Preoperative evaluation of pelvic MRI findings in patients with rectosigmoid cancer in Golestan province (north of Iran)

Document Type : Original Article

Authors

1 Specialist Radiology, Golestan University of Medical Sciences, Gorgan, Iran

2 Assistant Professor of Radiology, Department of Radiology, School of Medicine, 5th Azar Hospital, Golestan University of Medical Sciences, Gorgan, Iran

3 Ph.D. in Epidemiology, Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran

10.22034/ncm.2022.337938.1041

Abstract

Background: Colorectal cancer (CRC) is the third leading cause of death globally, representing 16% of all new cancer cases. Early detection of metastatic disease is crucial as it significantly influences treatment options. Magnetic resonance imaging (MRI) is widely regarded as the gold standard for preoperative assessment in CRC.
Objectives: The aim of this study was to investigate MRI findings in patients with rectosigmoid cancer in Gholestan Province, northern Iran, from 2019 to 2020.
Methods: This is a retrospective cross-sectional study that was performed on 43 patients with rectal cancer in Gorgan. Patients with other cancers, metastatic cancer, and a history of surgery were excluded. Demographic data (age, gender, and ethnicity) was obtained from patients' electronic records, and patients' MRI information was obtained through the Picture Archival and Communication System (PACS) of Gorgan MRI centers.
Results: Among 43 patients with rectosigmoid cancer, 65.1% of them were male, and the mean age was 58.58±14.73 years. The average mass length was 48.44 mm, and the distance from the anal verge was 69.81 mm. The most common morphology of patients' rectosigmoid masses in imaging was related to semicircular (51.2%) and circumscription (32.6%). T1/T2, N2a, and M0, with the percentages of 41.9%, 39.5%, and 90.7%, respectively, had the highest frequency in patients. TNM staging was not significantly related to gender or ethnicity. Peritoneal reflection was also more common in Sistan and Turkmen ethnic groups.
Conclusion: The findings of this study indicate that high-resolution MRI using an appropriate imaging protocol can provide accurate regional staging essential for optimal treatment.

