原发直肠癌环周切缘的术前磁共振评估价值
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摘要
目的以组织病理学为对照,研究原发直肠癌患者术前环周切缘(CRM)状态,进一步提高对术前CRM状态的预测准确性。方法回顾性分析63例原发直肠癌患者的MR影像学资料,评价肿瘤部位、肿瘤局部浸润、转移性淋巴结和(或)癌结节、壁外血管浸润,并与患者手术后的病理结果进行对照,所得数据进行统计学分析,P<0.05为差异有统计学意义。结果 63例患者中有16例肿瘤位于上段直肠(25.4%),38例肿瘤位于中段直肠(60.3%),9例肿瘤位于远段直肠(14.3%)。患者CRM的评价:所有患者均清晰地显示直肠系膜筋膜,CRM阳性21例,包括原发肿瘤4例、阳性淋巴结和(或)癌结节11例、壁外血管浸润6例,CRM阴性42例。其中3例病理学CRM阴性者被误判为CRM阳性,1例低位直肠癌病理学CRM阳性被MRI误判为阴性。MRI评估CRM的准确性、敏感性、特异性、阳性预测值和阴性预测值分别为93.7%、94.7%、93.2%、85.7%和97.6%。结论术前高分辨率MRI能有效地评估原发直肠癌患者手术环周切缘,更好的协助临床制定治疗方案,最大限度地使患者获益。
Objective To evaluate preoperative magnetic resonance imaging of the circumferential resection margin(CRM) in rectal cancer compared in comparison of histopathology, so as to improve the preoperative prediction accuracy of CRM status. Methods The MR images of 63 cases of primary rectal cancer were analyzed retrospectively. The tumor site, local invasion of tumor, metastasis lymph nodes and(or) tumor deposits, and extramural vascular invasion(EMVI) were evaluated and analyzed with the post-operation pathological results as reference standard. Statistical analysis was performed using SPSS software(version 13.0, SPSS) and p values less than 0.05 were considered to be statistically significant. Results Of these 63 patients, 16 tumors were located in the upper rectum(25.4%), 38 tumors in the middle rectum(60.3%), and 9 tumors in the distal rectum(14.3%). The mesorectal fascia was clearly defined on MR images in all patients. CRM was involved in 21 cases, including 4 cases of primary tumor invasion, 11 cases of positive lymph nodes and(or) tumor deposits, and 6 cases of EMVI. Of these patients, 3 cases were misdiagnosed in CRM involvement, and one case with low rectal cancer CRM involvement was misdiagnosed as CRM negative. The accuracy, sensitivity, specificity, PPV and NPV were 93.7%, 94.7%, 93.2%, 85.7% and 97.6% respectively. Conclusion The preoperative high resolution MRI can effectively evaluate the CRM status of the primary rectal cancer and benefit clinical treatment decision making.
Objective To evaluate preoperative magnetic resonance imaging of the circumferential resection margin(CRM) in rectal cancer compared in comparison of histopathology, so as to improve the preoperative prediction accuracy of CRM status. Methods The MR images of 63 cases of primary rectal cancer were analyzed retrospectively. The tumor site, local invasion of tumor, metastasis lymph nodes and(or) tumor deposits, and extramural vascular invasion(EMVI) were evaluated and analyzed with the post-operation pathological results as reference standard. Statistical analysis was performed using SPSS software(version 13.0, SPSS) and p values less than 0.05 were considered to be statistically significant. Results Of these 63 patients, 16 tumors were located in the upper rectum(25.4%), 38 tumors in the middle rectum(60.3%), and 9 tumors in the distal rectum(14.3%). The mesorectal fascia was clearly defined on MR images in all patients. CRM was involved in 21 cases, including 4 cases of primary tumor invasion, 11 cases of positive lymph nodes and(or) tumor deposits, and 6 cases of EMVI. Of these patients, 3 cases were misdiagnosed in CRM involvement, and one case with low rectal cancer CRM involvement was misdiagnosed as CRM negative. The accuracy, sensitivity, specificity, PPV and NPV were 93.7%, 94.7%, 93.2%, 85.7% and 97.6% respectively. Conclusion The preoperative high resolution MRI can effectively evaluate the CRM status of the primary rectal cancer and benefit clinical treatment decision making.
