磁共振成像在直肠癌中的准确性取决于肿瘤的位置。

Accuracy of magnetic resonance imaging in rectal cancer depends on location of the tumor.

作者信息

Peschaud Frédérique, Cuenod Charles-Anché, Benoist Stéphane, Julié Catherine, Beauchet Alain, Siauve Nathalie, Taieb-Kasbi Florence, Penna Christophe, Nordlinger Bernard

机构信息

Department of Surgery, Hospital Ambroise Paré, Boulogne, France.

出版信息

Dis Colon Rectum. 2005 Aug;48(8):1603-9. doi: 10.1007/s10350-005-0051-7.

DOI:10.1007/s10350-005-0051-7

PMID:15937629

Abstract

PURPOSE

This study was designed to evaluate prospectively magnetic resonance imaging for the prediction of the circumferential resection margin in rectal cancer to identify in which patient magnetic resonance imaging could accurately assess the circumferential resection margin before surgery and in which patients it could not.

METHODS

During a 17-month period, a preoperative magnetic resonance imaging for the assessment of circumferential resection margin was obtained prospectively in 38 patients with mid or low rectal cancer. The agreement of magnetic resonance imaging and pathologic examination for assessment of circumferential resection margin was analyzed.

RESULTS

Overall, magnetic resonance imaging agreed with histologic examination of the circumferential resection margin assessment in 28 patients (73 percent; kappa = 0.47). In all cases of disagreement between magnetic resonance imaging and pathology, magnetic resonance imaging overestimated the circumferential resection margin involvement. For the 11 patients with mid rectal cancer, circumferential resection margin was well predicted by magnetic resonance imaging in all cases (kappa = 1). For 27 patients with low rectal tumor, overall agreement between magnetic resonance imaging and histologic assessment was 63 percent (kappa = 0.35). Agreement was 22 percent (kappa = 0.03) for the 9 patients with low anterior and 83 percent (kappa = 0.67) for the 18 patients with low posterior rectal tumor. Univariate analysis revealed that only low and anterior rectal tumor was risk factor of overestimation of the circumferential resection margin by magnetic resonance imaging.

CONCLUSIONS

Although magnetic resonance imaging remains the best imaging tool for the preoperative assessment of the circumferential resection margin in patients with rectal cancer, it can overestimate the circumferential resection margin involvement in low and anterior tumor with the risk of overtreating the patients.

摘要

目的

本研究旨在前瞻性地评估磁共振成像在预测直肠癌环周切缘方面的作用，以确定哪些患者在手术前磁共振成像能够准确评估环周切缘，哪些患者不能。

方法

在17个月的时间里，前瞻性地对38例中低位直肠癌患者进行了术前磁共振成像检查以评估环周切缘。分析了磁共振成像与病理检查在评估环周切缘方面的一致性。

结果

总体而言，磁共振成像与环周切缘评估的组织学检查结果在28例患者中一致（73%；kappa = 0.47）。在磁共振成像与病理结果不一致的所有病例中，磁共振成像均高估了环周切缘受累情况。对于11例中位直肠癌患者，磁共振成像在所有病例中均能很好地预测环周切缘（kappa = 1）。对于27例低位直肠肿瘤患者，磁共振成像与组织学评估的总体一致性为63%（kappa = 0.35）。对于9例低位前位直肠肿瘤患者，一致性为22%（kappa = 0.03），对于18例低位后位直肠肿瘤患者，一致性为83%（kappa = 0.67）。单因素分析显示，只有低位前位直肠肿瘤是磁共振成像高估环周切缘的危险因素。