Preoperative assessment of prognostic factors in rectal cancer using high-resolution magnetic resonance imaging

✍ Scribed by G. Brown; A. G. Radcliffe; R. G. Newcombe; N. S. Dallimore; M. W. Bourne; G. T. Williams

• Publisher: John Wiley and Sons
• Year: 2003
• Tongue: English
• Weight: 314 KB
• Volume: 90
• Category: Article
• ISSN: 0007-1323
• DOI: 10.1002/bjs.4034

✦ Synopsis

Background:

The aim was to determine the accuracy of preoperative magnetic resonance imaging (mri) in the evaluation of pathological prognostic factors that influence local recurrence and survival in rectal cancer.

Methods:

Ninety-eight patients undergoing total mesorectal excision for biopsy-proven rectal cancer were assessed prospectively using high-resolution mri for tumour (t) and nodal (n) staging using the tumour node metastasis classification, depth of extramural tumour spread, the presence or absence of extramural venous invasion, a threatened circumferential resection margin and serosal involvement at or above the peritoneal reflection. preoperative magnetic resonance assessment of these prognostic factors was compared with histopathological findings in carefully matched whole-mount sections of the resection specimen.

Results:

There was 94 per cent weighted agreement (weighted kappa = 0.67) between mri and pathology assessment of t stage. agreement between mri and histological assessment of nodal status was 85 per cent (kappa = 0.68). although involvement of small veins by tumour was not discernible using mri, large (calibre greater than 3 mm) extramural venous invasion was identified correctly in 15 of 18 patients (kappa = 0.64). mri predicted circumferential resection margin involvement with 92 per cent agreement (kappa = 0.81). seven of nine patients with peritoneal perforation by tumour (stage t4) were identified correctly using mri.

Conclusion:

High-resolution mri of the rectum allows preoperative identification of important surgical and pathological prognostic risk factors. this may allow both better selection and assessment of patients undergoing preoperative therapy.