Author:
Maliborska S.V.,Holotiuk V.V.,Partykevich Y.D.,Holotiuk I.S.
Abstract
Aim: To improve the diagnostics of lymphogenic metastasis in patients with rectal cancer (RCa) by combining magnetic resonance imaging (MRI) with the blood carcinoembryonic antigen (CEA) level assessment. Materials and Methods: We have systematized and analyzed the results of the examination and treatment of 77 patients with stage II–III rectal adenocarcinoma (T2-3N0-2M0). Before the start of neoadjuvant treatment as well as 8 weeks after its completion, computed tomography (CT) and MRI were performed. We analyzed such prognostic criteria as the size, shape, and structure of lymph nodes as well as the patterns of contrast accumulation. As a prognostic marker, CEA levels in the blood of patients with RCa before surgical treatment were assessed. Results: Radiological exams showed a rounded shape and heterogeneous structure to be the most informative for predicting metastatic lymph node damage, increasing the probability by 4.39 and 4.98 times, respectively. After neoadjuvant treatment, the percentage of positive histopathological reports on lymph node involvement decreased significantly to 21.6% (р ˂ 0.001). MRI showed 76% sensitivity and 48% specificity for assessing lymphogenic metastasis. CEA levels differed significantly between stages II and III (N1–2) (р ˂ 0.032) with a threshold value of 3.95 ng/ml. Conclusions: In order to increase the effectiveness of the diagnosis of lymphogenic metastasis using radiological examination methods in RCa patients, such prognostic criteria as the round shape and heterogeneous structure of the lymph nodes and the threshold level of CEA should be considered.
Publisher
National Academy of Sciences of Ukraine (Co. LTD Ukrinformnauka) (Publications)
Reference21 articles.
1. Colorectal Cancer: Statistics. Available from: www.cancer.net/cancer-types/colorectal-cancer/statistics.
2. Cancer Stat Facts: Colorectal Cancer. Available from: https://seer.cancer.gov/statfacts/html/colorect.html
3. Moreno CC, Sullivan PS, Mittal PK. Rectal MRI for Cancer Staging and Surveillance. Gastroenterol Clin North Am. 2018; 47: 537-552. doi: 10.1016/j.gtc.2018.04.005
4. Al-Sukhni E, Milot L, Fruitman M, et al. Diagnostic accuracy of MRI for assessment of T category, lymph node metastases, and circumferential resection margin involvement in patients with rectal cancer: a systematic review and meta-analysis. Ann Surg Oncol 2012; 19: 2212-2223. doi: 10.1245/s10434-011-2210-5
5. Bipat S, Glas AS, Slors FJ, et al. Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging - a meta-analysis. Radiology 2004; 232: 773-783. doi: 10.1148/radiol.2323031368