatively.The border,shape and perfusion patterns of the tumor were observed.After surgery,the T staging made by DCUS and perfused contrast-enhanced ultrasonography (PCUS) was compared with final pathologic results respectively.Results The accuracy of PCUS and DCUS in determining the T stage of rectal carcinoma were 71.8％(T1 72.7％％,T250.0％,T374.4％,T476.9％) and 85.9％(T190.9％,T275.0％,T387.1％,T484.6％) respectively.The difference between these two methods was statistically significant (P ＜0.05).Conclusions DCUS is a new valuable method for T staging of rectal carcinoma with its high accuracy preoperatively. Key words: Ultrasonography; Microbubbles ; Rectal neoplasms; Neoplasm staging

The value of TRUS in the staging of rectal carcinoma before and after radiotherapy and comparison with the staging postoperative pathology

To compare the effectiveness of transrectal ultrasonography (TRUS) with that of postoperative pathological examination in staging rectal carcinoma before surgery and before and after radiotherapy. A prospective study was undertaken comprising 62 patients with stage T3 or T4 rectal carcinoma confirmed by endoscopic biopsy. TRUS showed significant differences (p < 0.01) in tumour echogenicity and volume, border delineation, local invasion, and draining lymph node involvement before and after radiotherapy, and significant reduction in blood flow resistance index after radiotherapy but no difference (p > 0.05) in the classification of tumour blood flow. In ultrasonographic assessments, 53 of the 62 cases (85.5%) showed lower T stages after radiotherapy. TRUS showed an accuracy of 94.1% for T2 cases, 77.3% for T3 cases, and 83.3% for T4 cases, and an overall accuracy of 87.1% in comparison with the results of postoperative pathological examination. TRUS is expected to play a vital role in the accurate preoperative staging of rectal carcinoma with the increasing utilization of adjuvant radiotherapy in rectal carcinoma and to contribute to the assessment of treatment.

Pre-operative staging of rectal cancer using multi-detector row computed tomography with multiplanar reformations: single center experience.

Technical advancement in imaging has helped to stage and plan treatment modality for carcinoma rectum with still some objectives controversial. The aim of our study was to evaluate the accuracy of multidetector row computed tomography (MDCT) with multiplanar reformations in the pre-operative staging of rectal carcinoma and correlation with intraoperative and histopathologic staging of retrieved specimen with respect to the depth of tumor invasion (T-staging), lymph node metastasis (N-staging) and mesorectal fascia (MRF) involvement. The study was a prospective one and consisted of 52 patients with biopsy proved rectal carcinoma. MDCT studies were performed on a 64-slice computed tomography system. Images were reconstructed in axial, coronal and sagittal planes. MDCT findings were compared with intraoperative and pathologic (reference standard) findings. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were assessed. The diagnostic accuracy of MDCT for T1/T2, T3 and T4 lesions was 77%, 86.5% and 100%, respectively. For perirectal lymph node metastasis (N+), the diagnostic accuracy of MDCT was 84.1%. The diagnostic accuracy of MDCT for MRF involvement was 91%. MDCT is a reliable radiological tool for local staging of rectal cancer with excellent accuracy rates for T and N-staging of rectal cancer.

The role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in the primary staging of rectal cancer

BackgroundIn this study we aimed to determine the need for 18F-flourodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in the preoperative staging of rectal carcinoma in our large patient group according to level and location of tumor.MethodTotally, 97 patients diagnosed with primary rectal adenocarcinoma between May 2009 and July 2011 were included in the study. Preoperative staging was performed by evaluating contrast-enhanced thoracic, abdominal, and pelvic computed tomographies. After staging by conventional methods, all patients underwent an 18F-FDG PET/CT. In all cases, the relationship between 18F-FDG uptake and gender, tumor height at the anal canal, localization in the rectal wall, plasma carcinoembryonic antigen levels, histopathological tumor type, and tumor stage were examined.ResultsWhile the ceCT was normal in 4 (4%) patients, it was positive for the rectum in 93 (95%), pelvic lymph nodes in 22 (22%), and distant metastases in 14 (14%) (liver (8), lung (8), bone (2), distant lymph nodes (6), and uterus (1)). Using computed tomography, disease stages were determined as stage 0, 1, 2, 3, and 4 in 4, 8, 48, 23, and 14 patients, respectively; 18F-FDG PET/CT was normal in two (2%) patients. The mean SUVmax of FDG-positive rectal tumors was calculated as 17.31 ± 9.37. Additionally, 18F-FDG uptake was seen in pelvic lymph nodes in 15 (15%) patients and in distant organs in 24 (24%) patients (liver (9), lung (12), bone (5), distant lymph nodes (11), uterus (1), and sigmoid colon (1)). According to an 18F-FDG PET/CT, 2, 7, 47, 20, and 21 patients were staged as stage 0, 1, 2, 3, and 4, respectively. In 14 patients (14.4%), the stage of the disease was either changed, and there was a need to make adjustments to the patient’s treatment strategy (n = 10), or the type of operation was changed (n = 4). In seven patients (0.7%), findings from 18F-FDG PET/CT images did not require any changes of the treatment plan.ConclusionF-FDG PET/CT provides new findings in addition to conventional techniques in the staging of primary rectal cancer. These findings could change the patients’ treatment strategies.

