A. Tfayli - Head and neck - Guidelines and clinical case presentation (2-3 ca...
MCC 2011 - Slide 2
1. Department of Surgery, University Medical Center Groningen Staging of rectal cancer as an example in oncology Theo Wiggers Cascais, Portugal Sunday February 13 th ,2011
Purpose: To prospectively determine diagnostic performance of predictive criteria for nodal staging with ultrasmall superparamagnetic iron oxide (USPIO)–enhanced magnetic resonance (MR) imaging in primary rectal cancer patients, with histopathologic findings as reference standard. Materials and Methods: Institutional review board approval and informed consent were obtained. Twenty-eight rectal cancer patients (18 men, 10 women; mean age, 68 years) underwent USPIOenhanced MR. Two observers with different experience evaluated each node on three-dimensional T2*-weighted images for border irregularity, short- and long-axis diameter, and estimated percentage (30%, 30%–50%, or 50%) of white region within the node. Ratio of measured surface area of white region within the node to measured surface area of total node (ratioA) was calculated. Signal intensity (SI) of gluteus muscle (SIGM), total node (SITN), and white (SIWR) and dark (SIDR) regions within the node were used to calculate SITN/SIGM and SIWR/SIDR ratios. Lesion-by-lesion, receiver operating characteristic curve, and interobserver agreement analyses were performed. The most accurate and practical criterion was evaluated by observer 3. Results: In 28 patients, 236 lymph nodes were examined. Area under the receiver operating characteristic curve (AUC) of estimated percentage of white region and ratioA were 0.96 and 0.99 (observer 1) and 0.95 and 0.97 (observer 2), respectively. AUC of estimated percentage criterion for observer 3 was 0.96. AUC of border, short- and long-axis diameter, and SITN/SIGM and SIWR/SIDR ratios were 0.65, 0.75, 0.79, 0.85, and 0.75 (observer 1) and 0.58, 0.75, 0.79, 0.89, and 0.79 (observer 2), respectively. Interobserver agreement ( value) for estimated white region between observers 1 and 2, 1 and 3, and 2 and 3 were 0.77, 0.79, and 0.84, respectively. For observers 1 and 2, value for border was 0.28. For observers 1 and 2, intraclass correlation coefficient for short- and long-axis diameters, ratioA, and SITN/SIGM and SIWR/SIDR ratios were 0.91, 0.96, 0.91, 0.72, and 0.92, respectively. Conclusion: Estimated percentage of white region and measured ratioA are the most accurate criteria for predicting malignant nodes with USPIO-enhanced MR imaging; the first criterion is the most practical.
Purpose: To retrospectively assess sensitivity and specificity of magnetic resonance (MR) imaging after chemotherapy and radiation therapy for predicting tumor invasion of the mesorectal fascia (MRF) in locally advanced primary rectal cancer, by using results of histologic examination and surgery as the reference standard, and to determine morphologic MR imaging criteria for MRF invasion. Materials and Methods: The Ethical Committee of University Hospital Maastricht approved this study and waived informed consent. Two observers independently scored postchemoradiation MR images in 64 patients with rectal cancer (38 male [mean age, 60 years] and 26 female [mean age, 64 years] patients) for MRF tumor invasion with a confidence level scoring system defined by subjective criteria. In a subsequent consensus reading session, morphologic MR criteria for invasion were defined by comparing morphologic changes with histologic findings. These criteria were evaluated and compared with the subjective criteria by comparing areas under the receiver operating characteristic curves (AUCs). Results: AUCs of postchemoradiation MR imaging for predicting MRF tumor invasion were 0.81 and 0.82 for observers 1 and 2, respectively. The following four types of morphologic tissue patterns at MR imaging were associated with whether or not MRF invasion was present at histologic examination: (a) development of fat pad larger than 2 mm (seen in no quadrants with and in four quadrants without invasion), (b) development or persistence of spiculations (seen in no quadrants with and in 22 quadrants without invasion), (c) development of diffuse hypointense “ fibrotic” tissue (seen in 21 quadrants with and in 32 quadrants without invasion), and (d) persistence of diffuse isoor hyperintense tissue (seen in 19 quadrants with and in two quadrants without invasion). AUC of postchemoradiation MR imaging for predicting MRF invasion on the basis of morphologic criteria was 0.80. There was no significant difference between the performance of subjective and morphologic criteria ( P .73–.76). Conclusion: Postchemoradiation MR imaging findings have moderate accuracy for predicting tumor invasion of the MRF related to the limitation in differentiating between diffuse “fibrotic” tissue with and that without small tumor foci. Specific other types of morphologic patterns atMRimaging can highly predict a tumor-free or invaded MRF.
Location of metastases Liver 43 Lung 15 (Retro)peritoneal lymph nodes 4 Bone 2
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