Skip to main content

How Can We Identify Nodal Involvement and Extramural Vascular Invasion?

  • Chapter
  • First Online:
  • 991 Accesses

Abstract

With the shift from postoperative to preoperative (chemo) radiotherapy (CRT) for rectal cancer patients, tumour risk profile assessment, previously based on histology of the resection specimen, is now based on preoperative imaging. Imaging provides information on the T-stage, N-stage and involvement of the mesorectal fascia. Nodal disease is one of the most important risk factors both for local and distant recurrence and is generally considered an indication for neoadjuvant and adjuvant therapy. This chapter will discuss whether we can accurately identify with imaging nodal involvement in patients with rectal cancer.

This is a preview of subscription content, log in via an institution.

References

  1. Wang C, Zhou Z, Wang Z, Zheng Y, Zhao G, Yu Y, Cheng Z, Chen D, Liu W (2005) Patterns of neoplastic foci and lymph node micrometastasis within the mesorectum. Langenbeck's Arch Surg 390:312–318

    Article  Google Scholar 

  2. Puli S, Reddy J, Bechtold M, Choudhary A, Antillon M, Brugge W (2009) Accuracy of endoscopic ultrasound to diagnose nodal invasion by rectal cancers: a meta-analysis and systematic review. Ann Surg Oncol 16:1255–1265

    Article  PubMed  Google Scholar 

  3. Lahaye MJ, Engelen SME, Nelemans PJ, Beets GL, Van De Velde CJH, Van Engelshoven JMA, Beets-Tan RGH (2005) Imaging for predicting the risk factors - the circumferential resection margin and nodal disease - of local recurrence in rectal cancer: a meta-analysis. Semin Ultrasound CT MR 26:259–268

    Article  CAS  PubMed  Google Scholar 

  4. Brown G, Richards C, Bourne M, Newcombe R, Radcliff A, Dallimore N, Williams G (2003) Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison. Radiology 227:371–377

    Article  PubMed  Google Scholar 

  5. Kim J, Beets G, Kim M, Kessels A, Beets-Tan R (2004) High-resolution MR imaging for nodal staging in rectal cancer: are there any criteria in addition to the size? Eur J Radiol 52:78–83

    Article  PubMed  Google Scholar 

  6. Lambregts DMJ, Beets GL, Maas M, Kessels AGH, Bakers FCH, Cappendijk VC, Engelen SME, Lahaye MJ, de Bruïne AP, Lammering G, Leiner T, Verwoerd JL, Wildberger JE, Beets-Tan RGH (2011) Accuracy of gadofosveset-enhanced MRI for nodal staging and restaging in rectal cancer. Ann Surg 253:539–545

    Article  PubMed  Google Scholar 

  7. Hatano S, Ishida H, Ishiguro T, Kumamoto K, Ishibashi K, Mochiki E, Tamaru J (2015) Prediction of metastasis to mesorectal, internal iliac and obturator lymph nodes according to size criteria in patients with locally advanced lower rectal cancer. Jpn J Clin Oncol 45:35–42

    Article  PubMed  Google Scholar 

  8. Wang C, Zhou Z, Yu Y, Li Y, Lei W, Cheng Z, Chen Z (2007) Patterns of lateral pelvic lymph node metastases and micrometastases for patients with lower rectal cancer. Eur J Surg Oncol 33:463–467

    Article  CAS  PubMed  Google Scholar 

  9. Lahaye MJ, Beets GL, Engelen SME, Kessels AGH, de Bruïne AP, Kwee HWS, JM a v E, van de Velde CJH, Beets-Tan RGH (2009) Locally advanced rectal cancer: MR imaging for restaging after neoadjuvant radiation therapy with concomitant chemotherapy. Part II. What are the criteria to predict involved lymph nodes? Radiology 252:81–91

    Article  PubMed  Google Scholar 

  10. Heijnen LA, Lambregts DMJ, Martens MH, Maas M, Bakers FCH, Cappendijk VC, Oliveira P, Lammering G, Riedl RG, Beets GL, Beets-Tan RGH (2014) Performance of gadofosveset-enhanced MRI for staging rectal cancer nodes: can the initial promising results be reproduced? Eur Radiol 24:371–379

    Article  PubMed  Google Scholar 

  11. Lambregts DMJ, Maas M, Riedl R, Bakers F, Verwoerd J, Kessels A, Lammering G, Boetes C, Beets G, Beets-Tan R (2011) Value of ADC measurements for nodal staging after chemoradiation in locally advanced rectal cancer-a per lesion validation study. Eur Radiol 21:265–273

    Article  PubMed  Google Scholar 

  12. van der Paardt M, Zagers M, Beets-Tan R, Stoker J, Bipat S (2013) Patients who undergo preoperative chemoradiotherapy for locally advanced rectal cancer restaged by using diagnostic MR imaging: a systematic review and meta-analysis. Radiology 269:101–112

    Article  PubMed  Google Scholar 

  13. Balyasnikova S, Brown G (2016) Imaging advances in colorectal cancer. Curr Colorectal Cancer Rep 12:162–169

    Article  PubMed  PubMed Central  Google Scholar 

  14. Siddiqui MRS, Simillis C, Hunter C, Chand M, Bhoday J, Garant A, Vuong T, Artho G, Rasheed S, Tekkis P, Abulafi AM, Brown G (2017) A meta-analysis comparing the risk of metastases in patients with rectal cancer and MRI-detected extramural vascular invasion (mrEMVI) vs mrEMVI-negative cases. Br J Cancer 116:1513–1519

    Article  PubMed  Google Scholar 

  15. Sohn B, Lim JS, Kim H, Myoung S, Choi J, Kim NK, Kim MJ (2015) MRI-detected extramural vascular invasion is an independent prognostic factor for synchronous metastasis in patients with rectal cancer. Eur Radiol 25:1347–1355

    Article  PubMed  Google Scholar 

  16. 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 95:229–236

    Article  CAS  PubMed  Google Scholar 

  17. Chand M, Swift RI, Tekkis PP, Chau I, Brown G (2014) Extramural venous invasion is a potential imaging predictive biomarker of neoadjuvant treatment in rectal cancer. Br J Cancer 110:19–25

    Article  CAS  PubMed  Google Scholar 

  18. Tripathi P, Rao SX, Zeng MS (2017) Clinical value of MRI-detected extramural venous invasion in rectal cancer. J Dig Dis 18:2–12

    Article  PubMed  Google Scholar 

  19. Lee E, Kim M, Hur B, Hyun J, Chang H, Baek J, Kim S, Kim D, Oh J (2018) Magnetic resonance imaging-detected extramural venous invasion in rectal cancer before and after preoperative Chemoradiotherapy: diagnostic performance and prognostic significance. Eur Radiol 28:496–505

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Monique Maas MD PhD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer-Verlag Berlin Heidelberg

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Maas, M., Beets-Tan, R.G.H. (2018). How Can We Identify Nodal Involvement and Extramural Vascular Invasion?. In: Valentini, V., Schmoll, HJ., van de Velde, C. (eds) Multidisciplinary Management of Rectal Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-43217-5_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-43217-5_11

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-43215-1

  • Online ISBN: 978-3-319-43217-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics