Preoperative staging with Magnetic Resonance Imaging (MRI) and EndoRectal Ultra- sonography (ERUS) for locally advanced rectal cancer (LARC) after chemoradiotherapy (CRT): accuracy with histopathologic findings

Van den Eynde, Marc;Kouinche, Nathalie;Van Maanen, Aline;Dragean, Cristina;Mourin, Anne;et.al.
(2016) 2016 ASCO Annual Meeting — Location: (United States) Chicago, IL (3.June.2016)

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  • Van den Eynde, MarcUCLouvain
    Author
  • Kouinche, Nathalie
    Author
  • Van Maanen, AlineUCLouvain
    Author
  • Dragean, CristinaUCLouvain
    Author
  • Danse, EtienneUCLouvain
    Author
  • Denis, Marie ArmelleUCLouvain
    Author
  • Kartheuser, AlexUCLouvain
    Author
  • Remue, Christopheorcid-logoUCLouvain
    Author
  • Léonard, DanielUCLouvain
    Author
  • Baldin, PamélaUCLouvain
    Author
  • Humblet, YvesUCLouvain
    Author
  • Scalliet, PierreUCLouvain
    Author
  • Mourin, AnneUCLouvain
    Author
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Abstract
Background: Pre-operative CRT followed by total mesorectal excision (TME) is nowadays the standard for LARC (cT3-T4N0 or cTxN+). TME could be avoided for patients with pathologic complete response. Our aim was to determine whether preoperative staging (MRI/ERUS) after CRT could accurately predict a pathological response. Methods: Between 1998 and 2014, 331 patients with LARC who underwent TME after CRT were identified. Only patients with available and complete results for both preoperative MRI and ERUS (T and N staging) and pathological staging were analyzed. Relevant categories of tumor downstaging (yT0N0: complete; yT1-2N0: present; yT3-T4N0 or yTxN+: absence) were compared. Accuracy of MRI and EUS was assessed using the ROC method and agreement between them by the kappa test. Mc-Nemar’s test evaluated accuracy difference. Results: 154 patients (sex ratio M/F 1.96; mean age 62.0 years-old; upper (15.5%), mid (26.6%) and low rectum (57.7%)) were analyzed. T-stage was accurately estimated by MRI in 53.2% (overstating (O): 35.1%, understaging (U): 11.7%) and by ERUS in 55.8% (O: 33.8%, U: 10.4%); Kappa coefficient: 0.489 (moderate agreement). N-stage was accurately estimated by MRI in 64.3% (O: 23.4%, U: 12.3%) and by ERUS in 63.6% (O: 14.9%, U: 21.4%); Kappa coefficient: 0.326 (fair agreement). Accuracies in the prediction of absence of tumor downstaging were similar with MRI (66.9%) and ERUS (74.0%; p = 0.25) both with an ability to predict non-responders (sensitivity) of respectively 85.6% and 87.6% (specificity of 35.1% and 50.9% respectively). Accuracies in the prediction of complete tumor downstaging were similar for MRI (85.1%) and ERUS (84.4%; p = 0.491) with a low ability to predict complete responders (sensitivity MRI: 25.0%, ERUS: 30.0%; specificity: MRI: 94.0%, ERUS: 92.5%). Conclusions: After CRT, preoperative MRI and ERUS accurately predict an absence of tumor downstaging but seem unhelpful for adequately estimate a complete pathological response and a possible non operative patient management.
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Van den Eynde, M., Kouinche, N., Van Maanen, A., Dragean, C., Danse, E., Denis, M. A., Kartheuser, A., Remue, C., Léonard, D., Baldin, P., Humblet, Y., Scalliet, P., & Mourin, A. (2016). Preoperative staging with Magnetic Resonance Imaging (MRI) and EndoRectal Ultra- sonography (ERUS) for locally advanced rectal cancer (LARC) after chemoradiotherapy (CRT): accuracy with histopathologic findings. Journal of Clinical Oncology, 64, 3618. https://hdl.handle.net/2078.5/174974 (Original work published 2016)