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- Title
Preoperative assessment of prognostic factors in rectal cancer using high-resolution magnetic resonance imaging.
- Authors
Brown, G.; Radcliffe, A. G.; Newcombe, R. G.; Dallimore, N. S.; Bourne, M. W.; Williams, G. T.
- Abstract
Background: The aim was to determine the accuracy of preoperative magnetic resonance imaging (MRI) in the evaluation of pathological prognostic factors that influence local recurrence and survival in rectal cancer. Methods: Ninety-eight patients undergoing total mesorectal excision for biopsy-proven rectal cancer were assessed prospectively using high-resolution MRI for tumour (T) and nodal (N) staging using the tumour node metastasis classification, depth of extramural tumour spread, the presence or absence of extramural venous invasion, a threatened circumferential resection margin and serosal involvement at or above the peritoneal reflection. Preoperative magnetic resonance assessment of these prognostic factors was compared with histopathological findings in carefully matched whole-mount sections of the resection specimen. Results: There was 94 per cent weighted agreement (weighted κ = 0.67) between MRI and pathology assessment of T stage. Agreement between MRI and histological assessment of nodal status was 85 per cent (κ = 0.68). Although involvement of small veins by tumour was not discernible using MRI, large (calibre greater than 3 mm) extramural venous invasion was identified correctly in 15 of 18 patients (κ = 0.64). MRI predicted circumferential resection margin involvement with 92 per cent agreement (κ = 0.81). Seven of nine patients with peritoneal perforation by tumour (stage T4) were identified correctly using MRI. Conclusion: High-resolution MRI of the rectum allows preoperative identification of important surgical and pathological prognostic risk factors. This may allow both better selection and assessment of patients undergoing preoperative therapy.
- Subjects
MAGNETIC resonance imaging; PREOPERATIVE care; PROGNOSIS; RECTAL cancer; SURGICAL excision; TUMORS
- Publication
British Journal of Surgery, 2003, Vol 90, Issue 3, p355
- ISSN
0007-1323
- Publication type
Article
- DOI
10.1002/bjs.4034