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Al Qudah M, Haboubi N. Pitfalls in the reporting of neoplastic and pseudo neoplastic lesions in the colon and rectum. Folia Med (Plovdiv) 2022; 64:393-400. [PMID: 35856099 DOI: 10.3897/folmed.64.e68357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/02/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Colonic biopsies comprise large portion of pathologists' daily work. Within various pathological entities, there are histological ranges and variations. Unawareness of all of these variabilities might lead to misdiagnosis by an inexperienced pathologist and, accordingly, to mismanagement.
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Affiliation(s)
| | - Najib Haboubi
- Spire Manchester Hospital, Manchester, United Kingdom
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Abstract
The management of rectal cancer is complex and continually evolving. With advancements in technology and the use of multidisciplinary teams to guide the treatment decision making, staging, oncologic, and functional outcomes are improving, and the management is moving toward personalized treatment strategies to optimize each individual patient's outcomes. Key in this evolution is imaging. Magnetic resonance imaging (MRI) has emerged as the dominant method of pelvic imaging in rectal cancer, and use of MRI for staging is best practice in multiple international guidelines. MRI allows a noninvasive assessment of the tumor site, relationship to surrounding structures, and provides highly accurate rectal cancer staging, which is necessary for determining the appropriate treatment strategy. However, the applications of MRI extend far beyond pretreatment staging. MRI can be used to predict outcomes in locally advanced rectal cancer and guide the surgical or nonsurgical plan, serving as a predictive and prognostic biomarker. With continued MRI hardware improvement and new sequence development, MRI may offer new perspectives in the assessment of treatment response and new innovations that could provide better insight into the staging, restaging, and outcomes with rectal cancer.
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Affiliation(s)
- Deborah S Keller
- Division of Colorectal Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
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Rutegård MK, Båtsman M, Axelsson J, Brynolfsson P, Brännström F, Rutegård J, Ljuslinder I, Blomqvist L, Palmqvist R, Rutegård M, Riklund K. PET/MRI and PET/CT hybrid imaging of rectal cancer - description and initial observations from the RECTOPET (REctal Cancer trial on PET/MRI/CT) study. Cancer Imaging 2019; 19:52. [PMID: 31337428 PMCID: PMC6651930 DOI: 10.1186/s40644-019-0237-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/09/2019] [Indexed: 12/24/2022] Open
Abstract
Purpose The role of hybrid imaging using 18F-fluoro-2-deoxy-D-glucose positron-emission tomography (FDG-PET), computed tomography (CT) and magnetic resonance imaging (MRI) to improve preoperative evaluation of rectal cancer is largely unknown. To investigate this, the RECTOPET (REctal Cancer Trial on PET/MRI/CT) study has been launched with the aim to assess staging and restaging of primary rectal cancer. This report presents the study workflow and the initial experiences of the impact of PET/CT on staging and management of the first patients included in the RECTOPET study. Methods This prospective cohort study, initiated in September 2016, is actively recruiting patients from Region Västerbotten in Sweden. This pilot study includes patients recruited and followed up until December 2017. All patients had a biopsy-verified rectal adenocarcinoma and underwent a minimum of one preoperative FDG-PET/CT and FDG-PET/MRI examination. These patients were referred to the colorectal cancer multidisciplinary team meeting at Umeå University Hospital. All available data were evaluated when making management recommendations. The clinical course was noted and changes consequent to PET imaging were described; surgical specimens underwent dedicated MRI for anatomical matching between imaging and histopathology. Results Twenty-four patients have so far been included in the study. Four patients were deemed unresectable, while 19 patients underwent or were scheduled for surgery; one patient was enrolled in a watch-and-wait programme after restaging. Consequent to taking part in the study, two patients were upstaged to M1 disease: one patient was diagnosed with a solitary hepatic metastasis detected using PET/CT and underwent metastasectomy prior to rectal cancer surgery, while one patient with a small, but metabolically active, lung nodulus experienced no change of management. PET/MRI did not contribute to any recorded change in patient management. Conclusions The RECTOPET study investigating the role of PET/CT and PET/MRI for preoperative staging of primary rectal cancer patients will provide novel data that clarify the value of adding hybrid to conventional imaging, and the role of PET/CT versus PET/MRI. Trial registration NCT03846882.
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Affiliation(s)
- Miriam K Rutegård
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, SE-901 85, Umeå, Sweden.
| | - Malin Båtsman
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | - Jan Axelsson
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, SE-901 85, Umeå, Sweden
| | - Patrik Brynolfsson
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, SE-901 85, Umeå, Sweden
| | - Fredrik Brännström
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Jörgen Rutegård
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Ingrid Ljuslinder
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Lennart Blomqvist
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, SE-901 85, Umeå, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Imaging and Physiology, Karolinska University Hospital, Solna, Sweden
| | - Richard Palmqvist
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | - Martin Rutegård
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.,Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Katrine Riklund
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, SE-901 85, Umeå, Sweden
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