CRM (T stage) Low rectal cancer Nodal disease Risk Factors for Loc recurrence.
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CRM (T stage) Low rectal cancer Nodal disease Risk Factors for Loc recurrence
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Transcript of CRM (T stage) Low rectal cancer Nodal disease Risk Factors for Loc recurrence.
CRM (T stage)
Low rectal cancer
Nodal disease
Risk Factors for Loc recurrence
Wang et al. Langenbecks Arch Surg 2005; 91: 167-172
Size as a criterium?
Based on Wang et al. Langenbecks Arch Surg 2005
0.0 0.2 0.4 0.6 0.8 1.0
1 - Specificity
0.0
0.2
0.4
0.6
0.8
1.0
Se
ns
itiv
ity
ROC Curve
Size as a criterium?
Lahaye, Beets-Tan et al. Semin US CT MR 2005
AUC 0.96
USPIO MRI
Nodal detection
> 2 mm
</= 2 mm LOCALLY ADVANCED
N2
N1
NO
EARLY TUMOR
Distaal
Mid rectaal
Hoog rectaal
NON LOCALLY ADVANCED
LOCALLY ADVANCED
LOCALLY ADVANCED
T3
T1-2
Hoog/mid rectaal
Distaal
CRM EARLY TUMOR
LOCALLY ADVANCED
NON LOCALLY ADVANCED
BeetsTan, vd Velde, Beets et al. Maastricht MR multicenter study
MR stratifies patients into a tailored RX multicenter study
LOCALLY ADVANCED
EARLY TUMOR
NON LOCALLY ADVANCED
TME (local excision)
5x5 Gy + TME
Chemoradiation + surgery*
* 2nd MRI before surgery
2003-2008: n=319 university hospital, 3 regional hospitals Each MRI prospective reading by local radiologist Each MRI double read by expert center:
Rx stratification
Maastricht MR multicenter study
Rx stratification based on MRI prospective multicenter study
2003-2008: n=319 university hospitals, 3 regional hospitals Each MRI prospective reading by local radiologist Each MRI double read by expert center:Rx stratification
Loc Recurrence, OS, DFS, death # complete resections Accuracy MRI in expert vs general centers Impact of double reading setting on
radiologists performance
Maastricht MR multicenter study
Rx stratification based on MRI prospective multicenter study
2003-2008: n=319 university hospitals, 3 regional hospitals Each MRI prospective reading by local radiologist Each MRI double read by expert center:Rx stratification
Loc Recurrence, OS, DFS, death # complete resections Accuracy MRI in expert vs general centers Impact of double reading setting on
radiologists performance
Maastricht MR multicenter study
Rx stratification based on MRI prospective multicenter study
No USPIO
General Expert
Sens 0.62 0.90
Spec 0.83 0.53
PPV 0.62 0.47
NPV 0.83 0.92
MRI for nodal disease
No USPIO WITH USPIO
General
ExpertGenera
lExpert
Sens 0.62 0.90 0.92 0.95
Spec 0.83 0.53 0.69 0.81
PPV 0.62 0.47 0.57 0.70
NPV 0.83 0.92 0.95 0.97
MRI for nodal disease
Maastricht MR multicenter study
Conventional MRI not reliable for detection of tumor less than 5 mm
Lessons to learn
Maastricht MR multicenter study
Conventional MRI not reliable for detection of tumor less than 5 mm
USPIO MRI selects N0
Lessons to learn
Maastricht MR multicenter study
Conventional MRI not reliable for detection of tumor less than 5 mm
USPIO MRI selects N0
MR stratification also in general hands
Lessons to learn
Conventional MRI not reliable for detection of tumor less than 5 mm
USPIO MRI selects N0
MR stratification also in general hands
USPIO not on the market
Maastricht MR multicenter study
Lessons to learn
Maastricht MR multicenter study
MS 325 enhanced MRI
n= 132 lymph nodes
(15/132 N+)
Sensitivity 93 % (14/14 +1)
Specificity 97 % (113/113+4)
PPV 78 % (14/14+4)
NPV 99 % (113/113+1)
Maastricht MR multicenter study
MS 325 MRI for nodal disease
