Rectal cancer: a methodological approach to matching PET/MRI to histopathology
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RESEARCH ARTICLE
Open Access
Rectal cancer: a methodological approach to matching PET/MRI to histopathology Miriam K. Rutegård1*† , Malin Båtsman2†, Lennart Blomqvist1,3, Martin Rutegård4,5, Jan Axelsson1, Ingrid Ljuslinder6, Jörgen Rutegård6, Richard Palmqvist2, Fredrik Brännström4, Patrik Brynolfsson1 and Katrine Riklund1
Abstract Purpose: To enable the evaluation of locoregional disease in the on-going RECTOPET (REctal Cancer Trial on PET/ MRI/CT) study; a methodology to match mesorectal imaging findings to histopathology is presented, along with initial observations. Methods: FDG-PET/MRI examinations were performed in twenty-four consecutively included patients with rectal adenocarcinoma. In nine patients, of whom five received neoadjuvant treatment, a postoperative MRI of the surgical specimen was performed. The pathological cut-out was performed according to clinical routine with the addition of photo documentation of each slice of the surgical specimen, meticulously marking the location, size, and type of pathology of each mesorectal finding. This allowed matching individual nodal structures from preoperative MRI, via the specimen MRI, to histopathology. Results: Preoperative MRI identified 197 mesorectal nodal structures, of which 92 (47%) could be anatomically matched to histopathology. Of the matched nodal structures identified in both MRI and histopathology, 25% were found to be malignant. These malignant structures consisted of lymph nodes (43%), tumour deposits (48%), and extramural venous invasion (9%). One hundred eleven nodal structures (55%) could not be matched anatomically. Of these, 97 (87%) were benign lymph nodes, and 14 (13%) were malignant nodal structures. Five were malignant lymph nodes, and nine were tumour deposits, all of which had a short axis diameter < 5 mm. Conclusions: We designed a method able to anatomically match and study the characteristics of individual mesorectal nodal structures, enabling further research on the impact of each imaging modality. Initial observations suggest that small malignant nodal structures assessed as lymph nodes in MRI often comprise other forms of mesorectal tumour spread. (Continued on next page)
* Correspondence: [email protected] † Miriam K. Rutegård and Malin Båtsman contributed equally to the study and share first authorship. 1 Department of Radiation Sciences, Diagnostic Radiology, Umeå University, Umeå, Sweden Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material
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