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Basendowah MH, Ezzat MA, Khayyat AH, Alamri ESA, Madani TA, Alzahrani AH, Bokhary RY, Badeeb AO, Hijazi HA. Comparison of flexible endoscopy and magnetic resonance imaging in determining the tumor height in rectal cancer. Cancer Rep (Hoboken) 2023; 6:e1705. [PMID: 36806725 PMCID: PMC9939992 DOI: 10.1002/cnr2.1705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 07/06/2022] [Accepted: 07/27/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Several modalities are available for the diagnosis of rectal cancer, including conventional gold standard rigid endoscopy and recent flexible endoscopy and magnetic resonance imaging (MRI). Each modality affects the management of these patients. AIM To compare the accuracy of flexible endoscopy and MRI in the measurement of tumor height in patients with rectal cancer. METHODS AND RESULTS This study included 174 patients with rectal cancer who underwent flexible endoscopy and MRI for the measurement of tumor height. Data on patient demographics, comorbidities, treatment, and histopathology were identified and collected. We evaluate intraclass correlation coefficient (ICC) and Bland-Altman plot to test the agreement between the measurements. ICC were excellent with an ICC of 89% (95%CI 48%-99%). The mean ± standard deviation of the distance from the anal verge to the distal part of the tumor was 7.73 ± .47 for flexible endoscopy and 6.21 ± 0.39 for MRI, with mean difference of 1.52 (p ˂ .001). The accordance between the two modalities was not affected by sex, age, body mass index, histopathology, or metastasis. CONCLUSION Excellent agreement between flexible endoscopy and MRI was noted, and no factor was found to affect such concordance.
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Affiliation(s)
| | | | | | | | - Turki A. Madani
- Faculty of MedicineKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Anas H. Alzahrani
- Department of Surgery, Faculty of MedicineKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Rana Y. Bokhary
- Department of Anatomical Pathology, Faculty of MedicineKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Arwa O. Badeeb
- Radiology Department, Faculty of MedicineKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Hussam A. Hijazi
- Radiation Oncology Unit, Radiology DepartmentKing Abdulaziz UniversityJeddahSaudi Arabia
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Abstract
BACKGROUND Rectal cancer is categorized into categories on the basis of tumor height measurements. Tumor height is used to guide initial treatment and determines the eligibility for clinical trials. OBJECTIVE This study aimed to determine the concordance between tumor heights measured by MRI and by clinical examination. DESIGN This was an institutional review board-approved retrospective analysis of MRI and the clinical measurements of tumor height. SETTING This study was conducted at a single university center that was accredited by the Commission on Cancer National Accreditation Program for Rectal Cancer. PATIENTS Ninety-five patients who were treated between 2015 and 2019 and who had an MRI and clinical evaluation were included. MAIN OUTCOME MEASUREMENTS The mean difference of tumor height between MRI and clinical examination was calculated. Secondary outcomes were to assess whether position in the rectum, age, BMI, or sex would affect the difference and how the measurements would change eligibility for rectal cancer trials. RESULTS Tumor height measurement by MRI and clinical examination had a good correlation, with r = 0.89 and p < 0.001. The mean absolute difference of measurement of tumor height was 1.56 cm. Higher tumors had a larger absolute difference between measurements. Body mass index was significantly associated with the difference in measurements. The discordance in measurements led to a change in eligibility for clinical trials for 38.9% of patients. Clinical trial eligibility was not significantly associated with tumor height category, sex, or patient age. LIMITATIONS This study was conducted at a single center with retrospective methodology. CONCLUSIONS Although MRI and clinical measurements showed a strong correlation, nearly 40% of our patients had a change in clinical trial eligibility depending on measurement modality. We suggest that trial investigators be consistent in establishing measurement technique as their inclusion criterion. See Video Abstract at http://links.lww.com/DCR/B756. MEDICIN DE LA ALTURA DEL TUMOR DE CNCER DE RECTO CONCORDANCIA ENTRE