Use of Preoperative MRI to Select Candidates for Local Excision of MRI-Staged T1 and T2 Rectal Cancer

Can MRI Select Patients with N0 Tumors?

Chansik An, Hyuk Huh, Kyung Hwa Han, Myeong Jin Kim, Namkyu Kim, Honsoul Kim, Joon Seok Lim

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

BACKGROUND: To minimize the recurrence rate after local excision of rectal cancer, the false-negative rate of nodal staging should be minimized. OBJECTIVE: The purpose of this study was to develop a set of criteria using preoperative MRI that would minimize the false-negative rate for the diagnosis of regional lymph node metastasis. DESIGN: A prospectively maintained colorectal cancer database and MRI images were retrospectively reviewed. SETTINGS: This study was conducted at a multidisciplinary tertiary center. PATIENTS: A total of 246 consecutive patients who underwent MRI and curative-intent surgery for MRI-staged T1/T2 rectal cancer from January 2008 to July 2012 were included. MAIN OUTCOME MEASURES: MRI features significantly associated with lymph node metastasis were identified using a χ2 test. Five diagnostic criteria for lymph node metastasis were created based on these predictive MRI features, and their false-negative rates were compared using the generalized estimating equation method. RESULTS: Small size/homogeneity of lymph nodes and no visible tumor/partially involved muscular layer were significantly associated with lower risks of lymph node metastasis. When tumor invasion depth was not considered, the false-negative rate did not decrease below 10%, even when the strictest criterion for morphologic evaluation of lymph nodes (not visible or <3 mm) was used. Adding invasion depth to the diagnostic criteria significantly decreased the false-negative rate as low as 1.8%. LIMITATIONS: This study is limited by its small sample size and retrospective nature. CONCLUSIONS: Assessing both the depth of tumor invasion and lymph node morphology may reduce the false-negative rate and can be helpful to better identify candidates suitable for local excision of early stage rectal cancer. However, strict MRI criteria for oncologic safety might result in considerable false-positive cases and limit the application of local excision.

Original languageEnglish
Pages (from-to)923-930
Number of pages8
JournalDiseases of the Colon and Rectum
Volume58
Issue number10
DOIs
Publication statusPublished - 2015 Oct 21

Fingerprint

Rectal Neoplasms
Lymph Nodes
Neoplasms
Neoplasm Metastasis
Sample Size
Colorectal Neoplasms
Databases
Safety
Recurrence

All Science Journal Classification (ASJC) codes

  • Gastroenterology

Cite this

An, Chansik ; Huh, Hyuk ; Han, Kyung Hwa ; Kim, Myeong Jin ; Kim, Namkyu ; Kim, Honsoul ; Lim, Joon Seok. / Use of Preoperative MRI to Select Candidates for Local Excision of MRI-Staged T1 and T2 Rectal Cancer : Can MRI Select Patients with N0 Tumors?. In: Diseases of the Colon and Rectum. 2015 ; Vol. 58, No. 10. pp. 923-930.
@article{a0457967d2014a5e9fc2b2fe8d9bd6ad,
title = "Use of Preoperative MRI to Select Candidates for Local Excision of MRI-Staged T1 and T2 Rectal Cancer: Can MRI Select Patients with N0 Tumors?",
abstract = "BACKGROUND: To minimize the recurrence rate after local excision of rectal cancer, the false-negative rate of nodal staging should be minimized. OBJECTIVE: The purpose of this study was to develop a set of criteria using preoperative MRI that would minimize the false-negative rate for the diagnosis of regional lymph node metastasis. DESIGN: A prospectively maintained colorectal cancer database and MRI images were retrospectively reviewed. SETTINGS: This study was conducted at a multidisciplinary tertiary center. PATIENTS: A total of 246 consecutive patients who underwent MRI and curative-intent surgery for MRI-staged T1/T2 rectal cancer from January 2008 to July 2012 were included. MAIN OUTCOME MEASURES: MRI features significantly associated with lymph node metastasis were identified using a χ2 test. Five diagnostic criteria for lymph node metastasis were created based on these predictive MRI features, and their false-negative rates were compared using the generalized estimating equation method. RESULTS: Small size/homogeneity of lymph nodes and no visible tumor/partially involved muscular layer were significantly associated with lower risks of lymph node metastasis. When tumor invasion depth was not considered, the false-negative rate did not decrease below 10{\%}, even when the strictest criterion for morphologic evaluation of lymph nodes (not visible or <3 mm) was used. Adding invasion depth to the diagnostic criteria significantly decreased the false-negative rate as low as 1.8{\%}. LIMITATIONS: This study is limited by its small sample size and retrospective nature. CONCLUSIONS: Assessing both the depth of tumor invasion and lymph node morphology may reduce the false-negative rate and can be helpful to better identify candidates suitable for local excision of early stage rectal cancer. However, strict MRI criteria for oncologic safety might result in considerable false-positive cases and limit the application of local excision.",
author = "Chansik An and Hyuk Huh and Han, {Kyung Hwa} and Kim, {Myeong Jin} and Namkyu Kim and Honsoul Kim and Lim, {Joon Seok}",
year = "2015",
month = "10",
day = "21",
doi = "10.1097/DCR.0000000000000437",
language = "English",
volume = "58",
pages = "923--930",
journal = "Diseases of the Colon and Rectum",
issn = "0012-3706",
publisher = "Lippincott Williams and Wilkins",
number = "10",

}

Use of Preoperative MRI to Select Candidates for Local Excision of MRI-Staged T1 and T2 Rectal Cancer : Can MRI Select Patients with N0 Tumors? / An, Chansik; Huh, Hyuk; Han, Kyung Hwa; Kim, Myeong Jin; Kim, Namkyu; Kim, Honsoul; Lim, Joon Seok.

