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Tech Coloproctol. 2014 Oct;18(10):937-43. doi: 10.1007/s10151-014-1199-8. Epub 2014 Jul 19.

Circumferential resection margins of rectal tumours post-radiotherapy: how can MRI aid surgical planning?

Author information

1
Department of Surgery, St George's Healthcare NHS Trust, London, UK, ermcglone@gmail.com.

Abstract

BACKGROUND:

Magnetic resonance imaging (MRI) is known to have high predictive accuracy for circumferential resection margin (CRM) involvement of pre-treatment rectal tumours. This study aims to assess predictive accuracy of MRI for CRM involvement in rectal cancers post-long-course chemoradiotherapy (CRT) and in particular to understand how this information can influence surgical planning.

METHODS:

Forty-seven rectal cancers treated with CRT followed by bowel resection in one hospital since 2005 were reviewed for clinical, radiological and pathological characteristics. Using a validated pro forma, a radiologist blinded to final histology and original MRI report predicted CRM status from post-CRT MRI images. Results were compared to histological CRM status of final specimen, and differential analysis by type of surgical operation was performed.

RESULTS:

Overall accuracy of MRI for CRM involvement post-CRT was 72 % with a negative predictive value of 92 %. Abdominoperineal excision (APE) post-CRT was associated with non-significantly higher rates of histologically involved CRM than anterior resection (AR; 41 vs. 21 %) as were mucinous adenocarcinomas when compared to non-mucinous (56 vs. 21 %). Overall accuracy and positive predictive value were non-significantly higher for cancer treated with a standard APE than AR, and negative predictive value was high for both groups.

CONCLUSIONS:

MRI post-CRT has high negative predictive value for CRM status. Such information is of particular clinical relevance in low rectal cancers treated with APE as it can indicate when a standard surgical approach is likely to be sufficient.

PMID:
25037073
DOI:
10.1007/s10151-014-1199-8
[Indexed for MEDLINE]

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