引文
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[15] Brown G,Richards CJ,Bourne MW,et al.Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison [J].Radiology,2003,227(2):371-376.
[16] Hohn B,Lim JS,Kim H,et al.MRI-detected extramural vascular invasion is an independent prognostic factor for synchronous metastasis in patients with rectal cancer [J].Eur Radiol,2015,25(5):1347-1355.
[2] Tsai C,Hague C,Xiong W,et al.Evaluation of endorectal ultrasound (ERUS) and MRI for prediction of circumferential resection margin (CRM) for rectal cancer[J].American Journal of Surgery,2017,213(5):936-942.
[3] Iannicelli E,Renzo SD,Ferri M,et al.Accuracy of high-resolution MRI with lumen distention in rectal cancer staging and circumferential margin involvement prediction [J].Korean J Radiol,2014,15(1):37-44.
[4] Algebally AM ,Mohey N,Szmigielski W,et al.The value of high-resolution MRI technique in patients with rectal carcinoma:pre-operative assessment of mesorectal fascia involvement,circumferential resection margin and local staging [J].Polish Journal of Radiology,2015,80(1):115-121.
[5] Jhaveri KS,Hosseini-Nik H.MRI of rectal cancer:an overview and update on recent advances [J].Ajr American Journal of Roentgenology,2015,205(1):42-55.
[6] Engin G,Sharifov R.Magnetic resonance imaging for diagnosis and neoadjuvant treatment evaluation in locally advanced rectal cancer:a pictorial review [J].World Journal of Clinical Oncology,2017,8(3):214-229.
[7] Ma X,Li X,Xu L,et al.Characteristics and prognostic significance of preoperative magnetic resonance imaging-assessed circumferential margin in rectal cancer[J].Gastroenterology Research and Practice,2015,2015(7):1-8.
[8] Wieder HA,Rosenberg R,Lordick F,et al.Rectal cancer:MR imaging before neoadjuvant chemotherapy and radiation therapy for prediction of tumor-free circumferential resection margins and long-term survival [J].Radiology,2007,243(3):744-749.
[9] Hoeffel C,Mulé S,Laurent V,et al.Current imaging of rectal cancer [J].Clinics & Research in Hepatology & Gastroenterology,2015,39(2):168-173.
[10] Smith NJ,Barbachano Y,Norman AR,et al.Prognostic significance of magnetic resonance imaging-detect extramural vascular invasion in rectal cancer [J].Brit J SURG,2008,95(2):229-236.
[11] Caricato M,Borzomati D,Ausania F,et al.Prognostic factors after surgery for locally recurrent rectal cancer:an overview [J].Eur J Surg Oncol,2006,32(2):126-132.
[12] Group MS.Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer:prospective observational study[J].Bmj British Medical Journal,2006,333(7572):779-782.
[13] Beets-Tan RG,Beets GL.Rectal cancer:review with emphasis on MR imaging [J].Radiology,2004,232(2):335-346.
[14] Taylor FG,Quirke P,Heald RJ,et al.One millimetre is the safe cut-off for magnetic resonance imaging prediction of surgical margin status in rectal cancer [J].BJS,2011,98(6):872-879.
[15] Brown G,Richards CJ,Bourne MW,et al.Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison [J].Radiology,2003,227(2):371-376.
[16] Hohn B,Lim JS,Kim H,et al.MRI-detected extramural vascular invasion is an independent prognostic factor for synchronous metastasis in patients with rectal cancer [J].Eur Radiol,2015,25(5):1347-1355.