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Observational Study
. 2020 Jun;48(6):300060520928685.
doi: 10.1177/0300060520928685.

Assessment of T and N staging with MRI3T in lower and middle rectal cancer and impact on clinical strategy

Liping Xu  1   2 , Zhaoyue Zhang  1 , Qin Qin  1 , Chi Zhang  1 , Xinchen Sun  1
Affiliations
Observational Study

Assessment of T and N staging with MRI3T in lower and middle rectal cancer and impact on clinical strategy

Liping Xu et al. J Int Med Res. 2020 Jun.

Abstract

Background: To determine the diagnostic accuracy of preoperative T/N stage using MRI in lower and middle rectal cancer patients and the impacts on clinical decision-making.

Patients and methods: There were 354 patients recruited from May 2017 to February 2019. MRI was performed within 2 weeks before surgery. Histopathologic results were evaluated for the postoperative T/N stage and MRI diagnostic accuracy was assessed based on the postoperative histopathologic results. Accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and Kappa values were used to evaluate MRI diagnostic accuracy and analysis consistency compared with postoperative histopathologic staging.

Results: Overall MRI diagnostic accuracy was 78.2% and 56.8% for T1-4 and N0-2 staging. The Kappa values were 0.625 and 0.323 for T1-4 and N0-2 staging, respectively. After combination, MRI diagnostic accuracy was 85% and 69.5% for T and N staging. The Kappa values were 0.693 and 0.4 for T and N staging. The diagnostic accuracy of MRI for treatment decision-making was 79.1%.

Conclusion: MRI enables a highly accurate preoperative assessment of T stage but only a fairly accurate preoperative assessment of the N stage for rectal cancer with surgery. The diagnostic accuracy of MRI for treatment decision-making is promising.

Keywords: Rectal cancer; diagnostic accuracy; magnetic resonance imaging staging; neoadjuvant chemoradiotherapy; pathological staging; treatment decision-making.

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Figures

Figure 1.
Figure 1.
Flow chart of the study.
Figure 2.
Figure 2.
Accuracy and error rate of MRI for clinical decision compared with pathologic results. MRI, magnetic resonance imaging.
Figure 3.
Figure 3.
The ROC curve of MRI assessment for decision-making. AUC = 0.594. ROC, receiver operating characteristics; MRI, magnetic resonance imaging; AUC, area under the curve.
See this image and copyright information in PMC

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