|Table of Contents|

Value of preoperative prediction of lymph node metastasis of rectal cancer by detection of extramural venous invasion by endorectal ultrasound and MRI

Journal Of Modern Oncology[ISSN:1672-4992/CN:61-1415/R]

Issue:
2024 20
Page:
3900-3905
Research Field:
Publishing date:

Info

Title:
Value of preoperative prediction of lymph node metastasis of rectal cancer by detection of extramural venous invasion by endorectal ultrasound and MRI
Author(s):
WANG Lirui1; 2; WU Guozhu2; GUO Jing3; GAO Yue4
1.Graduate School of Baotou Medical College,Inner Mongolia University of Science and Technology,Inner Mongolia Baotou 014040,China;2.Department of Ultrasound;3.Department of Imaging Medicine,Inner Mongolia Autonomous Region People's Hospital,Inner Mongolia Hohhot 010017,China;4.Shenzhen Mindray Bio-medical Electronics Co.,Ltd.,Guangdong Shenzhen 518057,China.
Keywords:
rectal cancer; extramural venous invasion; lymph node metastasis; endorectal ultrasound; magnetic resonance imaging
PACS:
R735.3
DOI:
10.3969/j.issn.1672-4992.2024.20.015
Abstract:
Objective:To compare the correlation between preoperative diagnosis of extramural venous invasion (EMVI) by endorectal ultrasound (ERUS) and magnetic resonance imaging (MRI) and postoperative regional lymph node metastatic (RLNM) status of rectal cancer,and to explore the clinical value of ERUS in predicting RLNM of rectal cancer.Methods:The clinical and imaging data of 71 patients with surgically confirmed rectal cancer were retrospectively analyzed.The patients were divided into positive and negative groups based on lymph node metastasis,and the risk factors that may affect lymph node metastasis were analyzed.The predictive efficacy of ERUS and MRI preoperative diagnostic EMVI for RLNM was evaluated using the receiver operating characteristic curve (ROC curve),and the area under the ROC curve and the sensitivity,specificity,positive predictive value,negative predictive value and accuracy were calculated.Results:Pathologic Tstage,EMVI status diagnosed by ERUS (ER-EMVI) and EMVI status diagnosed by MRI (MR-EMVI) were significantly related to RLNM of rectal cancer.Binary logistic regression analysis showed that ER-EMVI and MR-EMVI were independent risk factors for RLNM.The ROC curve analysis demonstrated that the AUC of ER-EMVI and MR-EMVI for predicting regional lymph node metastasis in rectal cancer were 0.663 (95%CI:0.531~0.796) and 0.674 (95%CI:0.543~0.805),and difference between them was not statistically significant (Z=0.134,P=0.893).The combination of ERUS and MRI in the diagnosis of EMVI with at least one positive diagnosis had the highest sensitivity and accuracy in predicting RLNM (82.8%,73.2%),while the combination of both diagnoses had the highest specificity in predicting RLNM (90.5%).Conclusion:ER-EMVI and MR-EMVI are independent risk factors for RLNM,and ERUS can be used as a complementary tool to MRI for evaluating regional lymph node metastasis in preoperative rectal cancer patients.

References:

