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Reliability in villous tumors staging between preoperative MRI and histopathological examination

  • Special Section: Rectal Cancer
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

This study aimed to assess the reliability of rectal villous tumors staging between rectal MRI and histological examination used as the Gold Standard and to investigate causes for discrepancies.

Methods

The rectal 1.5 T MR scans of 40 patients followed for a histologically proven rectal villous adenoma were retrospectively included. Two independent experienced radiologists staged each tumor according to the TNM classification and described the occurrence of retraction of the rectal wall or spiculations within the associated mesorectum. A third radiologist collected tumor’s morphological characteristics.

Results

Among the 40 villous tumors studied, 25 (63%) were non-invasive and 15 (37%) were invasive. The mean volume of tumors with spiculations and retraction was significantly greater (p < 0.05) compared to tumors without these characteristics. Spiculations and retraction of the rectal wall were observed regardless of the definitive histological stage and did not represent a malignancy criterion. A weak interobserver reliability [Gwet’s AC2: 0.31 (0.04–0.57)] in T-staging was observed between the two readers. Reader 1 showed a high reliability [Gwet’s AC2: 0.90 (0.81–0.99)] in T-staging between Histopathological examination and preoperative MRI. In the opposite, reader 2 showed a weak reliability [Gwet’s AC2: 0.31 (0.03–0.58)] in T-staging. He overstaged all tumors (100%) with spiculations (p < 0.05).

Conclusion

MRI understaged rectal villous adenoma and was unable to detect degenerative criteria, along with slight Interobserver agreement. The typical worrisome signs of rectal tumor, such as retractions and spiculations, occurred in all stages and were responsible for misstaging in most cases, in particular bulky tumors.

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References

  1. Haute Autorité de Santé - Dépistage et prévention du cancer colorectal, (2019). https://www.has-sante.fr/portail/jcms/c_1623732/fr/depistage-et-prevention-du-cancer-colorectal (accessed June 25, 2019).

  2. M. Gschwantler, S. Kriwanek, E. Langner, B. Göritzer, C. Schrutka-Kölbl, E. Brownstone, H. Feichtinger, W. Weiss, High-grade dysplasia and invasive carcinoma in colorectal adenomas: a multivariate analysis of the impact of adenoma and patient characteristics, Eur. J. Gastroenterol. Hepatol. 14 (2002) 183–188.

    Article  Google Scholar 

  3. E.R. Bresnihan, K.C. Simpkins, Villous adenoma of the large bowel; benign and malignant, Br. J. Radiol. 48 (1975) 801–806. doi: 10.1259/0007-1285-48-574-801.

    Article  PubMed  CAS  Google Scholar 

  4. P.M. Madsen, O. Braendstrup, Carcinoma recti. The predictive value of diagnostic biopsies for histologic grading, Dis. Colon Rectum. 28 (1985) 676–677.

  5. S.C. Nahas, A.R. Imperiale, S.E. Araújo, A.A. Aisaka, C.W. Sobrado Júnior, A. Habr-Gama, H.W. Pinotti, [Villous and tubulovillous adenomas of the colon and rectum. Results in 30 patients], Rev. Hosp. Clin. 53 (1998) 162–168.

  6. N.A. Ahmad, M.L. Kochman, G.G. Ginsberg, Endoscopic ultrasound and endoscopic mucosal resection for rectal cancers and villous adenomas, Hematol. Oncol. Clin. North Am. 16 (2002) 897–906. doi: 10.1016/S0889-8588(02)00038-2.

    Article  PubMed  Google Scholar 

  7. K. Konishi, Y. Akita, K. Kaneko, T. Kurahashi, T. Yamamoto, S. Kusayanagi, N. Yoshikawa, N. Miyasaka, H. Tajiri, K. Mitamura, Evaluation of endoscopic ultrasonography in colorectal villous lesions, Int. J. Colorectal Dis. 18 (2003) 19–24. doi: 10.1007/s00384-002-0423-6.

