Tumor regression grade after neoadjuvant chemoradiotherapy for locally advanced rectal cancer: MRI and pathological control study

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DONG Longchun LI Yiming SUN Chao BAO Cuiping YANG Jun ZHANG Mingqing YANG Zhengduo ZHONG Jin

Cite this article as: Dong LC, Li YM, Sun C, et al. Tumor regression grade after neoadjuvant chemoradiotherapy for locally advanced rectal cancer: MRI and pathological control study[J]. Chin J Magn Reson Imaging, 2022, 13(9): 91-94, 103. DOI:10.12015/issn.1674-8034.2022.09.017.

Abstract

[Abstract] Objective To investigate the diagnostic efficacy of magnetic resonance tumor regression grade (mrTRG) and affecting factors.Materials and Methods A retrospective study was conducted in 129 cases with locally advanced low rectal cancer admitted to the Anorectal Disease Diagnosis and Treatment Center of Tianjin Union Medical Center from October 2017 to June 2021. All patients received conventional long-term concurrent chemoradiotherapy and radical surgery. MRI scans were performed 1 week before and 4 weeks after the end of concurrent chemoradiotherapy. Using pathologic tumor regression grade (pTRG) as the gold standard, Kappa test was used to analyze the diagnostic efficacy of mrTRG. The effects of different MR factors [diffusion-weighted imaging (DWI), T staging, high signal intensity on T2WI, mesorectal fascia invasion positive (MRF+), extramural vascular invasion positive (EMVI+)] on the diagnostic efficacy of mrTRG were evaluated by stratified analysis.Results Using T2WI alone, 57 cases were mrTRG 1-2 and 72 cases were mrTRG 3-5. Using T2WI combined with DWI, 70 cases were mrTRG 1-2 and 59 cases were mrTRG 3-5. The pathological results showed that 66 cases were pTRG 0-1 and 63 cases were pTRG 2-3. mrTRG was moderately consistent with pTRG (T2WI alone: Kappa=0.602, P＜0.001; T2WI+DWI: Kappa=0.693, P＜0.001). Compared with T2WI, T2WI combined with DWI increased the sensitivity (86.4% vs. 82.9%), specificity (83.9% vs. 77.1%), negative predictive value (89.7% vs. 79.4%), Jorden index (70.3% vs. 60.0%) and total coincidence rate (84.9% vs. 80.2%) of mrTRG. High T stage, T2WI high signal intensity, MRF+ and EMVI+ reduced the sensitivity, specificity, positive predictive value, negative predictive value, Jordon index and total coincidence rate of mrTRG in varying degrees (except the effect of high T2WI signal on mrTRG sensitivity).Conclusions T2WI combined with DWI can improve the diagnostic efficiency of mrTRG. High T stage, T2WI high signal intensity, MRF+, EMVI+ before neoadjuvant chemoradiotherapy will reduce the accuracy of mrTRG assessment.

[Keywords] rectal cancer；neoadjuvant chemoradiotherapy；tumor regression grade；magnetic resonance imaging；diffusion-weighted imaging

Contributor Information

DONG Longchun¹ LI Yiming¹ SUN Chao¹ BAO Cuiping¹ YANG Jun¹ ZHANG Mingqing² YANG Zhengduo³ ZHONG Jin^1*

¹ Department of Radiology, Tianjin Union Medical Center, Tianjin 300010, China

² Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin 300010, China

³ Department of Pathology, Tianjin Union Medical Center, Tianjin 300010, China

*Zhong J, E-mail: zhongjin20@sina.com

Conflicts of interest None.

Publication Information

ACKNOWLEDGMENTS Tianjin Health Research Project (No. KJ20124);Tianjin Union Medical Center Research Project (No. 2017YJ015, 2018YJ007).

Received 2022-05-20

Accepted 2022-08-23

DOI: 10.12015/issn.1674-8034.2022.09.017

Text

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