EL EXAMEN CLNICO Y LA RESONANCIA MAGNTICA ANTECEDENTES:El cáncer de recto se clasifica en categorías basadas en las mediciones de la altura del tumor. La altura del tumor se usa para guiar el tratamiento inicial y determina la elegibilidad para los ensayos clínicos.OBJETIVO:Determinar la concordancia entre la altura de los tumores medida por resonancia magnética (RMN) y por examen clínico.DISEÑO:Este fue un análisis retrospectivo aprobado por el IRB de la resonancia magnética y las mediciones clínicas de la altura del tumor.AJUSTE:Esto se llevó a cabo en un único centro universitario que fue acreditado por el Programa Nacional de Acreditación del Cáncer de Recto de la Comisión de Cáncer.PACIENTE:Se incluyeron 95 pacientes que fueron atendidos entre 2015 y 2019 y que tuvieron una resonancia magnética y evaluación clínica.PRINCIPALES MEDIDAS DE RESULTADOS:Se calculó la diferencia media de la altura del tumor entre la resonancia magnética y el examen clínico. Los resultados secundarios fueron evaluar si la posición en el recto, la edad, el índice de masa corporal (IMC) o el sexo afectarían la diferencia y cómo las mediciones cambiarían la elegibilidad para los ensayos de cáncer de recto.RESULTADOS:La medición de la altura del tumor por resonancia magnética y el examen clínico tuvo una buena correlación con r = 0,89 y p < 0,001. La diferencia absoluta media de medición de la altura del tumor fue de 1,56 cm. Los tumores más altos tenían una diferencia absoluta más grande entre las mediciones. El IMC se asoció significativamente con la diferencia en las mediciones. La discordancia en las mediciones llevó a un cambio en la elegibilidad para los ensayos clínicos para el 38,9% de los pacientes. La elegibilidad para ensayos clínicos no se asoció significativamente con la categoría de altura del tumor, el sexo o la edad del paciente.LIMITACIONES:Se realizó en un solo centro con metodología retrospectiva.CONCLUSIONES:Aunque la resonancia magnética y las mediciones clínicas mostraron una fuerte correlación, casi el 40% de nuestros pacientes tuvieron un cambio en la elegibilidad para los ensayos clínicos según la modalidad de medición. Sugerimos que los investigadores del ensayo sean coherentes al establecer la técnica de medición como criterio de inclusión. Consulte Video Resumen en http://links.lww.com/DCR/B756.
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Affiliation(s)
- Shannon M. Navarro
- Department of Radiology, University of California, Davis Medical Center, Sacramento CA
| | - Shuai Chen
- Division of Biostatistics, Department of Public Health Sciences, University of California at Davis, CA
| | - Linda M. Farkas
- Division of Colon & Rectal Surgery, UT Southwestern Medical Center, Dallas, Texas
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Nougaret S, Rousset P, Gormly K, Lucidarme O, Brunelle S, Milot L, Salut C, Pilleul F, Arrivé L, Hordonneau C, Baudin G, Soyer P, Brun V, Laurent V, Savoye-Collet C, Petkovska I, Gerard JP, Rullier E, Cotte E, Rouanet P, Beets-Tan RGH, Frulio N, Hoeffel C. Structured and shared MRI staging lexicon and report of rectal cancer: A consensus proposal by the French Radiology Group (GRERCAR) and Surgical Group (GRECCAR) for rectal cancer. Diagn Interv Imaging 2022; 103:127-141. [PMID: 34794932 DOI: 10.1016/j.diii.2021.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE To develop French guidelines by experts to standardize data acquisition, image interpretation, and reporting in rectal cancer staging with magnetic resonance imaging (MRI). MATERIALS AND METHODS Evidence-based data and opinions of experts of GRERCAR (Groupe de REcherche en Radiologie sur le CAncer du Rectum [i.e., Rectal Cancer Imaging Research Group]) and GRECCAR (Groupe de REcherche en Chirurgie sur le CAncer du Rectum [i.e., Rectal Cancer Surgery Research Group]) were combined using the RAND-UCLA Appropriateness Method to attain consensus guidelines. Experts scoring of reporting template and protocol for data acquisition were collected; responses were analyzed and classified as "Recommended" versus "Not recommended" (when ≥ 80% consensus among experts) or uncertain (when < 80% consensus among experts). RESULTS Consensus regarding patient preparation, MRI sequences, staging and reporting was attained using the RAND-UCLA Appropriateness Method. A consensus was reached for each reporting template item among the experts. Tailored MRI protocol and standardized report were proposed. CONCLUSION These consensus recommendations should be used as a guide for rectal cancer staging with MRI.
