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Prognostic value of MRI in assessing extramural venous invasion in rectal cancer: multi-readers’ diagnostic performance

  • Jae Seok Bae
  • Se Hyung KimEmail author
  • Bo Yun Hur
  • Won Chang
  • Juil Park
  • Hye Eun Park
  • Jung Ho Kim
  • Hyo-Jin Kang
  • Mi Hye Yu
  • Joon Koo Han
Gastrointestinal
  • 42 Downloads

Abstract

Objectives

This study was conducted in order to determine the prognostic value of MRI for extramural venous invasion (EMVI) in rectal cancer compared to pathology and to assess the diagnostic performance of multireaders.

Methods

We retrospectively enrolled 222 patients (M:F = 148:74; mean age ± standard deviation, 61.5 ± 12 years) with histopathologically proven rectal cancers who underwent preoperative MRI between 2007 and 2016. Among them, 74 patients had positive EMVI on pathology (pEMVI) and 148 patients had negative pEMVI. Three radiologists with 7 (reviewer 1), 3 (reviewer 2), and 1 (reviewer 3) year of experience in rectal MR imaging determined the presence of EMVI on MRI (mrEMVI) using a 5-point grading system. Using histopathologic results as the reference standard, radiologists’ performances were analyzed and compared with receiver operating characteristic (ROC) analysis. For assessment of interobserver variation, intraclass correlation coefficients (ICC) were used. Lastly, Kaplan–Meier estimation and Cox proportional hazard models were used for survival analysis.

Results

The area under the ROC curve (AUC) was highest in reviewer 1 (0.829), followed by reviewer 2 (0.798) and reviewer 3 (0.658). Differences in AUCs between reviewer 1 or 2 and reviewer 3 were statistically significant (p < 0.001). ICC was substantial between reviewers 1 and 2. Overall survival (OS) was significantly different according to the positive circumferential resection margin, adjuvant treatment, and the presence of mrEMVI, but not by the presence of pEMVI.

Conclusions

For experienced radiologists, the diagnostic performance of mrEMVI was good, resulting in better prediction of OS than with pEMVI, with substantial interobserver agreement.

Key Points

When read by experienced radiologists, MR can provide reliable diagnostic performance in assessing EMVI for patients with rectal cancer.

Positive mrEMVI is an adverse prognostic factor of overall survival and may influence the clinical decision-making.

Keywords

Rectal neoplasms Blood vessels Magnetic resonance imaging Chemoradiotherapy Prognosis 

Abbreviations

CRT

Chemoradiation therapy

EMVI

Extramural venous invasion

mrEMVI

EMVI evaluated on MR

pEMVI

Pathologically detected EMVI

Notes

Funding

This study has received funding from the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Science, ICT & Future Planning (NRF-2016R1A2B4007762) and from the Seoul National University Hospital Research Fund No. 03-2016-450.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Joon Koo Han.

Conflict of interest

The authors declare that they have no conflict of interest.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• case–control study

• performed at one institution

Supplementary material

330_2018_5926_MOESM1_ESM.docx (18 kb)
ESM 1 (DOCX 18 kb)

