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- W2334136452 abstract "Pre-surgical imaging is key for selecting stage appropriate therapy for rectal cancer patients. A recent overview (2014) of international guidelines failed to reach a consensus on staging guidelines. Aims: To prospectively evaluate MRI and EUS staging concordance and performance characteristics. Over a 24 month period, 42 patients with primary rectal adenocarcinoma were enrolled, 39 of whom [59.3 ± 13.1 years, male (n=24; 61.5%), CEA (median (IQR): 2 (1.2-3.9)] completed MRI and subsequent EUS ± FNA staging, by an endosonographer who was blinded to the MRI findings. The Kappa statistic for T and N staging by MRI and EUS was 0.474 (95% CI 0.183-0.765) and 0.541 (95% CI 0.287-0.796), respectively. Patients with MRI and EUS TNM staging indicating a need for neoadjuvant therapy (≥ T3 and/or ≥ N1) were identified in 30 (76.9%) and 26 (66.7%), respectively, reflecting a clinically relevant discordance rate of 10%. EUS upstaged MRI T and N findings in 3 (7.7%) and 6 (15.4%) and downstaged MRI T and N findings in 8 (20.5%) and 5 (12.8%) patients. The Kappa statistic and agreement for T and N staging by MRI or EUS to gold standard surgical pathology in the absence of neoadjuvant therapy is highlighted in Table 1. Only 18% of patients had identical MRI, EUS and surgical pathology TNM staging. For T Stage (≥ T3), MRI and EUS had similar sensitivity (80% each) and EUS had greater specificity (100% vs. 83%; P=0.0001). For T Stage (≤ T2), EUS had greater sensitivity (100% vs. 75%; p=0.0001) with similar specificity to MRI (80% each). For N Stage, MRI had greater sensitivity (50% vs. 25%; p=0.0004) but EUS was more specific (100% vs. 80%; p=0.0001). Rectal EUS has superior sensitivity (≤ T2) and specificity (≥ T3) when compared to pelvic MRI. However, both imaging modalities had only fair kappa values when evaluating malignant nodal status. MRI and EUS are complementary rather than competitive to each other. A combined staging algorithm with enhanced features to include lymph node contrast enhancement patterns and elastography may enhance nodal staging accuracy.Table 1MRI - TEUS - TMRI - NEUS - NKappa0.63395% CI 0.174-1.00.81495% CI 0.471-1.00.308-0.307-0.9220.298-0.185-0.78AgreementGoodVery goodFairFair Open table in a new tab" @default.
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- W2334136452 date "2015-05-01" @default.
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- W2334136452 title "Mo1490 Prospective Evaluation of MRI and EUS for Primary Rectal Cancer Staging: the Sum Is Greater Than the Individual Parts" @default.
- W2334136452 doi "https://doi.org/10.1016/j.gie.2015.03.820" @default.
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