Accuracy of magnetic resonance imaging in prediction of tumour-free resection margin in rectal cancer surgery
Accuracy of magnetic resonance imaging in prediction of tumour-free resection margin in rectal cancer surgery
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DOI：
10.1016/s0140-6736(00)04040-x
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发表时间：
2001-02-17
期刊：
影响因子：
168.9
通讯作者：
van Engelshoven, JMA
中科院分区：
文献类型：
--
作者：
Beets-Tan, RGH;Beets, GL;van Engelshoven, JMA
直肠癌切除术后局部复发的主要原因是肿瘤周围扩散的不完全切除。本研究评估的准确性，磁共振成像（MRI）与相控阵线圈的术前分期和预测的距离肿瘤的圆周切除边缘在全直肠系膜surveillance.Methods 76例原发性直肠癌术前评估MRI在1.5 T，与相控阵线圈。两名观察员独立评分，在两个场合，肿瘤的阶段，并测量距离直肠系膜筋膜。结果76例患者中有63例（83%）的MRI肿瘤分期与组织学分期一致（加权kappa =0.77 [95% CI 0.66-0.89]），51例（67%）患者（加权kappa =0.52 [0.37-0.67]）观察者2，观察者内肿瘤分期一致性良好（kappa =0.80 [0.69-0.91]），但观察者2为中度（kappa =0.49 [0.34-0.65]），观察者间一致性为中度（kappa =0.53 [0.38-0.69]）。12例明显T4肿瘤患者。正确预测了0 mm的边缘。在病理学家报告距离至少为10 mm但未说明实际距离的29例患者中，观察者1预测28例患者的距离至少为10 mm，观察者2预测27例患者的距离至少为10 mm。对于其余的35例患者，回归曲线构建，从这一点，至少10 mm的组织学距离可以预测与高置信度时，在MRI上测量的距离是至少5.0 mm。解释MRI与相控阵线圈显示中等的准确性和可重复性预测肿瘤阶段的直肠癌。然而，临床上更重要的环周切除边缘可以以高准确性和一致性进行预测。允许术前识别有复发风险的患者，这些患者将受益于术前放疗、更广泛的手术或两者。
Background Incomplete surgical removal of the circumferential tumour spread is believed to be the main cause of local recurrence after resection of rectal cancer. This study assessed the accuracy of magnetic resonance imaging (MRI) with a phased-array coil for preoperative staging and prediction of the distance of the tumour from the circumferential resection margin in a total mesorectal excision.Methods 76 patients with primary rectal cancer were preoperatively assessed by MRI at 1.5 T, with a phased-array coil. Two observers independently scored, on two occasions, the tumour stage and measured the distance to the mesorectal fascia. Their findings were compared with the final histological findings.Findings The MRI tumour stage agreed with the histological stage in 63 (83%) of 76 patients (weighted kappa =0.77 [95% CI 0.66-0.89]) for observer 1, and in 51 (67%) patients (weighted kappa =0.52 [0.37-0.67]) for observer 2, The intraobserver agreement on the tumour stage was good (kappa =0.80 [0.69-0.91]) for observer 1 but moderate (kappa =0.49 [0.34-0.65]) for observer 2, The interobserver agreement was moderate (kappa =0.53 [0.38-0.69]). In 12 patients with an obvious T4 tumour. a margin of 0 mm was correctly predicted. Of 29 patients for whom the pathologist reported a distance of at least 10 mm without specifying the actual distance, a distance of at least 10 mm was predicted in 28 by observer 1 and 27 by observer 2. For the remaining 35 patients, a regression curve was constructed; from this, a histological distance of at least 1 0 mm can be predicted with high confidence when the measured distance on MRI is at least 5.0 mm.Interpretation MRI with a phased-array coil showed moderate accuracy and reproducibility for predicting the tumour stage of rectal cancers. The clinically more important circumferential resection margin can, however, be predicted with high accuracy and consistency. allowing preoperative identification of patients at risk of recurrence who will benefit from preoperative radiotherapy, more extensive surgery, or both.