    Article  PubMed  Google Scholar 

  8. M. De Vargas Macciucca, A. Casale, L. Manganaro, I. Floriani, F. Fiore, L. Marchetti, G. Panzironi, Rectal villous tumours: MR features and correlation with TRUS in the preoperative evaluation, Eur. J. Radiol. 73 (2010) 329–333. https://doi.org/10.1016/j.ejrad.2008.11.026.

  9. M. Zappa, L. Raynaud, C. Bertin, L. Maggiori, Y. Panis, V. Vilgrain, MR imaging of villous rectal tumours in the era of transanal endoscopic microsurgery, (2017). https://posterng.netkey.at/esr/viewing/index.php?module=viewing_poster&task=viewsection&pi=137807&ti=469706&si=1639&searchkey= (accessed June 24, 2019).

  10. J.-F. Fléjou, Classification OMS 2010 des tumeurs digestives : la quatrième édition,/data/revues/02426498/v31i5sS/S0242649811001775/. (2011). https://www.em-consulte.com/en/article/675515#N1022C (accessed October 21, 2019).

  11. R. Kikuchi, M. Takano, K. Takagi, N. Fujimoto, R. Nozaki, T. Fujiyoshi, Y. Uchida, Management of early invasive colorectal cancer. Risk of recurrence and clinical guidelines, Dis. Colon Rectum. 38 (1995) 1286–1295.

  12. C. Klessen, P. Rogalla, M. Taupitz, Local staging of rectal cancer: the current role of MRI, Eur. Radiol. 17 (2007) 379–389. doi: 10.1007/s00330-006-0388-x.

    Article  PubMed  Google Scholar 

  13. P.J. Brown, R. Hyland, A.J. Quyn, N.P. West, D. Sebag-Montefiore, D. Jayne, P. Sagar, D.J. Tolan, Current concepts in imaging for local staging of advanced rectal cancer, Clin. Radiol. (2019). doi: 10.1016/j.crad.2019.03.023.

    Article  PubMed  Google Scholar 

  14. N. Hayashi, S. Tanaka, D.G. Hewett, T.R. Kaltenbach, Y. Sano, T. Ponchon, B.P. Saunders, D.K. Rex, R.M. Soetikno, Endoscopic prediction of deep submucosal invasive carcinoma: validation of the Narrow-Band Imaging International Colorectal Endoscopic (NICE) classification, Gastrointest. Endosc. 78 (2013) 625–632. doi: 10.1016/j.gie.2013.04.185.

    Article  PubMed  Google Scholar 

  15. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. - PubMed - NCBI, (2019). https://www.ncbi.nlm.nih.gov/pubmed/14652541 (accessed June 26, 2019).

  16. M. Ferlitsch, A. Moss, C. Hassan, P. Bhandari, J.-M. Dumonceau, G. Paspatis, R. Jover, C. Langner, M. Bronzwaer, K. Nalankilli, P. Fockens, R. Hazzan, I.M. Gralnek, M. Gschwantler, E. Waldmann, P. Jeschek, D. Penz, D. Heresbach, L. Moons, A. Lemmers, K. Paraskeva, J. Pohl, T. Ponchon, J. Regula, A. Repici, M.D. Rutter, N.G. Burgess, M.J. Bourke, Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline, Endoscopy. 49 (2017) 270–297. doi: 10.1055/s-0043-102569.

    Article  PubMed  Google Scholar 

  17. P. Pimentel-Nunes, M. Dinis-Ribeiro, T. Ponchon, A. Repici, M. Vieth, A. De Ceglie, A. Amato, F. Berr, P. Bhandari, A. Bialek, M. Conio, J. Haringsma, C. Langner, S. Meisner, H. Messmann, M. Morino, H. Neuhaus, H. Piessevaux, M. Rugge, B. Saunders, M. Robaszkiewicz, S. Seewald, S. Kashin, J.-M. Dumonceau, C. Hassan, P. Deprez, Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline, Endoscopy. 47 (2015) 829–854. doi: 10.1055/s-0034-1392882.