Clinical value of radial endorectal ultrasound in the assessment of preoperative staging of rectal carcinoma

To evaluate the clinical value of radial endorectal ultrasound (ERUS) in the assessment of preoperative staging of rectal carcinoma. One hundred and ten patients with rectal cancer underwent preoperative endorectal ultrasound (ERUS) examination in our hospital from February 2010 to September 2011. ERUS was performed using a Hitachi 900, Hitachi HI Vision Preirus US scanner, with a 5 - 10 MHz rigid rotating radial transducer and a focal length of 2 - 5 cm. The size, shape, echo pattern, infiltration depth, degree of circumferential involvement, extra-rectal invasion of the lesions and lymph node involvement were observed. The results of ERUS staging were compared with histopathological findings of the surgical specimens. The accuracy of ERUS for T staging was 91.4%. The accuracy of ERUS in diagnosing stage T1, T2, T3, T4 cancers was 92.7%, 88.2%, 88.2% and 96.4%, respectively. The sensitivity of ERUS in diagnosing stage T1, T2, T3, T4 cancers was 92.3%, 72.7%, 85.4% and 71.4%, respectively. The specificity of ERUS in diagnosing stage T1, T2, T3, T4 cancer was 92.9%, 92.0%, 90.3% and 100.0%, respectively. Comparing the consistency of preoperative T-staging and postoperative pathological results, the Kappa value was 0.75, with a considerable consistency. The sensitivity, specificity, and accuracy of ERUS in the assessment of lymph node metastasis were 74.2%, 89.9% and 85.5%, respectively. Comparing the consistency of preoperative N-staging and postoperative pathological results, the Kappa value was 0.64, with a considerable consistency. ERUS is a practical and accurate tool in assessment of preoperative staging of rectal tumors in regard to tumor invasion depth (T) and regional lymph node status (N), with advantages of simple operation, less pain, and high accuracy.

Clinical significance of MRI and transrectal ultrasound combined with carcinoembryonic antigen examination on accurate preoperative staging of rectal carcinoma

Objective To study the consistency in the diagnosis of preoperative TNM rectal cancer staging using high resolution magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) combined with carcinoembryonic antigen (CEA) and postoperative pathological TNM.Methods 156 cases pathologically proven were retrospectively analyzed and divided into 4 groups including preoperative MRI group (39 cases),TRUS group (39 cases),MRI and TRUS group (39 cases),MRI and TRUS combined with CEA group (39 cases).The differences between preoperative T,N staging and postoperative pathologic T,N staging were analyzed.Results There were statistically significant differences in the diagnosis of preoperative T and postoperative pathological T in 4 groups (T: Kappa =0.685,P =0.000; N: Kappa =0.544,P =0.000),but there were no significant differences in preoperative N and postoperative pathological N staging in preoperative MRI group,TRUS group,MRI and TRUS group (Kappa =0.142,P =0.329; Kappa =0.154,P =0.645; Kappa =0.154,P=0.229),and significant difference was observed in MRI and TRUS combined with CEA group (Kappa =0.544,P =0.000).There were no significant differences in the accuracy of T staging among the 4 groups (x2 =0.326,P =0.574; x2 =0.562,P =0.719; x2 =0.287,P =0.986),but significant difference in the accuracy of N staging were showed among the 4 groups (x2 =4.643,P =0.026; x2 =6.643,P =0.026; x2 =5.243,P =0.019).Conclusion Preoperative evaluation by the MRI add TRUS combined with CEA can improve the accuracy of preoperative staging,which can provide more reliable basis for decision-making and improve the coincidence rate of operative procedures in line with the estimate.It also provides the basis fur the accurate preoperative diagnosis and individualized treatment. Key words: Rrciectal neoplasms ; Magnetic resonance imaging ; Endosonography ; Carcinoembryonic antigen ; Neoplasm staging

