直肠腔内三维超声和MRI检测对中下段直肠癌患者术前T分期和环周切缘的诊断价值

doi:10.13481/j.1671-587X.20210328

Abstract

Abstract: Objective

To compare the results of three-dimensional transrectal ultrasound （3D-ERUS） and magnetic resonance imaging （MRI） in the diagnosis of T substages and circumferential resection margin of the patients with middle and lower rectal cancer before operation，and to explore the diagnosis value of 3D-ERUS in the preoperative assessment of T substages and circumferential resection margin in the patients with middle and lower rectal cancer.

Methods

The data of 94 patients with rectal cancer confirmed by pathology were collected，and all the patients were examined by 3D-ERUS and MRI before operation. Kappa test was used to compare the consistency between the results of 3D-ERUS and MRI in the diagnosis of T substages and the pathological results.The specificity， sensitivity， positive predictive value （PPV）， negative predictive value （NPV），precision，Recall and F1 were used to evaluate the results of 3D-ERUS and MRI in the diagnosis of T substages and circumferential resection margin in the patients with middle and lower rectal cancer. The differences between 3D-ERUS and MRI in the diagnosis of T substages and circumferential resection margin in the patients with middle and lower rectal cancer were compared.

Results

The accuracies of 3D-ERUS and MRI and the pathological results in the diagnosis of T substages in the patients with middle and lower rectal cancer were 81.91%（Kappa=0.736，P<0.01）and 74.47%（Kappa=0.624，P<0.01），respectively，and there was no statistical difference in the diagnostic accuracy of T substages in the patients with middle and lower rectal cancer between the two methods（χ²=1.12，P=0.289）.The sensitivity， specificity， PPV， NPV， accuracy， recall and F1 diagnosed by 3D-ERUS in the rectal cancer patients at T_is， T₁ and T₂ stages were higher than those of MRI. The sensitivity， specificity， PPV， NPV， accuracies， recall and F1 diagnosed by MRI in the patients with rectal cancer at T₄ stage were higher than those of 3D-ERUS. The accuracies of 3D-ERUS and MRI in the diagnosis of circumferential resection margin were 88.30% and 84.04%，and there was no statistical difference in the diagnostic accuracy of circumferential resection margin in the patients with middle and lower rectal cancer between two methods（χ²=0.402，P=0.526）.

Conclusion

3D-ERUS and MRI have high accuracies in the evaluation of preoperative T substages and circumferential resection margin in the patients with middle and lower rectal cancer. 3D-ERUS has high clinical value in the evaluation of T substages of the patients with early rectal cancer.

Key words: rectal neoplasm, three-dimensional endorectal ultrasound, circumferential resection margin, magnetic resonance imaging

CLC Number:

R735.37

Dong CHEN, Zhiyao LI, Haitao CHEN, Zhirui CHUAN, Yingxian ZHANG, Xin JIN, Shicong TANG, Xiaomao LUO. Diagnostic values of three-dimensional transrectal ultrasound and MRI in diagnosis of T substages and circumferential resection margin of patients with middle and lower rectal cancer[J].Journal of Jilin University(Medicine Edition), 2021, 47(3): 753-760.

