Department of Surgery, University Hospital Ostrava, 17.listopadu 1790, Ostrava, Czech Republic.
Department of Pathology, University Hospital Ostrava, 17.listopadu 1790, Ostrava,Czech Republic.
Eur J Radiol. 2023 Aug;165:110961. doi: 10.1016/j.ejrad.2023.110961. Epub 2023 Jul 5.
Magnetic resonance imaging (MRI) is a fundamental diagnostic modality for the evaluation of primary rectal cancer, but MRI assessment of nodal involvement remains a confounding factor.
This prospective cohort study was conducted to investigate the accuracy of preoperative MRI in the assessment of nodal status by comparing histopathology reports to MRI findings on a node-by-node basis in 69 patients with rectal cancer.
Primary surgery was performed in 40 (58.0%) patients; 29 (42.0%) study patients underwent neoadjuvant chemoradiotherapy (CRT). Histopathological examination revealed T1 tumour in 8 (11.6%) patients, T2 tumour in 30 (43.5%), and T3 tumour in 25 (36.2%). In total, 897 lymph nodes (LNs) have been harvested (13.1 ± 5.4 LNs per specimen). There were 77 MRI-suspicious LNs, 21 (27.3%) of which were histologically proven malignant. The sensitivity of MRI for assessing nodal involvement was 51.2% and specificity 93.4%. Of the 28 patients with MRI-suspicious LNs the diagnosis was correct in 42.8%. The MRI accuracy was 33.3% in "primary surgery" subgroup (n = 18, malignant LNs found in 6 patients). Diagnosis of MRI-negative LNs was correct in 90.2% of study patients; malignant nodes were found in 9.8% of patients initially classified as cN0.
MRI prediction of nodal status in patients with rectal cancer has very low accuracy. Decisions regarding neoadjuvant CRT should not be based on MRI assessment of nodal status, but on the MRI evaluation of tumour depth invasion (T stage and relationship between the tumour and mesorectal fascia).
磁共振成像（MRI）是评估原发性直肠癌的基本诊断方式，但淋巴结受累的 MRI 评估仍然是一个混杂因素。
本前瞻性队列研究旨在通过对 69 例直肠癌患者的淋巴结进行逐个节点的比较，调查术前 MRI 在淋巴结状态评估中的准确性，将组织病理学报告与 MRI 结果进行比较。
40 例（58.0%）患者进行了主要手术；29 例（42.0%）研究患者接受了新辅助放化疗（CRT）。组织病理学检查显示 8 例（11.6%）患者为 T1 肿瘤，30 例（43.5%）为 T2 肿瘤，25 例（36.2%）为 T3 肿瘤。总共采集了 897 个淋巴结（每个标本 13.1±5.4 个淋巴结）。有 77 个 MRI 可疑淋巴结，其中 21 个（27.3%）经组织学证实为恶性。MRI 评估淋巴结受累的敏感性为 51.2%，特异性为 93.4%。在 28 例 MRI 可疑淋巴结患者中，诊断正确的患者占 42.8%。在“主要手术”亚组（n=18，6 例患者发现恶性淋巴结）中，MRI 准确性为 33.3%。MRI 阴性淋巴结的诊断在 90.2%的研究患者中是正确的；在最初分类为 cN0 的患者中，有 9.8%发现恶性淋巴结。
MRI 预测直肠癌患者的淋巴结状态准确性非常低。新辅助 CRT 的决策不应基于 MRI 评估淋巴结状态，而应基于 MRI 评估肿瘤深度侵犯（T 分期和肿瘤与直肠系膜筋膜的关系）。