In: Diseases of the Colon and Rectum, Vol. 58, No. 10, 21.10.2015, p. 923-930.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Use of Preoperative MRI to Select Candidates for Local Excision of MRI-Staged T1 and T2 Rectal Cancer

T2 - Can MRI Select Patients with N0 Tumors?

AU - An, Chansik

AU - Huh, Hyuk

AU - Han, Kyung Hwa

AU - Kim, Myeong Jin

AU - Kim, Namkyu

AU - Kim, Honsoul

AU - Lim, Joon Seok

PY - 2015/10/21

Y1 - 2015/10/21

N2 - BACKGROUND: To minimize the recurrence rate after local excision of rectal cancer, the false-negative rate of nodal staging should be minimized. OBJECTIVE: The purpose of this study was to develop a set of criteria using preoperative MRI that would minimize the false-negative rate for the diagnosis of regional lymph node metastasis. DESIGN: A prospectively maintained colorectal cancer database and MRI images were retrospectively reviewed. SETTINGS: This study was conducted at a multidisciplinary tertiary center. PATIENTS: A total of 246 consecutive patients who underwent MRI and curative-intent surgery for MRI-staged T1/T2 rectal cancer from January 2008 to July 2012 were included. MAIN OUTCOME MEASURES: MRI features significantly associated with lymph node metastasis were identified using a χ2 test. Five diagnostic criteria for lymph node metastasis were created based on these predictive MRI features, and their false-negative rates were compared using the generalized estimating equation method. RESULTS: Small size/homogeneity of lymph nodes and no visible tumor/partially involved muscular layer were significantly associated with lower risks of lymph node metastasis. When tumor invasion depth was not considered, the false-negative rate did not decrease below 10%, even when the strictest criterion for morphologic evaluation of lymph nodes (not visible or <3 mm) was used. Adding invasion depth to the diagnostic criteria significantly decreased the false-negative rate as low as 1.8%. LIMITATIONS: This study is limited by its small sample size and retrospective nature. CONCLUSIONS: Assessing both the depth of tumor invasion and lymph node morphology may reduce the false-negative rate and can be helpful to better identify candidates suitable for local excision of early stage rectal cancer. However, strict MRI criteria for oncologic safety might result in considerable false-positive cases and limit the application of local excision.

AB - BACKGROUND: To minimize the recurrence rate after local excision of rectal cancer, the false-negative rate of nodal staging should be minimized. OBJECTIVE: The purpose of this study was to develop a set of criteria using preoperative MRI that would minimize the false-negative rate for the diagnosis of regional lymph node metastasis. DESIGN: A prospectively maintained colorectal cancer database and MRI images were retrospectively reviewed. SETTINGS: This study was conducted at a multidisciplinary tertiary center. PATIENTS: A total of 246 consecutive patients who underwent MRI and curative-intent surgery for MRI-staged T1/T2 rectal cancer from January 2008 to July 2012 were included. MAIN OUTCOME MEASURES: MRI features significantly associated with lymph node metastasis were identified using a χ2 test. Five diagnostic criteria for lymph node metastasis were created based on these predictive MRI features, and their false-negative rates were compared using the generalized estimating equation method. RESULTS: Small size/homogeneity of lymph nodes and no visible tumor/partially involved muscular layer were significantly associated with lower risks of lymph node metastasis. When tumor invasion depth was not considered, the false-negative rate did not decrease below 10%, even when the strictest criterion for morphologic evaluation of lymph nodes (not visible or <3 mm) was used. Adding invasion depth to the diagnostic criteria significantly decreased the false-negative rate as low as 1.8%. LIMITATIONS: This study is limited by its small sample size and retrospective nature. CONCLUSIONS: Assessing both the depth of tumor invasion and lymph node morphology may reduce the false-negative rate and can be helpful to better identify candidates suitable for local excision of early stage rectal cancer. However, strict MRI criteria for oncologic safety might result in considerable false-positive cases and limit the application of local excision.

UR - http://www.scopus.com/inward/record.url?scp=84941900262&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84941900262&partnerID=8YFLogxK

U2 - 10.1097/DCR.0000000000000437

DO - 10.1097/DCR.0000000000000437

M3 - Article

VL - 58

SP - 923

EP - 930

JO - Diseases of the Colon and Rectum

JF - Diseases of the Colon and Rectum

SN - 0012-3706

IS - 10

ER -