    Article  PubMed  Google Scholar 

  18. J. Fleshman, M. Branda, D.J. Sargent, A.M. Boller, V. George, M. Abbas, W.R. Peters, D. Maun, G. Chang, A. Herline, A. Fichera, M. Mutch, S. Wexner, M. Whiteford, J. Marks, E. Birnbaum, D. Margolin, D. Larson, P. Marcello, M. Posner, T. Read, J. Monson, S.M. Wren, P.W.T. Pisters, H. Nelson, Effect of Laparoscopic-Assisted Resection vs Open Resection of Stage II or III Rectal Cancer on Pathologic Outcomes: The ACOSOG Z6051 Randomized Clinical Trial, JAMA. 314 (2015) 1346. doi: 10.1001/jama.2015.10529.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  19. F. Glaser, P. Schlag, C. Herfarth, Endorectal ultrasonography for the assessment of invasion of rectal tumours and lymph node involvement, Br. J. Surg. 77 (1990) 883–887. doi: 10.1002/bjs.1800770813.

    Article  PubMed  CAS  Google Scholar 

  20. M.S. Absar, N.Y. Haboubi, Colonic neoplastic polyps: biopsy is not efficient to exclude malignancy. The Trafford experience, Tech. Coloproctology. 8 Suppl 2 (2004) s257-260. https://doi.org/10.1007/s10151-004-0172-3.

  21. A. Pikarsky, S. Wexner, P. Lebensart, J. Efron, E. Weiss, J. Nogueras, P. Reissman, The use of rectal ultrasound for the correct diagnosis and treatment of rectal villous tumors, Am. J. Surg. 179 (2000) 261–265. doi: 10.1016/s0002-9610(00)00328-7.

    Article  PubMed  CAS  Google Scholar 

  22. Histologic grade of metastatic lymph node and prognosis of rectal cancer. - PubMed - NCBI, (n.d.). https://www.ncbi.nlm.nih.gov/pubmed/11052477 (accessed October 28, 2019).

  23. P. Videhult, K. Smedh, P. Lundin, W. Kraaz, Magnetic resonance imaging for preoperative staging of rectal cancer in clinical practice: high accuracy in predicting circumferential margin with clinical benefit, Colorectal Dis. 9 (2007) 412–419. Doi : 10.1111/j.1463-1318.2006.01167.x.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Brabois Imaging Department, Nancy University Hospital, Université de Lorraine, Nancy 1, Allée du Morvan, 54 511, Vandœuvre-lès-Nancy, France

    Céline Vogrig, Xavier Orry & Valérie Laurent

  2. Digestive and General Surgery, Nancy University Hospital, Université de Lorraine, Nancy 1, Allée du Morvan, 54 511, Vandœuvre-lès-Nancy, France

    Julie Leclerc & Adeline Germain

  3. Department of Gastroenterology, Nancy University Hospital, Université de Lorraine, Nancy 1, Allée du Morvan, 54 511, Vandœuvre-lès-Nancy, France

    Vincent Haghnejad

  4. Unité de métholodolique, Data Management et Statistique, Université de Lorraine, Inserm, IADI, 54000, Nancy, France

    Thomas Remen

Authors
  1. Céline Vogrig
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  7. Valérie Laurent
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by CV, Prof VL and RT. The first draft of the manuscript was written by CV and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Céline Vogrig.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The studies have been approved by the appropriate institutional and/or national research ethics committee and have been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. A declaration was made to the National Commission on Information Technology and Civil Liberties (CNIL) and registered under CNIL number 2019PI073.

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Vogrig, C., Leclerc, J., Haghnejad, V. et al. Reliability in villous tumors staging between preoperative MRI and histopathological examination. Abdom Radiol 45, 3046–3056 (2020). https://doi.org/10.1007/s00261-020-02450-5

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  • DOI: https://doi.org/10.1007/s00261-020-02450-5

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