Comparative study of endoluminal ultrasonography and magnetic resonance imaging in preoperative staging of rectal carcinoma

Objective To comparative study of endoluminal ultrasonography (EUS) and magnetic resonance imaging (MRI) in reoperative staging of rectal carcinoma.Methods MRI and EUS was performed prior to surgery in 58 patients with rectal carcinoma to assess its value in staging the tumor.Results The accuracy of MRI for T staging and N staging were 76.4％ and 63.9％.The accuracy of EUS for T staging and N staging were 81.8％ and 65.5％.Conclusion EUS is superior to MRI in judgment for early tumors infiltrate depth.But both have certain limitations in detection of N staging. Key words: Rectal neoplasms; Preoperative staging; Endoluminal ultrasound; Magnetic resonance imaging

Preoperative staging of rectal carcinoma with high-resolution MRI: correlation with histopathologic findings

To assess the correlation of preoperative high-resolution-MRI with histopathologic findings in tumor staging of rectal carcinoma. From January 2005 to December 2008, 245 cases of pathologically confirmed rectal cancer, who received preoperative scan by a 1.5 T high-resolution-MRI were included in this retrospective study. To extract image signs from high-resolution MRI, and made a diagnosis for tumor staging classification. Assessment for diagnostic accuracy of high-resolution MRI was extract made with comparison of histopathological classification. The overall diagnostic accuracy of T-stage was 83.7% (205/245). The consistency coefficient (κ) between the MRI and histopathologic T-stage was 0.693 (95%CI: 0.611 - 0.776), which was considered good. For the 97 cases with preoperative chemoradiotherapy, the agreement rate between the post-chemoradiotherapy MRI and histopathologic T-stage was 73.2% (71/97, κ = 0.563, 95%CI: 0.428 - 0.698). For the 148 cases without preoperative chemoradiotherapy, the agreement rate between the MRI and histopathologic T-stage was 90.5% (134/148, κ = 0.794, 95%CI: 0.692 - 0.896). The histopathologic T-stage and diameter infringement were in moderate related degree (ρ = 0.619, P < 0.01). High-resolution MRI is proved to have a high degree of diagnostic accuracy for T-stage of rectal carcinoma. Preoperative MRI is helpful in treatment planning. Patients undergoing preoperative chemoradiotherapy should receive MRI scan again after neoadjuvant therapy for restaging. The assessment of circumference violation make sense for the accurate diagnosis for tumor staging.

Local excision of rectal cancer afterchemoradiation: feasibility depends on the primary stage

Local excision of rectal cancer afterchemoradiation: feasibility depends on the primary stage

Transrectal ultrasonography in preoperative staging of rectal carcinoma: diagnostic value and relationship with TNM staging

Transrectal ultrasonography in preoperative staging of rectal carcinoma: diagnostic value and relationship with TNM staging

Effect of using endorectal coil in preoperative staging of rectal carcinoma by pelvic MR imaging

Effect of using endorectal coil in preoperative staging of rectal carcinoma by pelvic MR imaging

The value and limits of endorectal sonography in the preoperative stage classification of rectal cancer

The article deals with the valuation of endorectal and abdominal sonography in preoperative staging of rectal carcinoma. Data processing of 40 patients suffering from tumours of the rectum examined rectoscopically, by biopsy and via sonography showed that endorectal sonography can achieve preoperative staging (T) with a sensitivity of 89%, a specificity of 100%, a positive predictive value of 89% and a negative predictive value of 100%, the overall accuracy being 81%. Identification of pararectal adenopathies can be performed with a sensitivity of 16% and a specificity of 100%. Liver metastases were determined with a sensitivity and specificity of 100%. Hence, endorectal sonography is a valuable method for preoperative staging of carcinoma of the rectum.

Preoperative staging of rectal carcinoma by endorectal ultrasound: is there a learning curve?