［1］SUNG H,FERLAY J,SIEGEL RL,et al.Global cancer statistics 2020:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries［J］.CA Cancer J Clin,2021,71(3):209-249.
［2］HAAK HE,BEETS GL,PEETERS K,et al.Prevalence of nodal involvement in rectal cancer after chemoradiotherapy［J］.Br J Surg,2021,108(10):1251-1258.
［3］BENSON AB,VENOOK AP,AL-HAWARY MM,et al.NCCN guidelines insights:rectal cancer,version 6.2020［J］.J Natl Compr Canc Netw,2020,18(7):806-815.
［4］中华人民共和国国家卫生健康委员会.中国结直肠癌诊疗规范（2023版）［J］.中华消化外科杂志,2023,22(6):667-698. National Health and Health Commission of the People's Republic of China.Chinese protocol of diagnosis and treatment of colorectal cancer (2023 edition)［J］.Chinese Journal of Surgery,2023,22(6):667-698.
［5］HAN J,HUR H,MIN BS,et al.Predictive factors for lymph node metastasis in submucosal invasive colorectal carcinoma:anew proposal of depth of invasion for radical surgery［J］.World J Surg,2018,42(8):2635-2641.
［6］XIONG X,WANG C,CAO J,et al.Lymph node metastasis in T1-2 colorectal cancer:a population-based study［J］.Int J Colorectal Dis,2023,38(1):94.
［7］MC ENTEE PD,SHOKUHI P,ROGERS AC,et al.Extramural venous invasion (EMVI) in colorectal cancer is associated with increased cancer recurrence and cancer-related death［J］.Eur J Surg Oncol,2022,48(7):1638-1642.
［8］刘立艳,刘佳宝,吕晗,等.MRI检出的壁外血管侵犯对直肠癌区域淋巴结转移的预测价值研究［J］.实用放射学杂志,2020,36(1):57-60,131. LIU LY,LIU JB,LU H,et al.Predictive performance of MRI-detected extramural vascular invasion for regional lymph node metastasis in rectal cancer［J］.Journal of Practical Radiology,2020,36(1):57-60,131.
［9］宋玉娟.直肠腔内超声与MRI三维重建在直肠癌术前分期及环周切缘评估中的应用研究［J］.中国CT和MRI杂志,2021,19(9):141-143. SUN YJ.Application of endorectal ultrasound and MRI three-dimensional reconstruction in preoperative staging of rectal cancer and evaluation of circumferential resection margin［J］.Chinese Journal of CT and MRI,2021,19(9):141-143.
［10］陈东,陈海涛,李支尧,等.直肠腔内三维超声和MRI对中下段直肠癌壁外血管侵犯程度的评估效果［J］.吉林大学学报（医学版）,2021,47(1):203-209. CHEN D,CHEN HT,LI ZR,et al.Effects of three-dimensional transrectal ultrasound and MRI in evaluation of extramural vascular invasion degrees of middle and lower rectal cancer［J］.Journal of Jilin University(Medicine Edition),2021,47(1):203-209.
［11］樊淑英,吴国柱,高艳伟,等.经直肠腔内超声诊断直肠癌壁外血管侵犯的价值［J］.中华超声影像学杂志,2022,31(11):966-972. FAN SY,WU GZ,GAO YW,et al.Diagnosis of extramural venous invasion of rectal cancer by transrectal ultrasound［J］.Chinese Journal of Ultrasonography,2022,31(11):966-972.
［12］SMITH NJ,BARBACHANO Y,NORMAN AR,et al.Prognostic significance of magnetic resonance imaging-detected extramural vascular invasion in rectal cancer［J］.Br J Surg,2008,95(2):229-236.
［13］AMIN MB,GREENE FL,EDGE SB,et al.The eighth edition AJCC cancer staging manual:continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging［J］.CA Cancer J Clin,2017,67(2):93-99.
［14］KIM BH,KIM JM,KANG GH,et al.Standardized pathology report for colorectal cancer,2nd Edition［J］.J Pathol Transl Med,2020,54(1):1-19.
［15］SAKANAKA T,IWAMOTO H,MATSUDA K,et al.Double negativity of MRI-detected and pathologically-diagnosed extramural venous invasion is a favorable prognostic factor for rectal cancer［J］.Ann Surg Oncol,2024,31(4):2425-2438.
［16］ BAZARGANI S,LALL C,GOPIREDDY DR,et al.Extramural venous invasion:a novel magnetic resonance imaging biomarker for adverse pathology in bladder cancer［J］.Am J Clin Exp Urol,2023,11(2):185-193.
［17］ 李清婉,李振辉,蒋赵娟,等.胃癌壁外血管侵犯研究进展［J］.现代肿瘤医学,2024,32(2):371-375. LI QW,LI ZH,JIANG ZJ,et al.Research progress of extramural vascular invasion in gastric cancer［J］.Modern Oncology,2024,32(2):371-375.
［18］ SIDDIQUI MRS,SIMILLIS C,HUNTER C,et al.A meta-analysis comparing the risk of metastases in patients with rectal cancer and MRI-detected extramural vascular invasion (mrEMVI) vs mrEMVI-negative cases［J］.Br J Cancer,2017,116(12):1513-1519.
［19］ NAHAS CSR,NAHAS SC,BUSTAMANTE-LOPEZ L,et al.T≤2N0 TRG1-2 in post-chemoradiation therapy MRI:what can it predict［J］.Surg Technol Int,2019,35:161-168.
［20］ MENG Y,WAN L,YE F,et al.MRI morphologic and clinicopathologic characteristics for predicting outcomes in patients with locally advanced rectal cancer［J］.Abdom Radiol (NY),2019,44(11):3652-3663.
［21］ OPARA CO,KHAN FY,KABIRAJ DG,et al.The value of magnetic resonance imaging and endorectal ultrasound for the accurate preoperative T-staging of rectal cancer［J］.Cureus,2022,14(10):e30499.
［22］ GAO Y,LI J,MA X,et al.The value of four imaging modalities in diagnosing lymph node involvement in rectal cancer:an overview and adjusted indirect comparison［J］.Clin Exp Med,2019,19(2):225-234.
［23］ YAN L,WEIFENG Z,QIN W,et al.A model based on endorectal ultrasonography predicts lateral lymph node metastasis in low and middle rectal cancer［J］.J Clin Ultrasound,2022,50(5):705-712.

Memo

Memo:
内蒙古自治区自然科学基金项目(编号：2021MS08034);内蒙古医学科学院公立医院科研联合基金科技项目(编号：2023GLLH0075)
Last Update: 1900-01-01