Jiang Jin-bo, Dai Yong, Zhang Xiao-ming, Li Chuan-fu, Jin Zu-tao, Bi Dong-song, Sun Jing-zhong
Department of General Surgery, Qilu hospital of Shandong University, Jinan 250012, China.
Zhonghua Yi Xue Za Zhi. 2006 Apr 11;86(14):961-4.
To evaluate the accuracy of preoperative magnetic resonance imaging (MRI) in prediction of pathological staging and involvement of circumferential resection margin (CRM) in rectal cancer.
Fifty-three patients undergoing total mesorectal excision for biopsy-proven rectal cancer were assessed prospectively using high-resolution MRI for tumour (T) and mesorectal nodal (N) staging as well as CRM status using the depth of tumour spread, tumour node metastasis and CRM involvement. Preoperative MRI assessment of these prognostic factors was compared with the histopathological findings in carefully matched whole-mount sections of the specimen.
MRI correctly staged the tumor in 41 patients, understaged in 8, and overstaged in 4. The accuracy of T stage was 77.4% (41/53). There was ageneric correlation between pathologic and MRI tumor staging (Kappa = 0.602, P < 0.001). Node status was correctly staged in 37 patients, overstaged in 10, and understaged in 6. The accuracy of node staging was 69.8% (37/53), sensitivity was 75% (18/24), and specificity was 65.5% (19/29). The correlation between pathologic and MRI node staging was poor (Kappa = 0.399, P = 0.003). The CRM status was correctly reported in 51 patients, overstaged in 1, and understaged in 1. The accuracy of CRM status was 96.2% (51/53), sensitivity was 80% (1/5), and specificity was 97.9% (47/48). There was a good correlation between pathologic and MRI CRM involvement (Kappa = 0.779, P < 0.001).
Preoperative MRI provides poor predictive data as to subsequent pathologic tumor and mesorectal node stage, but does produce reliable prediction of clear CRM.
评估术前磁共振成像（MRI）在预测直肠癌病理分期及环周切缘（CRM）受累情况方面的准确性。
对53例经活检证实为直肠癌并接受全直肠系膜切除术的患者进行前瞻性评估，使用高分辨率MRI对肿瘤（T）和直肠系膜淋巴结（N）进行分期，并根据肿瘤扩散深度、肿瘤淋巴结转移及CRM受累情况评估CRM状态。将这些预后因素的术前MRI评估结果与标本经仔细匹配的全层切片的组织病理学结果进行比较。
MRI正确分期41例患者的肿瘤，分期过低8例，分期过高4例。T分期的准确率为77.4%（41/53）。病理与MRI肿瘤分期之间存在一般相关性（Kappa = 0.602，P < 0.001）。37例患者的淋巴结状态分期正确，分期过高10例，分期过低6例。淋巴结分期的准确率为69.8%（37/53），敏感性为75%（18/24），特异性为65.5%（19/29）。病理与MRI淋巴结分期之间的相关性较差（Kappa = 0.399，P = 0.003）。51例患者的CRM状态报告正确，分期过高1例，分期过低1例。CRM状态的准确率为96.2%（51/53），敏感性为80%（1/5），特异性为97.9%（47/48）。病理与MRI CRM受累情况之间存在良好相关性（Kappa = 0.779，P < 0.001）。
术前MRI对后续病理肿瘤和直肠系膜淋巴结分期的预测数据较差，但对CRM阴性可产生可靠预测。
