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Assessment of remaining tumour involved lymph nodes with MRI in patients with complete luminal response after neoadjuvant treatment of rectal cancer
Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Norrköping.
Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Norrköping.
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2018 (English)In: British Journal of Radiology, ISSN 0007-1285, E-ISSN 1748-880X, Vol. 91, no 1087, article id 20170938Article in journal (Refereed) Published
Abstract [en]

Objective: To assess the accuracy of MRI to predict remaining lymph node metastases in patients with complete pathological luminal response (ypTO) after neoadjuvant therapy. Methods: Data from a national registry were used. 19 patients with histopathologically remaining lymph node metastases (ypTON+) were identified. Another 19 patients without lymph node metastases (ypTONO) were used as matched controls. Two radiologists blinded to all patient information evaluated staging and restaging MRI that was compared to histopathological findings of the resected specimen. Results: The average size of the largest lymph node on restaging MRI was significantly larger (4.5 mm) in the ypTON+ group than in the ypTONO group (2.6 mm) (p = 0.04). Presence of ypN+ was correctly predicted by MRI in 7 of 19 patients. In patients without lymph node metastases (ypTONO), these were correctly classified by MRI in 16 of 19 patients. All patients who had MR-identified lymph nodes larger than 8mm at restaging were ypTN+. The sensitivity, specificity, positive predictive value and negative for prediction of remaining lymph node metastasis with MRI were 37, 84, 70 and 57%. Conclusion: In patients with ypTO in rectal cancer after neoadjuvant treatment, remaining regional lymph node metastases cannot safely be predicted by restaging MRI alone using presently known criteria. Presence of a lymph node over 8mm on restaging MRI strongly indicates yPN+. Advances In knowledge: This is one of the first studies on MRI lymph node assessment after chemo- radiotherapy (CRT) in luminal complete response.

Place, publisher, year, edition, pages
BRITISH INST RADIOLOGY , 2018. Vol. 91, no 1087, article id 20170938
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Radiology, Nuclear Medicine and Medical Imaging
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URN: urn:nbn:se:liu:diva-149755DOI: 10.1259/bjr.20170938ISI: 000436607600020PubMedID: 29668301OAI: oai:DiVA.org:liu-149755DiVA, id: diva2:1234359
Available from: 2018-07-24 Created: 2018-07-24 Last updated: 2018-07-24

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Loftås, PerHallböök, OlofAlmlöv, KarinArbman, Gunnar
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Division of Surgery, Orthopedics and OncologyFaculty of Health SciencesDepartment of Surgery in NorrköpingDepartment of Surgery in LinköpingDepartment of Clinical and Experimental MedicineFaculty of Medicine and Health SciencesDivision of Clinical Sciences
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British Journal of Radiology
Radiology, Nuclear Medicine and Medical Imaging

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