直肠腔内三维超声和MRI对中下段直肠癌壁外血管侵犯程度的评估效果

doi:10.13481/j.1671-587x.20210128

Abstract

Abstract: Objective

To compare the results of three-dimensional endorectal ultrasound （3D-ERUS） and magnetic resonance imaging （MRI） in the diagnosis of extramural vascular invasion （EMVI） of middle and lower rectal cancer before operation，and to explore the clinical value of 3D-ERUS in the evaluation of EMVI of middle and lower rectal cancer before operation.

Methods

A total of 94 patients with rectal cancer confirmed by pathology were selected，and all patients were examined by 3D-ERUS and MRI. The 3D-ERUS and MRI images were evaluated with a grade 5 scores （0－4 scores） for EMVI.Receiver operating characteristic（ROC） curve was used to evaluate the results of 3D-ERUS and MRI in the diagnosis of EMVI， and the specificity （Sp），sensitivity （Se），positive predictive value （PPV），negative predictive value （NPV） accuracy，and the area under ROC curve（AUC） were calculated. Kappa test was used to evaluate the consistency between the results of 3D-ERUS and MRI in the diagnosis of EMVI and the pathological results.

Results

The accuracy of 3D-ERUS in the diagnosis of EMVI was 90.43%（Kappa=0.685，P<0.01）， AUC was 0.868， Se was 81.25%，Sp was 92.31%，PPV was 68.42% and NPV was 96.00%.The accuracy of MRI in the diagnosis of EMVI was 87.23%（Kappa=0.589，P<0.01），AUC was 0.824， Se was 75.00%，Sp was 89.74%，PPV was 60.00% and NPV was 94.59%. There was no statistical difference in the accuracy of diagnosis between 3D-ERUS and MRI（χ²=0.214，P=0.643），and there was no statistical difference in the AUC of diagnosis between 3D-ERUS and MRI（Z=1.355，P=0.175）.

Conclusion

3D-ERUS and MRI eualuation on EMVI of the patients with middle and lower rectal cancer before operation have highly clinical values. 3D-REUS can be used as a complementary tool of MRI to evaluate the EMVI of the patients with middle and lower rectal cancer before operation.

Key words: rectal neoplasms, three-dimensional endorectal ultrasound, magnetic resonance imaging, extramural vascular Invasion

CLC Number:

R735.37

Dong CHEN,Haitao CHEN,Zhiyao LI,Fengming RANG,Xi ZHANG,Zhirui CHUAN,Shicong TANG,Xiaomao LUO. Effects of three-dimensional transrectal ultrasound and MRI in evaluation of extramural vascular invasion degrees of middle and lower rectal cancer[J].Journal of Jilin University(Medicine Edition), 2021, 47(1): 203-209.

