用于结肠癌局部分期的磁共振成像：磁共振成像能否成为结肠癌患者的最佳分期方式？

MRI for Local Staging of Colon Cancer: Can MRI Become the Optimal Staging Modality for Patients With Colon Cancer?

作者信息

Nerad Elias, Lambregts Doenja M J, Kersten Erik L J, Maas Monique, Bakers Frans C H, van den Bosch Harrie C M, Grabsch Heike I, Beets-Tan Regina G H, Lahaye Max J

机构信息

1 Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands 2 GROW School of Oncology and Developmental Biology, University of Maastricht Medical Centre, Maastricht, the Netherlands 3 Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands 4 Department of Radiology, Maastricht University Medical Centre, Maastricht, the Netherlands 5 Department of Pathology, Maastricht University Medical Centre, Maastricht, the Netherlands 6 Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, United Kingdom.

出版信息

Dis Colon Rectum. 2017 Apr;60(4):385-392. doi: 10.1097/DCR.0000000000000794.

DOI:10.1097/DCR.0000000000000794

PMID:28267005

Abstract

BACKGROUND

Colon cancer is currently staged with CT. However, MRI is superior in the detection of colorectal liver metastasis, and MRI is standard in local staging of rectal cancer. Optimal (local) staging of colon cancer could become crucial in selecting patients for neoadjuvant treatment in the near future (Fluoropyrimidine Oxaliplatin and Targeted Receptor Preoperative Therapy trial).

OBJECTIVE

The purpose of this study was to evaluate the diagnostic performance of MRI for local staging of colon cancer.

DESIGN

This was a retrospective study.

SETTINGS

The study was conducted at the Maastricht University Medical Centre.

PATIENTS

In total, 55 patients with biopsy-proven colon carcinoma were included.

MAIN OUTCOME MEASURES

All of the patients underwent an MRI (1.5-tesla; T2 and diffusion-weighted imaging) of the abdomen and were retrospectively analyzed by 2 blinded, independent readers. Histopathology after resection was the reference standard. Both readers evaluated tumor characteristics, including invasion through bowel wall (T3/T4 tumors), invasion beyond bowel wall of ≥5 mm and/or invasion of surrounding organs (T3cd/T4), serosal involvement, extramural vascular invasion, and malignant lymph nodes (N+). Interobserver agreement was compared using κ statistics.

RESULTS

MRI had a high sensitivity (72%-91%) and specificity (84%-89%) in detecting T3/T4 tumors (35/55) and a low sensitivity (43%-67%) and high specificity (75%-88%) in detecting T3cd/T4 tumors (15/55). For detecting serosal involvement and extramural vascular invasion, MRI had a high sensitivity and moderate specificity, as well as a moderate sensitivity and specificity in the detection of nodal involvement. Interobserver agreements were predominantly good; the more experienced reader achieved better results in the majority of these categories.

LIMITATIONS

The study was limited by its retrospective nature and moderate number of inclusions.

CONCLUSIONS

MRI has a good sensitivity for tumor invasion through the bowel wall, extramural vascular invasion, and serosal involvement. In addition, together with its superior liver imaging, MRI might become the optimal staging modality for colon cancer. However, more research is needed to confirm this. See Video Abstract at http://links.lww.com/DCR/A309.

摘要

背景

目前结肠癌采用CT进行分期。然而，MRI在检测结直肠癌肝转移方面更具优势，且在直肠癌局部分期中是标准方法。在不久的将来（氟嘧啶奥沙利铂和靶向受体术前治疗试验），结肠癌的最佳（局部）分期对于选择新辅助治疗的患者可能至关重要。

目的

本研究旨在评估MRI对结肠癌局部分期的诊断性能。

设计

这是一项回顾性研究。

地点

该研究在马斯特里赫特大学医学中心进行。

患者

总共纳入了55例经活检证实为结肠癌的患者。

主要观察指标

所有患者均接受了腹部MRI检查（1.5特斯拉；T2加权成像和扩散加权成像），并由2名盲法、独立的阅片者进行回顾性分析。手术切除后的组织病理学检查为参考标准。两位阅片者评估肿瘤特征，包括肠壁侵犯（T3/T4肿瘤）、肠壁外侵犯≥5mm和/或周围器官侵犯（T3cd/T4）、浆膜受累、壁外血管侵犯以及恶性淋巴结（N+）。采用κ统计量比较观察者间的一致性。

结果

MRI检测T3/T4肿瘤（35/55）时具有较高的敏感性（72%-91%）和特异性（84%-89%），而检测T3cd/T4肿瘤（15/55）时敏感性较低（43%-67%）、特异性较高（75%-88%）。对于检测浆膜受累和壁外血管侵犯，MRI具有较高的敏感性和中等特异性，在检测淋巴结受累方面也具有中等的敏感性和特异性。观察者间的一致性大多良好；经验更丰富的阅片者在大多数类别中取得了更好的结果。