Rudinská Lucia Ihnát, Sengul Ilker, Škarda Jozef, Sengul Demet, Pelikán Anton, Koscielnik Pavel, Ihnát Peter
University Hospital Ostrava, Department of Forensic Medicine - Ostrava, Czech Republic.
Giresun University, Faculty of Medicine, Division of Endocrine Surgery - Giresun, Turkey.
Rev Assoc Med Bras (1992). 2025 Jul 7;71(6):e20250301. doi: 10.1590/1806-9282.20250301. eCollection 2025.
Multidisciplinary treatment is the standard of care for patients with cancer of the rectum. Neoadjuvant therapy decisions rely on the local carcinoma stage's magnetic resonance imaging assessment. However, the reliability of magnetic resonance imaging in evaluating mesorectal lymphadenopathy remains highly questionable.
A prospective clinical study was conducted to assess the accuracy of preoperative magnetic resonance imaging in assessing T-stage and N-stage rectal carcinoma. The magnetic resonance imaging findings were compared with those of a detailed histopathological examination of rectal specimens in each patient.
The study included 48 patients with cancer of the rectum who had undergone rectal resection with total mesorectal excision. The magnetic resonance imaging assessment of the T-stage was accurate in 26 out of the 48 cases (54.2%). Overstaging of the T-stage was recognized in 18 patients (37.5%), and 4 (8.3%) were understaged. According to preoperative magnetic resonance imaging (using Horvat's criteria), 56 suspicious/malignant lymph nodes were identified. However, only 13 (23.2%) of these lymph nodes were proved malignant on histopathology examination. The sensitivity of magnetic resonance imaging for nodal involvement assessment was 52.0% and specificity was 93.6%. Of the 646 magnetic resonance imaging-negative lymph nodes, 12 (1.9%) were false negatives (histopathology revealed metastatic lymph nodes). Of note, 20 study patients with malignant lymphadenopathy (according to magnetic resonance imaging) were detected. The magnetic resonance imaging diagnosis of malignant lymphadenopathy was correct in only 30.0% of these patients.
The accuracy of magnetic resonance imaging in evaluating mesorectal lymph nodes for cases with cancer of the rectum is remarkably low. Therefore, neoadjuvant therapy indications should be based primarily on the magnetic resonance imaging description of the depth of carcinoma invasion.
多学科治疗是直肠癌患者的标准治疗方案。新辅助治疗决策依赖于局部癌灶分期的磁共振成像评估。然而，磁共振成像在评估直肠系膜淋巴结病方面的可靠性仍备受质疑。
开展一项前瞻性临床研究，以评估术前磁共振成像在评估直肠癌T分期和N分期方面的准确性。将磁共振成像结果与每位患者直肠标本的详细组织病理学检查结果进行比较。
该研究纳入了48例接受直肠全系膜切除直肠切除术的直肠癌患者。48例患者中，磁共振成像对T分期的评估准确的有26例（54.2%）。18例患者（37.5%）存在T分期过度分期情况，4例（8.3%）存在T分期过低分期情况。根据术前磁共振成像（采用霍瓦特标准），共识别出56个可疑/恶性淋巴结。然而，经组织病理学检查，这些淋巴结中仅13个（23.2%）被证实为恶性。磁共振成像评估淋巴结受累的敏感性为52.0%，特异性为93.6%。在646个磁共振成像阴性的淋巴结中，有12个（1.9%）为假阴性（组织病理学显示为转移性淋巴结）。值得注意的是，检测到20例研究患者存在恶性淋巴结病（根据磁共振成像）。这些患者中，磁共振成像对恶性淋巴结病的诊断仅在30.0%的患者中正确。
磁共振成像评估直肠癌病例直肠系膜淋巴结的准确性极低。因此，新辅助治疗指征应主要基于癌灶浸润深度的磁共振成像描述。