Figures/Tables 5

Tab.1

Tab.2

Fig.1

Fig.2

Tab.3

References 22

1	BRAY F， FERLAY J， SOERJOMATARAM I，et al. Global cancer statistics 2018： GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries［J］. CA Cancer J Clin， 2018， 68（6）： 394-424.
2	BENSON A B， VENOOK A P， AL-HAWARY M M， et al. Rectal cancer，version 2.2018， NCCN clinical practice guidelines in oncology［J］. J Natl Compr Canc Netw， 2018， 16（7）： 874-901.
3	SHIN Y M， PYO J S， PARK M J. The Impact of extramural venous invasion in colorectal cancer： a detailed analysis based on tumor location and evaluation methods［J］. Int J Surg Pathol， 2020， 28（2）： 120-127.
4	DRESEN R C， PETERS E E， RUTTEN H J， et al. Local recurrence in rectal cancer can be predicted by histopathological factors［J］. Eur J Surg Oncol， 2009， 35（10）： 1071-1077.
5	CHAND M， PALMER T， BLOMQVIST L， et al. Evidence for radiological and histopathological prognostic importance of detecting extramural venous invasion in rectal cancer： recommendations for radiology and histopathology reporting［J］. Colorectal Dis， 2015， 17（6）： 468-473.
6	ALE ALI H， KIRSCH R， RAZAZ S， et al. Extramural venous invasion in rectal cancer： overview of imaging， histopathology， and clinical implications［J］. Abdom Radiol （NY）， 2019， 44（1）： 1-10.
7	GU C Y， YANG X Y， ZHANG X B， et al. The prognostic significance of MRI-detected extramural venous invasion， mesorectal extension， and lymph node status in clinical T3 mid-low rectal cancer［J］. Sci Rep， 2019， 9（1）： 12523.
8	KENNEDY E D， SIMUNOVIC M， JHAVERI K， et al. Safety and feasibility of using magnetic resonance imaging criteria to identify patients with “good prognosis” rectal cancer eligible for primary surgery： The phase 2 nonrandomized QuickSilver clinical trial［J］. JAMA Oncol， 2019， 5（7）： 961-966.
9	PINTO R A， CORREA NETO I J， NAHAS S C， et al. Efficacy of 3-dimensional endorectal ultrasound for staging early extraperitoneal rectal neoplasms［J］. Dis Colon Rectum， 2017， 60（5）： 488-496.
10	SMITH N J， RARBACHANO Y， NORMAN A R， et al. Prognostic significance of magnetic resonance imaging-detected extramural vascular invasion in rectal cancer［J］. Br J Surg， 2008， 95（2）： 229-236.
11	TALBOT I C，RITCHIE S，LEIGHTON M， et al. Invasion of veins by carcinoma of rectum： method of detection， histological features and significance［J］. Histopathology，1981， 5（2）： 141-163.
12	SHIRAISHI T， SASAKI T， IKEDA K， et al. Predicting prognosis according to preoperative chemotherapy response in patients with locally advanced lower rectal cancer［J］. BMC Cancer， 2019， 19（1）： 1222.
13	BROWN G， RADCLIFFE A G， NEWCOMBE R G， et al. Preoperative assessment of prognostic factors in rectal cancer using high-resolution magnetic resonance imaging［J］. Br J Surg， 2003， 90（3）： 355-364.
14	CHAND M， EVANS J， SWIFT R I， et al. The prognostic significance of postchemoradiotherapy high-resolution MRI and histopathology detected extramural venous invasion in rectal cancer［J］. Ann Surg， 2015， 261（3）： 473-479.
15	SERRA-ARACIL X， GALVEZ A， MORA-LOPEZ L， et al. Endorectal ultrasound in the identification of rectal tumors for transanal endoscopic surgery： factors influencing its accuracy［J］. Surg Endosc， 2018， 32（6）： 2831-2838.
16	CHAN B P H， PATEL R， MBUAGBAW L， et al. EUS versus magnetic resonance imaging in staging rectal adenocarcinoma： a diagnostic test accuracy meta-analysis［J］.Gastrointest Endosc， 2019， 90（2）：196-203.e1.
17	OIEN K， FORSMO H M， ROSLER C，et al. Endorectal ultrasound and magnetic resonance imaging for staging of early rectal cancers： how well does it work in practice？［J］. Acta Oncol， 2019， 58（Sup1）： S49-S54.
18	KOLEV N Y， TONEV A Y， IGNATOV V L， et al. The role of 3-D endorectal ultrasound in rectal cancer： our experience［J］. Int Surg， 2014， 99（2）： 106-111.
19	TSAI C， HAGUE C， XIONG W， et al. Evaluation of endorectal ultrasound （ERUS） and MRI for prediction of circumferential resection margin （CRM） for rectal cancer［J］. Am J Surg， 2017， 213（5）： 936-942.
20	YE D L， ZHU Z M， CHEN F， et al. Correlation between endorectal ultrasound and magnetic resonance imaging for predicting the circumferential resection margin in patients with mid-low rectal cancer without preoperative chemoradiotherapy［J］. J Ultrasound Med， 2020， 39（3）： 569-577.
21	SOHN B， LIM J S， KIM H， et al. MRI-detected extramural vascular invasion is an independent prognostic factor for synchronous metastasis in patients with rectal cancer［J］. Eur Radiol， 2015， 25（5）： 1347-1355.
22	SIDDIQUI M R S， SIMILLIS C， HUNTER C， et al. A meta-analysis comparing the risk of metastases in patients with rectal cancer and MRI-detected extramural vascular invasion （mrEMVI） vs mrEMVI-negative cases［J］. Br J Cancer， 2017， 116（12）： 1513-1519.

Clinicopathological feature	n	EMVI（－）	EMVI（+）	χ²	P
Gender
Male	54	44（81.5）	10（18.5）	0.029	0.864
Female	40	34（85.0）	6（15.0）	0.029	0.864
Age（year）
<60	42	40（95.2）	2 （4.8）	8.079	0.004
≥60	52	38（73.1）	14（26.9）	8.079	0.004
Pathological T stage
T_is/T₁/T₂	27	27（100.0）	0 （ 0.0）	8.524	0.014
T₃	22	18（81.8）	4（18.2）
T₄	45	33（73.3）	12（26.7）
Pathological N stage				11.119	0.004
N₀	60	53（88.3）	7（11.7）
N₁	19	17（89.5）	2（10.5）
N₂	15	8（53.3）	7（46.7）
Histological type
Poor differentiation	5	1（20.0）	4（80.0）	17.566	0.001
Poor-moderate differentiation	12	10（83.3）	2（16.7）
Moderate differentiation	60	54（90.0）	6（10.0）
Moderate/ Well differentiation	12	8（66.7）	4（33.3）
CEA level（ng·Ｌ^－1）
<5	67	61（91.0）	6 （9.0）	10.745	0.001
≥5	27	17（63.0）	10（37.0）	10.745	0.001

Method	EMVI（+）	EMVI（－）
3D-ERUS
EMVI（+）	13	3
EMVI（－）	6	72
MRI
EMVI（+）	12	4
EMVI（－）	8	70

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Effects of three-dimensional transrectal ultrasound and MRI in evaluation of extramural vascular invasion degrees of middle and lower rectal cancer

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Method	Sensitivity	Specificity	PPV	NPV
3D-ERUS	81.25	92.31	68.42	96.00
MRI	75.00	89.74	60.00	94.59