Can MR imaging be useful in differentiating low rectal cancer from anal cancer?
Tóm tắt
To evaluate the role of pelvic MR imaging in differentiating between low rectal and anal cancers using the pathological results as the gold standard. In this study, retrospective analysis of 100 patients with a history of low rectal (n = 50) or anal (n = 50) cancers who underwent staging pelvic MR imaging before treatment was performed. The following parameters were analyzed: distance from the anal verge to the tumor, percentage of tumor above puborectalis muscle, tumor size, T2W signal intensity, sphincter/levator muscles invasion, organ invasion, and MRI diagnosis. Multivariable logistic regression was performed to determine factors associated with low rectal and anal cancers. Distances from the anal verge to the tumor were compared using receiver-operating characteristic (ROC) curves. From the ROC curves, the cut-off value for the distance from the anal verge to the tumor in differentiating between low rectal and anal cancers was 2.1 cm and the area under the ROC curve was 0.90 (95% CI 0.84–0.97). Multivariate logistic regression revealed three significant factors in differentiating between low rectal and anal cancers, including T2 mixed hyper- and hyposignal intensity (OR 66.00, 95% CI 4.66–934.81), distance cut-off value (OR 34.72, 95% CI 5.73–210.27), and absence of sphincter invasion (OR 18.75, 95% CI 1.91–183.96), with sensitivity, specificity, PPV, and NPV of 98%, 88%, 89%, and 97%, respectively, and diagnostic accuracy increased from 79% (reader 1) and 82% (reader 2) to 93%. MR imaging can be useful to differentiating between low rectal and anal cancers which benefits staging and treatment planning.
Tài liệu tham khảo
Cancer Facts & Figures 2017 n.d. https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2017.html. Accessed 19 Apr 2018.
Matalon SA, Mamon HJ, Fuchs CS, et al. (2015) Anorectal cancer: critical anatomic and staging distinctions that affect use of radiation therapy. RadioGraphics 35:2090–2107. https://doi.org/10.1148/rg.2015150037
Benson III ALB, Venook AP, AL-Hawary MM, Cederquist L, Chen Y-J, Ciombor KK, et al. (n.d.) NCCN clinical practice guidelines Version 1.2018: anal carcinoma. J Natl Compr Canc Netw
Benson AB, Venook AP, Al-Hawary MM, et al. (2018) NCCN clinical practice guidelines Version 1.2018: rectal cancer. J Natl Compr Canc Netw 16:359–369. https://doi.org/10.6004/jnccn.2018.0021
Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 2010;17:1471–1474. https://doi.org/10.1245/s10434-010-0985-4.
Surabhi VR, Menias CO, Amer AM, et al. (2016) Tumors and tumorlike conditions of the anal canal and perianal region: MR imaging findings. RadioGraphics 36:1339–1353. https://doi.org/10.1148/rg.2016150209
Rectal Cancer: ESMO Clinical Practice Guidelines|ESMO (n.d.) http://www.esmo.org/Guidelines/Gastrointestinal-Cancers/Rectal-Cancer. Accessed 6 May 2018.
Tonolini M, Bianco R (2012) MRI and CT of anal carcinoma: a pictorial review. Insights Imaging 4:53–62. https://doi.org/10.1007/s13244-012-0199-3
Teama AH, Alarabawy RA, Mohamed HA, Eissa HH (2015) Role of magnetic resonance imaging in assessment of rectal neoplasms. Egypt J Radiol Nucl Med 46:833–846. https://doi.org/10.1016/j.ejrnm.2015.09.003
Parikh J, Shaw A, Grant LA, et al. (2011) Anal carcinomas: the role of endoanal ultrasound and magnetic resonance imaging in staging, response evaluation and follow-up. Eur Radiol 21:776–785. https://doi.org/10.1007/s00330-010-1980-7
Kaur H, Choi H, You YN, et al. (2012) MR imaging for preoperative evaluation of primary rectal cancer: practical considerations. RadioGraphics 32:389–409. https://doi.org/10.1148/rg.322115122
Halappa VG, Villalobos CPC, Bonekamp S, et al. (2012) Rectal imaging: part I, high-resolution MRI of carcinoma of the rectum at 3 T. AJR Am J Roentgenol 199:W35–W42. https://doi.org/10.2214/AJR.11.8134
Algebally AM, Mohey N, Szmigielski W, Yousef RRH, Kohla S (2015) The value of high-resolution MRI technique in patients with rectal carcinoma: pre-operative assessment of mesorectal fascia involvement, circumferential resection margin and local staging. Pol J Radiol 80:115–121. https://doi.org/10.12659/PJR.892583
Durot C, Dohan A, Boudiaf M, et al. (2017) Cancer of the anal canal: diagnosis, staging and follow-up with MRI. Korean J Radiol 18:946–956. https://doi.org/10.3348/kjr.2017.18.6.946
Nougaret S, Reinhold C, Mikhael HW, et al. (2013) The use of MR imaging in treatment planning for patients with rectal carcinoma: have you checked the “DISTANCE”? Radiology 268:330–344. https://doi.org/10.1148/radiol.13121361
Crane CH, Skibber JM, Feig BW, et al. (2003) Response to preoperative chemoradiation increases the use of sphincter-preserving surgery in patients with locally advanced low rectal carcinoma. Cancer 97:517–524. https://doi.org/10.1002/cncr.11075
Battersby NJ, How P, Moran B, et al. (2016) Prospective validation of a low rectal cancer magnetic resonance imaging staging system and development of a local recurrence risk stratification model: the MERCURY II study. Ann Surg 263:751–760. https://doi.org/10.1097/SLA.0000000000001193
Hussain SM, Outwater EK, Siegelman ES (1999) Mucinous versus nonmucinous rectal carcinomas: differentiation with MR imaging. Radiology 213:79–85. https://doi.org/10.1148/radiology.213.1.r99se3879
Kim M, Park JS, Park SI, et al. (2003) Accuracy in differentiation of mucinous and nonmucinous rectal carcinoma on MR imaging. J Comput Assist Tomogr 27:48–55
Holzer Brigitte, Urban Michael, Hölbling Nikolaus, et al. (2003) Magnetic resonance imaging predicts sphincter invasion of low rectal cancer and influences selection of operation. Surgery 133:656–661. https://doi.org/10.1067/msy.2003.150
Ghieda U, Hassanen O, Eltomey MA (2014) MRI of rectal carcinoma: preoperative staging and planning of sphincter-sparing surgery. Egypt J Radiol Nucl Med 45:1–5. https://doi.org/10.1016/j.ejrnm.2013.11.004
Beaugerie L, Carrat F, Nahon S, et al. (2017) High risk of anal and rectal cancer in patients with anal and/or perianal Crohn’s disease. Clin Gastroenterol Hepatol . https://doi.org/10.1016/j.cgh.2017.11.041