Milanzi Elasma, Pelly Rachel M, Hayes Ian P, Gibbs Peter, Faragher Ian, Reece Jeanette C
Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia.
Colorectal Surgery Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia.
J Surg Oncol. 2024 Dec;130(8):1674-1682. doi: 10.1002/jso.27852. Epub 2024 Sep 5.
High-resolution magnetic resonance imaging (MRI) accuracy for staging preoperative rectal cancer varies across studies. We examined MRI accuracy for T- and N-staging of rectal cancer compared with final histopathology of the resected specimen in a large Australian cohort who did not receive neoadjuvant therapy or radiation.
Retrospective analysis of prospectively-collected clinical data from 153 rectal adenocarcinomas locally staged by high-resolution MRI between January 2012 and December 2019 that did not undergo chemoradiotherapy or radiation before surgery. T- and N-stage agreement between MRI and final histopathology was assessed using Kappa statistic. Agreement at each T-stage was evaluated using log-linear modeling. N-staging accuracy was examined using positive and negative predictive values.
Overall agreement between MRI and final histopathology for T-stage and N-stage was 55% and 65%, respectively. Kappa statistic found higher agreement between MRI and final histopathology for T-staging (κ = 0.33) versus N-staging (κ = 0.18). MRI correctly assessed 91% of T1 tumors, 43% of T2 tumors, 65% of T3 tumors, and 80% of T4 tumors. MRI accuracy was higher for N-negative tumors (74.1%) than for N-positive tumors (44.4%).
MRI is moderately accurate at staging T1, T3, and T4 rectal tumors but caution when staging tumors as T2 is advised. Greater accuracy for staging N-negative versus N-positive tumors is indicated.
不同研究中，术前直肠癌分期的高分辨率磁共振成像（MRI）准确性存在差异。我们在一个未接受新辅助治疗或放疗的大型澳大利亚队列中，将直肠癌T分期和N分期的MRI准确性与切除标本的最终组织病理学结果进行了比较。
对2012年1月至2019年12月期间前瞻性收集的153例局部经高分辨率MRI分期的直肠腺癌临床数据进行回顾性分析，这些患者术前未接受放化疗或放疗。使用Kappa统计量评估MRI与最终组织病理学之间的T分期和N分期一致性。使用对数线性模型评估每个T分期的一致性。通过阳性和阴性预测值检查N分期准确性。
MRI与最终组织病理学在T分期和N分期的总体一致性分别为55%和65%。Kappa统计量显示，MRI与最终组织病理学在T分期（κ = 0.33）方面的一致性高于N分期（κ = 0.18）。MRI正确评估了91%的T1肿瘤、43%的T2肿瘤、65%的T3肿瘤和80%的T4肿瘤。MRI对N阴性肿瘤的准确性（74.1%）高于N阳性肿瘤（44.4%）。
MRI对T1、T3和T4期直肠肿瘤分期具有中等准确性，但在将肿瘤分期为T2时建议谨慎。结果表明，MRI对N阴性肿瘤分期的准确性高于N阳性肿瘤。