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Affiliation(s)
- Stephanie Nougaret
- Department of Radiology, Institut Régional du Cancer de Montpellier, Montpellier Cancer Research Institute, INSERM U1194, University of Montpellier, 34295, Montpellier, France.
| | - Pascal Rousset
- Department of Radiology, Lyon 1 Claude-Bernard University, 69495 Pierre-Benite, France
| | - Kirsten Gormly
- Dr Jones & Partners Medical Imaging, Kurralta Park, 5037, Australia; University of Adelaide, North Terrace, Adelaide, South Australia 5000, Australia
| | - Oliver Lucidarme
- Department of Radiology, Pitié-Salpêtrière Hospital, Sorbonne Université, 75013 Paris, France; LIB, INSERM, CNRS, UMR7371-U1146, 75013 Paris, France
| | - Serge Brunelle
- Department of Radiology, Institut Paoli-Calmettes, 13009 Marseille, France
| | - Laurent Milot
- Radiology Department, Hospices Civils de Lyon, Lyon Sud University Hospital, 69495 Pierre Bénite, France; Lyon 1 Claude Bernard University, 69100 Villeurbanne, France
| | - Cécile Salut
- Department of Radiology, CHU de Bordeaux, Université de Bordeaux, 33000 Bordeaux, France
| | - Franck Pilleul
- Department of Radiology, Centre Léon Bérard, Lyon, France Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621, Lyon, France
| | - Lionel Arrivé
- Department of Radiology, Hopital St Antoine, Paris, France
| | - Constance Hordonneau
- Department of Radiology, CHU Estaing, Université Clermont-Auvergne, 63000 Clermont-Ferrand, France
| | - Guillaume Baudin
- Department of Radiology, Centre Antoine Lacassagne, 06100 Nice, France
| | - Philippe Soyer
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université de Paris, 75006 Paris, France
| | - Vanessa Brun
- Department of Radiology, CHU Hôpital Pontchaillou, 35000 Rennes Cedex, France
| | - Valérie Laurent
- Department of Radiology, Brabois-Nancy University Hospital, Université de Lorraine, 54500 Vandoeuvre-lès-Nancy, France
| | | | - Iva Petkovska
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Jean Pierre Gerard
- Department of Radiotherapy, Centre Antoine Lacassagne, 06100 Nice, France
| | - Eric Rullier
- Department of Digestive Surgery, Hôpital Haut-Lévèque, Université de Bordeaux, 33600 Pessac, France
| | - Eddy Cotte
- Department of Digestive Surgery, Hospices Civils de Lyon, Lyon Sud University Hospital, 69310 Pierre Bénite, France; Lyon 1 Claude Bernard University, 69100 Villeurbanne, France
| | - Philippe Rouanet
- Department of surgery, Institut Régional du Cancer de Montpellier, Montpellier Cancer Research Institute, INSERM U1194, University of Montpellier, 34295, Montpellier, France
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, 1066 CX, Amsterdam, the Netherlands
| | - Nora Frulio
- Department of Radiology, CHU de Bordeaux, Université de Bordeaux, 33000 Bordeaux, France
| | - Christine Hoeffel
- Department of Radiology, Hôpital Robert Debré & CRESTIC, URCA, 51092 Reims, France
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Han YE, Park BJ, Sung DJ, Kim MJ, Han NY, Sim KC, Cho SB, Kim J, Kim SH, An H. How to accurately measure the distance from the anal verge to rectal cancer on MRI: a prospective study using anal verge markers. Abdom Radiol (NY) 2021; 46:449-458. [PMID: 32691110 DOI: 10.1007/s00261-020-02654-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/27/2020] [Accepted: 07/09/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE To determine an accurate method for localizing rectal cancer using the distance from the anal verge on preoperative MRI. METHODS This prospective study included 50 patients scheduled for MRI evaluation of rectal cancer. After rectal filling with gel, MRI was performed with