MRI for nodal restaging after neoadjuvant therapy in rectal cancer with histopathologic comparison

Cancer Imaging

Research Article

Quanmeng Liu¹  Zhiwen Zhang¹  Ziqiang Wen¹  Yan Chen¹  Yuru Ma¹  Shenping Yu¹  Wenjie Fan²  Yutao Que²  Xuehan Wu²  Yunzhu Wu³ 

[1] Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 510080, Guangzhou, China;Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 510080, Guangzhou, China;Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-sen University, 518036, Shenzhen, China;MR Scientific Marketing, SIEMENS Healthineers Ltd, 200124, Shanghai, China;

关键词: Rectal cancer;    Neoadjuvant therapy;    Lymph node;    Magnetic resonance imaging;    Histopathology;   

DOI  :  10.1186/s40644-023-00589-0

 received in 2023-02-12, accepted in 2023-07-02,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundAfter neoadjuvant therapy, most of the lymph nodes (LNs) will shrink and disappear in patients with rectal cancer. However, LNs that are still detectable on MRI carry a risk of metastasis. This study aimed to evaluate the performance of the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) criterion (short-axis diameter ≥ 5 mm) in diagnosing malignant LNs in patients with rectal cancer after neoadjuvant therapy, and whether nodal morphological characteristics (including shape, border, signal homogeneity, and enhancement homogeneity) could improve the diagnostic efficiency for LNs ≥ 5 mm.MethodsThis retrospective study included 90 patients with locally advanced rectal cancer who underwent surgery after neoadjuvant therapy and performed preoperative MRI. Two radiologists independently measured the short-axis diameter of LNs and evaluated the morphological characteristics of LNs ≥ 5 mm in consensus. With a per node comparison with histopathology as the reference standard, a ROC curve was performed to evaluate the diagnostic performance of the size criterion. For categorical variables, either a χ2 test or Fisher’s exact test was used.ResultsA total of 298 LNs were evaluated. The AUC for nodal size in determining nodal status was 0.81. With a size cutoff value of 5 mm, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 65.9%, 87.0%, 46.8%, 93.6% and 83.9%, respectively. No significant differences were observed in any of the morphological characteristics between benign and malignant LNs ≥ 5 mm (all P > 0.05).ConclusionsThe ESGAR criterion demonstrated moderate diagnostic performance in identifying malignant LNs in patients with rectal cancer after neoadjuvant therapy. It was effective in determining the status of LNs < 5 mm but not for LNs ≥ 5 mm, and the diagnostic efficiency could not be improved by considering nodal morphological characteristics.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

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