Radiological staging of rectal cancer in a resource limited setting
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(2020) 13:479 Lokuhetty et al. BMC Res Notes https://doi.org/10.1186/s13104-020-05327-4
Open Access
RESEARCH NOTE
Radiological staging of rectal cancer in a resource limited setting Naradha Lokuhetty1* , Suranjith L. Seneviratne1, Fathima Asma Rahman2, Thanushka Marapana1, Roshan Niloofa2 and Ishan De Zoysa1
Abstract Objective: Current guidelines on rectal cancer (RC) management recommend pre-operative MRI for loco-regional staging and CT for staging of metastases. This allows appropriate selection of patients for chemo-radiotherapy (CRT). However, MRI is not freely available in many low-income countries. We assessed the status of pre-operative imaging for RC in Sri Lanka and evaluated the performance of CT in RC staging. Results: A pre-tested interview-administered questionnaire was used to assess the pre-operative use of MRI and CT in RC. CT findings from 37 RC patients were then compared with histopathology findings. Of the 64 surgeons interviewed, 57 (89.1%) did not request an MRI for their RC patients. Reasons cited included limited availability and long waiting times due to competing health needs. A CT was requested by all. In RC, the overall accuracy of CT for T staging was 43.2% and 29.7% of T1–T2 tumours were over-staged as T3. The overall accuracy of CT for regional lymph node staging was 70.3%. In summary, CT alone is not suitable for RC staging in any setting. It leads to over-staging and patients may thus receive unnecessary CRT. Steps must be taken to improve access to pre-operative MRI among Sri Lankan RC patients. Keywords: Rectal cancer, Radiological staging, Computed tomography, Magnetic resonance imaging Introduction Colorectal cancer (CRC) is the third most common cancer in the world [1]. It’s incidence is increasing in the South Asian region [2, 3, 4]. Rectal cancer (RC) comprises roughly one third of CRC [5]. According to international RC management guidelines, magnetic resonance imaging (MRI) is best for loco-regional staging and computed tomography (CT) for metastatic staging [6, 7]. However, it is often difficult to obtain pre-operative MRI scans for RC patients in many lower-middle income countries including Sri Lanka [8]. CT is cheaper, faster and is more widely available [9, 10]. It is believed that surgeons who operate on RC’s from such countries may not routinely request pre-operative MRI scans. *Correspondence: [email protected] 1 Department of Surgery, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka Full list of author information is available at the end of the article
The National Institute of Clinical Excellence (NICE) 2020 guideline update recommends pre-operative chemo-radiotherapy (CRT) for T3/T4 or any N, M0 RC’s [11]. Neo-adjuvant treatment in RC, down-stages the disease, and reduces overall mortality and disease recurrence [12]. At the National Hospital of Sri Lanka, RC patients with CT stage T3 and T4 receive neo-adjuvant CRT. We assessed the status of pre-operative imaging for RC in Sri Lanka and evaluated the performance of CT in RC staging
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