two markers attached at the anal verge. The distance between the tumor and the anal verge on a sagittal T2-weighted image (T2WI) was measured independently by two radiologists using six methods divided into three groups of similar measurement approaches, and compared to those obtained on rigid sigmoidoscopy. The anal verge location relative to the external anal sphincter was assessed on oblique coronal T2WI in reference to the markers. Correlation analysis was performed using the intraclass correlation coefficient (ICC) for verification, and a paired t test was used to evaluate the mean differences. RESULTS The highest correlation (ICC 0.797-0.815) and the least mean difference (0.74-0.85 cm) with rigid sigmoidoscopy, and the least standard deviation (3.12-3.17 cm) were obtained in the direct methods group using a straight line from the anal verge to the tumor. The anal verge was localized within a range of - 1.4 to 1.5 cm (mean - 0.31 cm and - 0.22 cm) from the lower end of the external anal sphincter. CONCLUSION The direct methods group provided the most accurate tumor distance among the groups. Among the direct methods, we recommend the direct mass method for its simplicity. Despite minor differences in location, the lower end of the external anal sphincter was a reliable anatomical landmark for the anal verge.
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Falch C, Mueller S, Braun M, Gani C, Fend F, Koenigsrainer A, Kirschniak A. Oncological outcome of carcinomas in the rectosigmoid junction compared to the upper rectum or sigmoid colon – A retrospective cohort study. Eur J Surg Oncol 2019; 45:2037-2044. [DOI: 10.1016/j.ejso.2019.06.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 06/12/2019] [Indexed: 01/05/2023] Open
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Chung E, Kang D, Lee HS, Cho ES, Kim JH, Park EJ, Baik SH, Lee KY, Kang J. Accuracy of pelvic MRI in measuring tumor height in rectal cancer patients with or without preoperative chemoradiotherapy. Eur J Surg Oncol 2019; 45:324-330. [DOI: 10.1016/j.ejso.2018.08.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 06/24/2018] [Accepted: 08/30/2018] [Indexed: 01/23/2023] Open
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D'Souza N, Balyasnikova S, Tudyka V, Lord A, Shaw A, Abulafi M, Tekkis P, Brown G. Variation in landmarks for the rectum: an MRI study. Colorectal Dis 2018; 20:O304-O309. [PMID: 30176118 DOI: 10.1111/codi.14398] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 07/30/2018] [Indexed: 02/08/2023]
Abstract
AIM This study aimed to assess the reliability of measurements and bony landmarks for the rectosigmoid junction on MRI. METHOD The staging MRI scans for 100 patients were reviewed. The junction of the mesorectum and mesocolon was used to identify the rectum and sigmoid. The performance of current metric measurements or bony landmarks was then compared against the actual anatomical bowel segment. RESULTS The mean distance of the sigmoid take-off from the anal verge was 12.6 cm (SD 1.8 cm, range 9.4-19.0 cm). At a cutoff of 12 cm, the anatomical bowel segment was found to be sigmoid colon rather than rectum in 35% of patients. At 15 and 16 cm the bowel segment was sigmoid in 84% and 96% of patients, respectively. At the sacral promontory and the third sacral segment, the bowel segment was sigmoid in 28% and 100% of patients, respectively. CONCLUSION Current definitions of the rectum that rely on arbitrary measurements or bony landmarks will not locate the correct point of transition between the rectum and sigmoid in the majority of patients. The sigmoid take-off offers an alternative, anatomically bespoke, landmark.
