Improving staging of rectal cancer in the pelvis: the role of PET/MRI
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ORIGINAL ARTICLE
Improving staging of rectal cancer in the pelvis: the role of PET/MRI Onofrio A. Catalano 1,2,3 & Susanna I. Lee 1 & Chiara Parente 4 & Christy Cauley 5 & Felipe S. Furtado 1,2 & Robin Striar 1,2 & Andrea Soricelli 3,4 & Marco Salvatore 4,6 & Yan Li 7 & Lale Umutlu 7 & Lina Garcia Cañamaque 8 & David Groshar 9,10 & Umar Mahmood 1,2 & Lawrence S. Blaszkowsky 11,12 & David P. Ryan 11 & Jeffrey W. Clark 11,13 & Jennifer Wo 14 & Theodore S. Hong 14 & Hiroko Kunitake 5 & Liliana Bordeianou 5 & David Berger 5 & Rocco Ricciardi 5 & Bruce Rosen 1,2 Received: 3 August 2020 / Accepted: 11 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose The role of positron emission tomography/magnetic resonance (PET/MR) in evaluating the local extent of rectal cancer remains uncertain. This study aimed to investigate the possible role of PET/MR versus magnetic resonance (MR) in clinically staging rectal cancer. Methods This retrospective two-center cohort study of 62 patients with untreated rectal cancer investigated the possible role of baseline staging PET/MR versus stand-alone MR in determination of clinical stage. Two readers reviewed T and N stage, mesorectal fascia involvement, tumor length, distance from the anal verge, sphincter involvement, and extramural vascular invasion (EMVI). Sigmoidoscopy, digital rectal examination, and follow-up imaging, along with surgery when available, served as the reference standard. Results PET/MR outperformed MR in evaluating tumor size (42.5 ± 21.03 mm per the reference standard, 54 ± 20.45 mm by stand-alone MR, and 44 ± 20 mm by PET/MR, P = 0.004), and in identifying N status (correct by MR in 36/62 patients [58%] and by PET/MR in 49/62 cases [79%]; P = 0.02) and external sphincter infiltration (correct by MR in 6/10 and by PET/MR in 9/10; P = 0.003). No statistically significant differences were observed in relation to any other features. Conclusion PET/MR provides a more precise assessment of the local extent of rectal cancers in evaluating cancer length, N status, and external sphincter involvement. PET/MR offers the opportunity to improve clinical decision-making, especially when evaluating low rectal tumors with possible external sphincter involvement. Keywords Rectal cancer . Staging . PET/MRI . MRI . PET . PET/MR
Summary statement PET/MR is a promising modality in staging rectal cancer in the pelvis, especially in assessing cancer length, lymphadenopathy and external sphincter involvement. Key results PET/MR enabled more accurate evaluation of tumor size, N status, and external sphincter infiltration. Although PET/MR ensured a better assessment of the T stage than MR, the differences were not statistically significant. This article is part of the Topical Collection on Oncology - Digestive tract Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00259-020-05036-x) contains supplementary material, which is available to authorized users.
Abbreviations CT Computed tomography EMVI Extramur
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