References

  1. 1.
    Talbot IC, Ritchie S, Leighton MH, Hughes AO, Bussey HJ, Morson BC (1980) The clinical significance of invasion of veins by rectal cancer. Br J Surg 67:439–442CrossRefGoogle Scholar
  2. 2.
    Knudsen JB, Nilsson T, Sprechler M, Johansen A, Christensen N (1983) Venous and nerve invasion as prognostic factors in postoperative survival of patients with resectable cancer of the rectum. Dis Colon Rectum 26:613–617CrossRefGoogle Scholar
  3. 3.
    Freedman LS, Macaskill P, Smith AN (1984) Multivariate analysis of prognostic factors for operable rectal cancer. Lancet 2:733–736CrossRefGoogle Scholar
  4. 4.
    Messenger DE, Driman DK, Kirsch R (2012) Developments in the assessment of venous invasion in colorectal cancer: implications for future practice and patient outcome. Hum Pathol 43:965–973CrossRefGoogle Scholar
  5. 5.
    Madison MS, Dockerty MB, Waugh JM (1954) Venous invasion in carcinoma of the rectum as evidenced by venous radiography. Surg Gynecol Obstet 99:170–178PubMedGoogle Scholar
  6. 6.
    Dukes CE, Bussey HJ (1958) The spread of rectal cancer and its effect on prognosis. Br J Cancer 12:309–320CrossRefGoogle Scholar
  7. 7.
    Jass JR, Atkin WS, Cuzick J et al (1986) The grading of rectal cancer: historical perspectives and a multivariate analysis of 447 cases. Histopathology 10:437–459CrossRefGoogle Scholar
  8. 8.
    Sasaki O, Atkin WS, Jass JR (1987) Mucinous carcinoma of the rectum. Histopathology 11:259–272CrossRefGoogle Scholar
  9. 9.
    Minsky BD, Mies C, Recht A, Rich TA, Chaffey JT (1988) Resectable adenocarcinoma of the rectosigmoid and rectum. II. The influence of blood vessel invasion. Cancer 61:1417–1424CrossRefGoogle Scholar
  10. 10.
    MERCURY Study Group (2006) Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study. BMJ 333:779CrossRefGoogle Scholar
  11. 11.
    Smith NJ, Barbachano Y, Norman AR, Swift RI, Abulafi AM, Brown G (2008) Prognostic significance of magnetic resonance imaging-detected extramural vascular invasion in rectal cancer. Br J Surg 95:229–236CrossRefGoogle Scholar
  12. 12.
    Patel UB, Taylor F, Blomqvist L et al (2011) Magnetic resonance imaging-detected tumor response for locally advanced rectal cancer predicts survival outcomes: MERCURY experience. J Clin Oncol 29:3753–3760CrossRefGoogle Scholar
  13. 13.
    Beets-Tan RG, Lambregts DM, Maas M et al (2013) Magnetic resonance imaging for the clinical management of rectal cancer patients: recommendations from the 2012 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. Eur Radiol 23:2522–2531CrossRefGoogle Scholar
  14. 14.
    KSAR Study Group for Rectal Cancer (2017) Essential items for structured reporting of rectal cancer MRI: 2016 consensus recommendation from the Korean Society of Abdominal Radiology. Korean J Radiol 18:132–151CrossRefGoogle Scholar
  15. 15.
    Lee ES, Kim MJ, Park SC et al (2018) Magnetic resonance imaging-detected extramural venous invasion in rectal cancer before and after preoperative chemoradiotherapy: diagnostic performance and prognostic significance. Eur Radiol 28:496–505CrossRefGoogle Scholar
  16. 16.
    Zhang XY, Wang S, Li XT et al (2018) MRI of extramural venous invasion in locally advanced rectal cancer: relationship to tumor recurrence and overall survival. Radiology 289(3):677–685.  https://doi.org/10.1148/radiol.2018172889 CrossRefPubMedGoogle Scholar
  17. 17.
    Kim SH, Lee JM, Hong SH et al (2009) Locally advanced rectal cancer: added value of diffusion-weighted MR imaging in the evaluation of tumor response to neoadjuvant chemo- and radiation therapy. Radiology 253:116–125CrossRefGoogle Scholar
  18. 18.
    Kim SH, Lee JM, Lee MW, Kim GH, Han JK, Choi BI (2008) Sonography transmission gel as endorectal contrast agent for tumor visualization in rectal cancer. AJR Am J Roentgenol 191:186–189CrossRefGoogle Scholar
  19. 19.
    Iannicelli E, Di Renzo S, Ferri M et al (2014) Accuracy of high-resolution MRI with lumen distention in rectal cancer staging and circumferential margin involvement prediction. Korean J Radiol 15:37–44CrossRefGoogle Scholar
