MRI 用于新辅助治疗后直肠癌的淋巴结分期与组织病理学比较。
MRI for nodal restaging after neoadjuvant therapy in rectal cancer with histopathologic comparison.
机构信息
Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 510080, Guangzhou, China.
Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-sen University, 518036, Shenzhen, China.
出版信息
Cancer Imaging. 2023 Jul 13;23(1):67. doi: 10.1186/s40644-023-00589-0.
BACKGROUND
After neoadjuvant therapy, most of the lymph nodes (LNs) will shrink and disappear in patients with rectal cancer. However, LNs that are still detectable on MRI carry a risk of metastasis. This study aimed to evaluate the performance of the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) criterion (short-axis diameter ≥ 5 mm) in diagnosing malignant LNs in patients with rectal cancer after neoadjuvant therapy, and whether nodal morphological characteristics (including shape, border, signal homogeneity, and enhancement homogeneity) could improve the diagnostic efficiency for LNs ≥ 5 mm.
METHODS
This retrospective study included 90 patients with locally advanced rectal cancer who underwent surgery after neoadjuvant therapy and performed preoperative MRI. Two radiologists independently measured the short-axis diameter of LNs and evaluated the morphological characteristics of LNs ≥ 5 mm in consensus. With a per node comparison with histopathology as the reference standard, a ROC curve was performed to evaluate the diagnostic performance of the size criterion. For categorical variables, either a χ test or Fisher's exact test was used.
RESULTS
A total of 298 LNs were evaluated. The AUC for nodal size in determining nodal status was 0.81. With a size cutoff value of 5 mm, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 65.9%, 87.0%, 46.8%, 93.6% and 83.9%, respectively. No significant differences were observed in any of the morphological characteristics between benign and malignant LNs ≥ 5 mm (all P > 0.05).
CONCLUSIONS
The ESGAR criterion demonstrated moderate diagnostic performance in identifying malignant LNs in patients with rectal cancer after neoadjuvant therapy. It was effective in determining the status of LNs < 5 mm but not for LNs ≥ 5 mm, and the diagnostic efficiency could not be improved by considering nodal morphological characteristics.
背景
新辅助治疗后，大多数直肠癌患者的淋巴结（LNs）会缩小和消失。然而，MRI 仍能检测到的淋巴结仍有转移的风险。本研究旨在评估欧洲胃肠道和腹部放射学会（ESGAR）标准（短轴直径≥5mm）在诊断新辅助治疗后直肠癌患者恶性淋巴结的性能，以及淋巴结形态特征（包括形状、边界、信号均匀性和增强均匀性）是否可以提高≥5mm 淋巴结的诊断效率。
方法
本回顾性研究纳入 90 例局部进展期直肠癌患者，新辅助治疗后行手术治疗并进行术前 MRI 检查。两名放射科医生独立测量 LNs 的短轴直径，并通过共识评估≥5mm LNs 的形态特征。以每个节点与组织病理学比较作为参考标准，通过 ROC 曲线评估大小标准的诊断性能。对于分类变量，使用 χ 检验或 Fisher 确切检验。
结果
共评估了 298 个 LNs。淋巴结大小判断淋巴结状态的 AUC 为 0.81。当大小截断值为 5mm 时，敏感性、特异性、阳性预测值、阴性预测值和准确性分别为 65.9%、87.0%、46.8%、93.6%和 83.9%。≥5mm 的良性和恶性淋巴结之间，任何形态特征均无显著差异（均 P>0.05）。
结论
ESGAR 标准在识别新辅助治疗后直肠癌患者的恶性淋巴结方面具有中等诊断性能。它在确定<5mm 的淋巴结状态方面有效，但对≥5mm 的淋巴结无效，并且考虑淋巴结形态特征并不能提高诊断效率。
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