Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jan;47(1):38-47.
doi: 10.1007/s00261-021-03281-8. Epub 2021 Oct 4.

Evolutions in rectal cancer MRI staging and risk stratification in The Netherlands

Nino Bogveradze  1   2   3 , Najim El Khababi  1   2 , Niels W Schurink  1   2 , Joost J M van Griethuysen  1   2 , Shira de Bie  4 , Gerlof Bosma  5 , Vincent C Cappendijk  6 , Remy W F Geenen  7 , Peter Neijenhuis  8 , Gerald Peterson  9 , Cornelis J Veeken  10 , Roy F A Vliegen  11 , Monique Maas  1 , Max J Lahaye  1 , Geerard L Beets  2   12 , Regina G H Beets-Tan  1   2   13 , Doenja M J Lambregts  14
Affiliations

Evolutions in rectal cancer MRI staging and risk stratification in The Netherlands

Nino Bogveradze et al. Abdom Radiol (NY). 2022 Jan.

Abstract

Purpose: To analyze how the MRI reporting of rectal cancer has evolved (following guideline updates) in The Netherlands.

Methods: Retrospective analysis of 712 patients (2011-2018) from 8 teaching hospitals in The Netherlands with available original radiological staging reports that were re-evaluated by a dedicated MR expert using updated guideline criteria. Original reports were classified as "free-text," "semi-structured," or "template" and completeness of reporting was documented. Patients were categorized as low versus high risk, first based on the original reports (high risk = cT3-4, cN+, and/or cMRF+) and then based on the expert re-evaluations (high risk = cT3cd-4, cN+, MRF+, and/or EMVI+). Evolutions over time were studied by splitting the inclusion period in 3 equal time periods.

Results: A significant increase in template reporting was observed (from 1.6 to 17.6-29.6%; p < 0.001), along with a significant increase in the reporting of cT-substage, number of N+ and extramesorectal nodes, MRF invasion and tumor-MRF distance, EMVI, anal sphincter involvement, and tumor morphology and circumference. Expert re-evaluation changed the risk classification from high to low risk in 18.0% of cases and from low to high risk in 1.7% (total 19.7%). In the majority (17.9%) of these cases, the changed risk classification was likely (at least in part) related to use of updated guideline criteria, which mainly led to a reduction in high-risk cT-stage and nodal downstaging.

Conclusion: Updated concepts of risk stratification have increasingly been adopted, accompanied by an increase in template reporting and improved completeness of reporting. Use of updated guideline criteria resulted in considerable downstaging (of mainly high-risk cT-stage and nodal stage).

Keywords: Magnetic resonance imaging; Neoplasm staging; Rectal neoplasms; Risk assessment.

PubMed Disclaimer

Conflict of interest statement

None of the authors have any conflicts of interest or competing interests to disclose.

Figures

Fig. 1
Fig. 1
Effect after re-evaluation of study cases using updated staging criteria on classification of patients into low risk versus intermediate/high risk. * Note, in 11 out of the 119 discrepant cases, the change in risk classification was clearly due to interpretation differences (rather than use of updated criteria) between the original staging reports and the expert-re-evaluation: 7 cases originally staged as cT4 were downstaged to low-risk cT12-3ab disease, 2 cases originally staged as cT1-2 MRF + were re-evaluated as cT1-2 MRF-, and 2 cases originally staged as cT1-2 MRF- were re-evaluated as cT3 MRF + . This left a total of 108/604 = 17.9% remaining discrepant cases
Fig. 2
Fig. 2
Changes in nodal stage after re-evaluation of cases using updated nodal staging criteria
See this image and copyright information in PMC

References

    1. Glynne-Jones R, Wyrwicz L, Tiret E, Brown G, Rödel C, Cervantes A, Arnold D; ESMO Guidelines Committee. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2017 Jul 1;28(suppl_4):iv22-iv40. - PubMed
    1. National Comprehensive Cancer Network. Rectal cancer (version 1.2021) Available at: https://www.nccn.org/professionals/physician_gls/pdf/rectal.pdf Accessed April 20, 2021
    1. Federatie Medische specialisten. Landelijke richtlijn colorectaal carcinoom (2019 update). Available at: https://richtlijnendatabase.nl/richtlijn/colorectaal_carcinoom_crc/start... Accessed April 20, 2021
    1. National Institute for Health and Care Excellence. (2020). Colorectal cancer [NICE Guideline No. 151]. https://www.nice.org.uk/guidance/ng151 - PubMed
    1. Jessup M.J, Goldberg R.M, Asare E.A. et al. CP. Colon and Rectum. In: Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, Washington MK, et al. Eds. AJCC Cancer Staging Manual (8th edition). Springer, 2017: 251–73.

Publication types

LinkOut - more resources