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Assessment of MRI Accuracy in Predicting Disease-free Circumferential Resection Margin in Rectal Cancer Staging
EP33123
Poster Title: Assessment of MRI Accuracy in Predicting Disease-free Circumferential Resection Margin in Rectal Cancer Staging
Submitted on 12 Oct 2020
Author(s): Szeyi Lai, Pallavi Mehrota
Affiliations: Sunderland Royal Hospital
Poster Views: 98
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Poster Information
Abstract: In rectal cancer staging, accurate prediction of the circumferential resection margin (CRM) involvement is essential as it carries significant implications for the patient in terms of treatment and prognosis. In particular, tumour involvement within 1 mm from the mesorectal fascia is an independent predictor of both local recurrence and poor survival. Rectal MRI represents the first-choice modality for rectal cancer staging and in particular, for evaluating CRM involvement. Our audit looked to determine the accuracy of this method compared with the published standard, where MRI should accurately predict clear margins in rectal cancer assessment, with post-operative histopathology findings used as a gold standard to determine MRI report accuracy. Between June & November 2019, pre-operative MRI reports of rectal cancer patients who had undergone surgery with no chemo-radiotherapy or radiotherapy in the intervening period since MRI examination were obtained and compared with subsequent post-operative histopathology reports, specifically looking at CRM involvement. 26 consecutive patients presenting with all stages of rectal cancer were identified. Of these, 24 patients underwent primary surgery. In comparison with subsequent post-operative histopathology reports, the accuracy for prediction of a clear margin was 88%, with a specificity of 96% and a negative predictive value of 91%. Our audit demonstrated that MRI can predict CRM with high accuracy and consistency in rectal cancer staging, affirming its role as first-line technique as well as its importance in the decision making strategy.Summary: Rectal MRI represents the first-choice modality for rectal cancer staging and in particular, for evaluating CRM involvement which is a predictor of both local recurrence and poor survival. With optimal MRI technique and sequence parameters, accurate staging of rectal cancer can be achieved. The aim of this audit was to determine the accuracy of this method compared with the published standard.
References: 1. MERCURY Study Group. Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study. BMJ 2006 Oct 14; 333(7572):779. www.bmj.com/content/early/2005/12/31/bmj.38937.646400.55
2. Extramural Depth of Tumor Invasion at Thin-Section MR in Patients with Rectal Cancer: Results of the MERCURY Study Radiology February 28, 2007. 10.1148/ Radiol.2431051825. http://pubs.rsna.org/doi/abs/10.1148/radiol.2431051825?journalCode=radiology
3. Lafrate F, et al. Preoperative Staging of rectal cancer with MR Imaging: Correlation with Surgical and Histopathologic Findings. Radiographics 2006 May; 26:701-714.xray.ufl.edu/files/2010/02/Rectal-Cancer.pdf
4. Taylor FG, Quirke P, Heald RJ et al (2014) Preoperative magnetic resonance imaging assessment of circumferential resection margin predicts disease-free survival and local
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