Keywords

References

  1. Rompianesi G, Pegoraro F, Ceresa CD, Montalti R, Troisi RI. Artificial intelligence in the diagnosis and management of colorectal cancer liver World J Gastroenterol. 2022; 28(1):108.
  2. Kang SI, Kim DW, Cho JY, Park J, Lee KH, Son IT, et al. Is MRI of the liver needed during routine preoperative workup for colorectal Cancer?. Dis Colon Rectum. 2017;60(9):936-44. doi:10.1097/DCR.0000000000000914
  3. Lavdas I, Rockall AG, Daulton E, Kozlowski K, Honeyfield L, Aboagye EO, et al. Histogram analysis of apparent diffusion coefficient from whole-body diffusion-weighted MRI to predict early response to chemotherapy in patients with metastatic colorectal cancer: preliminary results. Clin Radiol. 2018;73 (9):832-e9. doi:10.1016/j.crad.2018.04.011
  4. Pourahmad S, Pourhashemi S, Mohammadianpanah M. Colorectal cancer staging using three clustering methods based on preoperative clinical findings. Asian Pac J Cancer Prev. 2016; 17(2):823-7.doi:10.7314/APJCP.2016.17.2.823
  5. Taylor SA, Mallett S, Beare S, Bhatnagar G, Blunt D, Boavida P, et al. Diagnostic accuracy of whole-body MRI versus standard imaging pathways for metastatic disease in newly diagnosed colorectal cancer: the prospective Streamline C trial. Lancet Gastroenterol Hepatol. 2019;4 (7): 529-37.doi:10.3310/hta23660
  6. Odalovic S, Stojiljkovic M, Sobic-Saranovic D, Pandurevic S, Brajkovic L, Milosevic I, et al. Prospective study on diagnostic and prognostic significance of postoperative FDG PET/CT in recurrent colorectal carcinoma patients: comparison with MRI and tumor markers. Neoplasma. 2017; 64(6):954-61.doi:10.4149/neo_2017_613     
  7. Ahmad Ea, Nehal Km, Mohamed Ae, Mohamed Zm. Role of Diffusion-Weighted MRI in Colorectal Cancer. Med J Cairo Univ. 2019;87(June):1631-7. doi:10.21608/mjcu.2019.53892
  8. Park JS, Jang YJ, Choi GS, Park SY, Kim HJ, Kang H, et al. Accuracy of preoperative MRI in predicting pathology stage in rectal cancers: node-for-node matched histopathology validation of MRI features. Dis Colon Rectum. 2014;57(1):32-8.doi:10.1097/DCR.0000000000000004
  9. Kang B, Lee JM, Song YS, Woo S, Hur BY, Jeon JH, et al. Added value of integrated whole-body PET/MRI for evaluation of colorectal cancer: comparison with contrast-enhanced MDCT. Am J Roentgenol. 2016; 206(1):W10-20.doi:10.2214/AJR.14.13818             
  10. Jung EJ, Ryu CG, Kim G, Kim SR, Nam SE, Park HS, et al. Is rectal MRI beneficial for determining the location of rectal cancer with respect to the peritoneal reflection?. Radiol Oncol. 2012;46(4):296.doi:10.2478/v10019-012-0038-7
  11. Lehtonen TM, Koskenvuo LE, Seppälä TT, Lepistö AH. The prognostic value of extramural venous invasion in preoperative MRI of rectal cancer patients. Colorectal Dis. 2022.doi:10.1111/codi.16103
  12. Niknam N, Kalteh EA, Charkazi A. The burden of premature mortality due to colorectal cancer in Golestan province from 2011-2015: a sequential cross-sectional study. Stud Med Sci. 2019; 30(5):373-80.
  13. Kalisz KR, Enzerra MD, Paspulati RM. MRI evaluation of the response of rectal cancer to neoadjuvant chemoradiation therapy. Radiographics. 2019;39(2):538-56.doi:10.1148/rg.2019180075
  14. Ludwig DR, Mintz AJ, Sanders VR, Fowler KJ. Liver imaging for colorectal cancer metastases. Curr Colorectal Cancer Rep. 2017; 13 (6):470-80.
  15. Cleary RK, Morris AM, Chang GJ, Halverson AL. Controversies in surgical oncology: does the minimally invasive approach for rectal cancer provide equivalent oncologic outcomes compared with the open approach?. Ann Surg Oncol. 2018;25(12): 3587-95.doi:10.1245/s10434-018-6740-y
  16. Platt E, Dovell G, Smolarek S. Systematic review of outcomes following pelvic exenteration for the treatment of primary and recurrent locally advanced rectal cancer. Tech Coloproctol. 2018; 22(11):835-45.doi:10.1007/s10151-018-1883-1
  17. Beets-Tan RG, Lambregts DM, Maas M, Bipat S, Barbaro B, Curvo-Semedo L, et al. Magnetic resonance imaging for clinical management of rectal cancer: updated recommendations from the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. Eur Radiol. 2018; 28 (4): 1465-75.doi:10.1007/s00330-017-5026-2
  18. Al-Sukhni E, Milot L, Fruitman M, Beyene J, Victor JC, Schmocker S, et al. Diagnostic accuracy of MRI for assessment of T category, lymph node metastases, and circumferential resection margin involvement in patients with rectal cancer: a systematic review and meta-analysis. Ann Surg Oncol. 2012;19 (7): 2212-23.doi:10.1245/s10434-011-2210-5
  19. Kennedy ED, Simunovic M, Jhaveri K, Kirsch R, Brierley J, Drolet S, et al. Safety and feasibility of using magnetic resonance imaging criteria to identify patients with "good prognosis" rectal cancer eligible for primary surgery: the phase 2 nonrandomized QuickSilver clinical trial. JAMA Oncol. 2019;5(7):961-6.doi:10.1001/jamaoncol.2019.0186
  20. Taylor FG, Quirke P, Heald RJ, Moran B, Blomqvist L, Swift I, et al. Preoperative high-resolution magnetic resonance imaging can identify good prognosis stage I, II, and III rectal cancer best managed by surgery alone: a prospective, multicenter, European study. Ann Surg. 2011;253(4):711-9. doi:10.1097/SLA.0b013e31820b8d52
  21. Gollub MJ, Lall C, Lalwani N, Rosenthal MH. Current controversy, confusion, and imprecision in the use and interpretation of rectal MRI. Abdom Radiol. 2019; 44 (11): 3549-58.doi:10.1007/s00261-019-01996-3
  22. Nougaret S, Reinhold C, Mikhael HW, Rouanet P, Bibeau F, Brown G. The use of MR imaging in treatment planning for patients with rectal carcinoma: have you checked the "DISTANCE"?. Radiology. 2013;268(2):330-44.doi:10.1148/radiol.13121361
  23. Shihab OC, Quirke P, Heald RJ, Moran BJ, Brown G. Magnetic resonance imaging-detected lymph nodes close to the mesorectal fascia are rarely a cause of margin involvement after total mesorectal excision. J Br Surg. 2010;97(9):1431-6.doi:10.1002/bjs.7116
  24. Beets-Tan RG, Lambregts DM, Maas M, Bipat S, Barbaro B, Caseiro-Alves F, et al. Magnetic resonance imaging for the clinical management of rectal cancer patients: recommendations from the 2012 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. Eur Radiol. 2013;23(9):2522-31.doi:10.1007/s00330-013-2864-4
  25. Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, et al. The eighth edition AJCC cancer staging manual: continuing to build a bridge from a population‐based to a more "personalized" approach to cancer staging. CA: Cancer J Clin. 2017;67(2):93-9.doi:10.3322/caac.21388
  26. Schaap DP, Ogura A, Nederend J, Maas M, Cnossen JS, Creemers GJ, et al. Prognostic implications of MRI-detected lateral nodal disease and extramural vascular invasion in rectal cancer. J Br Surg. 2018;105(13):1844-52.doi:10.1002/bjs.10949
  27. Prampolini F, Taschini S, Pecchi A, Sani F, Spallanzani A, Gelsomino F, et al. Magnetic resonance imaging performed before and after preoperative chemoradiotherapy in rectal cancer: predictive factors of recurrence and prognostic significance of MR-detected extramural venous invasion. Abdom Radiol. 2020; 45(10):2941-9. doi:10.1007/s00261-018-1838-z

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History

  • Receive Date: 16 April 2022
  • Revise Date: 23 April 2022
  • Accept Date: 30 April 2022

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