Endorectal ultrasound (ERUS) is becoming an essential tool in the management of rectal cancer. However, accuracy in the assessment of disease staging may be dependent on operator experience. The aim of this study was to determine if a learning curve exists. From October 1999 to December 2004, all patients with rectal cancer had a pre-operative ERUS performed by a single radiologist. ERUS staging was compared with post-operative pathology findings using the tumour, node, metastases (TNM) classification. The accuracy of ERUS in tumour (T) and node (N) staging after each additional consecutive ten patients was calculated. One hundred and thirty one patients were investigated by ERUS, of which 36 were excluded, leaving 95 patients in the study (60 men). Overall accuracy for T staging was 71.6%. No improvement with experience was noted (p > 0.05). With regard to T staging, ERUS tended to overstage more frequently than understage (24.2 versus 4.2%). The sensitivity, specificity, positive predictive value and negative predictive value of uT3 staging were 96.6, 33.3, 70.4 and 85.7%, respectively. Overall accuracy of uN staging was 68.8%. ERUS tended to overstage nodal disease more frequently than understage (16.1 versus 15.1%). Sensitivity, specificity, positive predictive value and negative predictive value were calculated for ultrasound-detected nodal disease (73.2, 62.2, 74.5 and 60.5%, respectively). Nodal staging accuracy improved from 50% after assessment of 10 cases to 77% after 30 cases were examined. ERUS is an accurate method for staging rectal cancer pre-operatively. Accurate assessment of tumour stage can be achieved immediately by an experienced radiologist without specific training in ERUS. Nodal staging accuracy tends to improve with experience but reaches a plateau after 30 cases.

Comparative study of endoluminal ultrasonography and spiral computed tomography in preoperative staging of rectal carcinoma

To compare the efficacy of endoluminal ultrasonography (EUS) and spiral computed tomography (SCT) in preoperative staging of rectal carcinoma. Both EUS and SCT were performed prior to surgery in 68 patients with rectal carcinoma. After radical surgery, the preoperative findings were compared with histologic findings of the operative specimens, and the efficacy of EUS and SCT in staging the rectal carcinoma were evaluated. For T stage, EUS accuracy was 86.8%, while SCT was 70.6%. The difference was significant (P<0.05). For N stage, EUS accuracy was 67.6% and SCT was 63.2%. The difference was not significant (P>0.05). EUS is superior to SCT for the judgement of tumor infiltration depth, but neither is able to provide satisfactory assessment of lymph node metastases.

Preoperative MRI of rectal cancer with and without rectal water filling: an intraindividual comparison.

The purpose of our study was to determine if a rectal distention using warm water may improve the accuracy of MRI for the preoperative staging of rectal carcinoma. SUBJECTS AND METHODS. Sixty-two patients with surgically proven rectal carcinomas underwent pelvic MRI before and after a rectal distention by warm water. Four radiologists, who were blinded to the study, reviewed each set of T1- and T2-weighted axial images obtained before and after the rectal distention and scored the image of the tumor. The accuracies for determining the tumor penetration of the outer wall of the rectum and the regional lymph node involvement were compared by analyzing the area under the receiver operating characteristic curve (A(z)). For all reviewers, the tumor depiction scores were significantly higher in the distended images (3.8-3.9 for reviewers 1-4) than in the nondistended images (3.0-3.2) (p < 0.01). For determining the outer wall penetration, the accuracy of the three reviewers was significantly higher with the rectal distention images than with the nondistended images (p < 0.05). The mean accuracy of the all reviewers was significantly better with the distended images (A(z) = 0.922) than with the nondistended images (A(z) = 0.841) (p < 0.05). For determining the presence of regional lymph node involvement, all the reviewers came to similar conclusions in analyzing the two image sets. Rectal distention by water filling may improve the depiction of a primary rectal tumor and the assessment accuracy of a perirectal tumor extension, but it does not improve the accuracy for determining the presence of regional lymph node involvement.

Preoperative staging of rectal carcinoma.

The development of treatment modalities for rectal cancer, including local excision, total mesorectal excision and preoperative radiotherapy, has increased the importance of accurate preoperative staging to allow the optimum treatment to be selected. A literature review was undertaken of methods of preoperative staging of rectal carcinoma and the evidence for each was evaluated critically. Clinical assessment of rectal carcinoma may give an indication of fixity but is not accurate for staging. Endoanal ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), radioimmunoscintigraphy and positron emission tomography have all been used for staging. The extent of tumour spread through the bowel wall (T stage) is most accurately assessed by endoanal ultrasonography, although this technique is poor at assessing tumour extension into adjacent organs for which both CT and MRI are more accurate. No method accurately determines lymph node involvement, but endoanal ultrasonography is the best available. Liver metastases may be assessed by abdominal ultrasonography, CT, MRI and CT portography (with increasing sensitivity and cost in that order). Endoanal ultrasonography is the most effective method of local tumour staging, with the addition of either CT or MRI if adjacent organ involvement is suspected. Abdominal ultrasonography or CT is recommended for routine preoperative assessment of the liver.