  20. 20.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174CrossRefGoogle Scholar
  21. 21.
    Courtney ED, West NJ, Kaur C et al (2009) Extramural vascular invasion is an adverse prognostic indicator of survival in patients with colorectal cancer. Colorectal Dis 11:150–156CrossRefGoogle Scholar
  22. 22.
    McClelland D, Murray GI (2015) A comprehensive study of extramural venous invasion in colorectal cancer. PLoS One 10:e0144987CrossRefGoogle Scholar
  23. 23.
    Chand M, Siddiqui MR, Swift I, Brown G (2016) Systematic review of prognostic importance of extramural venous invasion in rectal cancer. World J Gastroenterol 22:1721–1726CrossRefGoogle Scholar
  24. 24.
    Sternberg A, Mizrahi A, Amar M, Groisman G (2006) Detection of venous invasion in surgical specimens of colorectal carcinoma: the efficacy of various types of tissue blocks. J Clin Pathol 59:207–210CrossRefGoogle Scholar
  25. 25.
    West NP, Hohenberger W, Weber K, Perrakis A, Finan PJ, Quirke P (2010) Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon. J Clin Oncol 28:272–278CrossRefGoogle Scholar
  26. 26.
    Kirsch R, Messenger DE, Riddell RH et al (2013) Venous invasion in colorectal cancer: impact of an elastin stain on detection and interobserver agreement among gastrointestinal and nongastrointestinal pathologists. Am J Surg Pathol 37:200–210CrossRefGoogle Scholar
  27. 27.
    Roxburgh CS, McMillan DC, Anderson JH, McKee RF, Horgan PG, Foulis AK (2010) Elastica staining for venous invasion results in superior prediction of cancer-specific survival in colorectal cancer. Ann Surg 252:989–997CrossRefGoogle Scholar
  28. 28.
    Jhaveri KS, Hosseini-Nik H, Thipphavong S et al (2016) MRI detection of extramural venous invasion in rectal cancer: correlation with histopathology using elastin stain. AJR Am J Roentgenol 206:747–755CrossRefGoogle Scholar
  29. 29.
    Biau DJ, Resche-Rigon M, Godiris-Petit G, Nizard RS, Porcher R (2007) Quality control of surgical and interventional procedures: a review of the CUSUM. Qual Saf Health Care 16:203–207CrossRefGoogle Scholar
  30. 30.
    Kim YE, Park MS, Hong HS et al (2009) Effects of neoadjuvant combined chemotherapy and radiation therapy on the CT evaluation of resectability and staging in patients with pancreatic head cancer. Radiology 250:758–765CrossRefGoogle Scholar
  31. 31.
    Engin G, Sharifov R, Güral Z et al (2012) Can diffusion-weighted MRI determine complete responders after neoadjuvant chemoradiation for locally advanced rectal cancer? Diagn Interv Radiol 18:574–581PubMedGoogle Scholar
  32. 32.
    Sohn B, Lim JS, Kim H et al (2015) MRI-detected extramural vascular invasion is an independent prognostic factor for synchronous metastasis in patients with rectal cancer. Eur Radiol 25:1347–1355CrossRefGoogle Scholar
  33. 33.
    Talbot IC, Ritchie S, Leighton MH, Hughes AO, Bussey HJ, Morson BC (1981) Spread of rectal cancer within veins. Histologic features and clinical significance. Am J Surg 141:15–17CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Jae Seok Bae
    • 1
    • 2
  • Se Hyung Kim
    • 1
    • 2
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  • Bo Yun Hur
    • 3
  • Won Chang
    • 4
  • Juil Park
    • 1
    • 2
  • Hye Eun Park
    • 5
  • Jung Ho Kim
    • 5
  • Hyo-Jin Kang
    • 1
    • 2
  • Mi Hye Yu
    • 6
  • Joon Koo Han
    • 1
    • 2
    • 7
  1. 1.Department of RadiologySeoul National University HospitalSeoulSouth Korea
  2. 2.Department of RadiologySeoul National University College of MedicineSeoulSouth Korea
  3. 3.Department of RadiologyNational Cancer CenterSeoulSouth Korea
  4. 4.Department of RadiologySeoul National University Bundang HospitalSeongnamSouth Korea
  5. 5.Department of PathologySeoul National University HospitalSeoulSouth Korea
  6. 6.Department of RadiologyKonkuk University School of MedicineSeoulSouth Korea
  7. 7.Seoul National University Medical Research CenterInstitute of Radiation MedicineSeoulSouth Korea

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