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Affiliation(s)
- N D'Souza
- Royal Marsden Hospital, Sutton, UK.,Croydon University Hospital, Croydon, UK.,Imperial College, London, UK
| | - S Balyasnikova
- Royal Marsden Hospital, Sutton, UK.,Imperial College, London, UK.,N. N. Petrov Research Institute of Oncology, Saint Petersburg, Russia
| | | | - A Lord
- Royal Marsden Hospital, Sutton, UK.,Croydon University Hospital, Croydon, UK.,Imperial College, London, UK
| | - A Shaw
- Royal Marsden Hospital, Sutton, UK.,Croydon University Hospital, Croydon, UK.,Imperial College, London, UK
| | - M Abulafi
- Croydon University Hospital, Croydon, UK
| | - P Tekkis
- Royal Marsden Hospital, Sutton, UK.,Imperial College, London, UK
| | - G Brown
- Royal Marsden Hospital, Sutton, UK.,Imperial College, London, UK
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Jacobs L, Meek DB, van Heukelom J, Bollen TL, Siersema PD, Smits AB, Tromp E, Los M, Weusten BL, van Lelyveld N. Comparison of MRI and colonoscopy in determining tumor height in rectal cancer. United European Gastroenterol J 2017; 6:131-137. [PMID: 29435323 PMCID: PMC5802669 DOI: 10.1177/2050640617707090] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 03/29/2017] [Indexed: 01/11/2023] Open
Abstract
Background and aim Endoscopy and magnetic resonance imaging (MRI) are used routinely in the diagnostic and preoperative work-up of rectal cancer. We aimed to compare colonoscopy and MRI in determining rectal tumor height. Methods Between 2002 and 2012, all patients with rectal cancer with available MRIs and endoscopy reports were included. All MRIs were reassessed for tumor height by two abdominal radiologists. To obtain insight in techniques used for endoscopic determination of tumor height, a survey among regional endoscopists was conducted. Results A total of 211 patients with rectal cancer were included. Tumor height was significantly lower when assessed by MRI than by endoscopy with a mean difference of 2.5 cm (95% CI: 2.1-2.8). Although the agreement between tumor height as measured by MRI and endoscopy was good (intraclass correlation coefficient (ICC) 0.7 (95% CI: 0.7-0.8)), the 95% limits of agreement varied from -3.0 cm to 8.0 cm. In 45 patients (21.3%), tumors were regarded as low by MRI and middle-high by endoscopy. MRI inter- and intraobserver agreements were excellent with an ICC of 0.8 (95% CI: 0.7-0.9) and 0.9 (95% CI: 0.9-1.0), respectively. The survey showed no consensus among endoscopists as to how to technically measure tumor height. Conclusion This study showed large variability in rectal tumor height as measured by colonoscopy and MRI. Since MRI measurements showed excellent inter- and intraobserver agreement, we suggest using tumor height measurement by MRI for diagnostic purposes and treatment allocation.
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Affiliation(s)
- Lotte Jacobs
- Department of Gastroenterology and Hepatology, St Antonius Hospital Nieuwegein, The Netherlands
| | - David B Meek
- Department of Radiology, St Antonius Hospital Nieuwegein, The Netherlands
| | - Joost van Heukelom
- Department of Gastroenterology and Hepatology, St Antonius Hospital Nieuwegein, The Netherlands
| | - Thomas L Bollen
- Department of Radiology, St Antonius Hospital Nieuwegein, The Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, The Netherlands.,Department of Gastroenterology and Hepatology, Radboud University Medical Center Nijmegen, The Netherlands
| | - Anke B Smits
- Department of Surgery, St Antonius Hospital Nieuwegein, The Netherlands
| | - Ellen Tromp
- Department of Epidemiology and Statistics, St Antonius Hospital Nieuwegein, The Netherlands
| | - Maartje Los
- Department of Internal Medicine/Oncology, St Antonius Hospital Nieuwegein, The Netherlands
| | - Bas Lam Weusten
- Department of Gastroenterology and Hepatology, St Antonius Hospital Nieuwegein, The Netherlands.,Department of Gastroenterology and Hepatology, University Medical Center Utrecht, The Netherlands
| | - Niels van Lelyveld
- Department of Gastroenterology and Hepatology, St Antonius Hospital Nieuwegein, The Netherlands
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