Figures/Tables 9

Fig. 1

Fig. 2

Fig. 3

Fig. 4

Fig. 5

Tab.1

Tab.2

Tab.3

Tab.4

References

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	GLYNNE-JONES R， WYRWICZ L， TIRET E， et al. Rectal cancer： ESMO Clinical Practice Guidelines for diagnosis， treatment and follow-up［J］. Ann Oncol， 2018， 29（）： iv263.
4	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.
5	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.
6	LEON-CARLYLE M， BROWN J A， HAMM J， et al. The accuracy of endorectal ultrasound in staging rectal lesions in patients undergoing transanal endoscopic microsurgery［J］. Am J Surg， 2016， 212（3）： 455-460.
7	RESTIVO A， ZORCOLO L， MARONGIU L， et al. Limits of endorectal ultrasound in tailoring treatment of patients with rectal cancer［J］. Dig Surg， 2015， 32（2）： 129-134.
8	PINTO R A， CORRêA 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.
9	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.
10	HILDEBRANDT U， FEIFEL G. Preoperative staging of rectal cancer by intrarectal ultrasound［J］. Dis Colon Rectum， 1985， 28（1）： 42-46.
11	DING P R， AN X， CAO Y， et al. Depth of tumor invasion independently predicts lymph node metastasis in T2 rectal cancer［J］. J Gastrointest Surg， 2011， 15（1）： 130-136.
12	PARK J S， HUH J W， PARK Y A， et al. A circumferential resection margin of 1 mm is a negative prognostic factor in rectal cancer patients with and without neoadjuvant chemoradiotherapy［J］. Dis Colon Rectum， 2014， 57（8）： 933-940.
13	AMIN M B， GREENE F L， EDGE S B， et al. The Eighth Edition AJCC Cancer Staging Manual： Continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging［J］. CA Cancer J Clin， 2017， 67（2）： 93-99.
14	SERRA-ARACIL X， GáLVEZ A， MORA-LóPEZ 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.
15	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.
16	谭蜀川，罗晓茂，钏志睿，等. 经直肠双重超声造影在直肠癌术前T分期中的价值［J］. 临床超声医学杂志， 2016， 18（5）： 316-319.
17	汤绚,江慧洪,汤二将,等.比较基因组杂交技术分析结直肠癌远处转移的遗传变异[J].同济大学学报(医学版),2020,41(1):26-32.
18	OIEN K， FORSMO H M， R?SLER 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.
19	SANTORO G A，GIZZI G， PELLEGRINI L，et al. The value of high-resolution three-dimensional endorectal ultrasonography in the management of submucosal invasive rectal tumors［J］. Dis Colon Rectum， 2009， 52（11）： 1837-1843.
20	QUIRKE P， DURDEY P， DIXON M F， et al. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision［J］. Lancet， 1986， 2（8514）： 996-999.
21	PHANG P T， GOLLUB M J， LOH B D， et al. Accuracy of endorectal ultrasound for measurement of the closest predicted radial mesorectal margin for rectal cancer［J］. Dis Colon Rectum， 2012， 55（1）： 59-64.

result Pathological	3D-ERUS result					Total
result Pathological	pT_is	pT₁	pT₂	pT₃	pT₄	Total
uT_is	3	0	0	0	0	3
uT₁	1	7	1	0	0	0
uT₂	0	1	12	2	0	15
uT₃	0	0	2	16	6	24
uT₄	0	0	0	4	39	43
Total	4	8	15	22	45	94

result Pathological	MRIresult					Total
result Pathological	pT_is	pT₁	pT₂	pT₃	pT₄	Total
T_is	2	0	0	0	0	2
T₁	1	4	2	0	0	7
T₂	1	4	8	2	0	15
T₃	0	0	5	16	5	26
T₄	0	0	0	4	40	44
Total	4	8	15	22	45	94

Diagnosis method	Sensitivity	Specificity	PPV	NPV	Precision	Recall	F1
3D-ERUS
uT_is	75.00	100.00	100.00	98.90	100.00	75.00	85.71
uT₁	87.50	97.67	77.78	98.82	77.78	87.50	82.35
uT₂	80.00	96.20	80.00	96.20	80.00	80.00	80.00
uT₃	72.73	88.89	66.67	91.43	66.67	72.73	69.57
uT₄	86.67	91.84	90.70	88.24	90.70	86.67	88.64
MRI
T_is	50.00	100.00	100.00	97.83	100.00	50.00	66.67
T₁	50.00	96.51	57.14	95.40	57.14	50.00	53.33
T₂	53.33	91.14	53.33	91.14	53.33	53.33	53.33
T₃	72.73	86.11	61.54	91.18	61.54	72.73	66.67
T₄	88.89	91.84	90.91	90.00	90.91	88.89	89.89

Atem	Pathologic results		Total
Atem	CRM(－)	CRM(+)	Total
3D-ERUS
CRM(－）	83	0	83
CRM(+)	11	0	11
Total	94	0	94
MRI
CRM(－)	79	0	79
CRM(+)	15	0	15
Total	94	0	94

[1]	Chuwen WU,Mengling PENG,Yu FU,Shanshan ZHOU. Comparison of clinical characteristics and prognostic influence factors between patients with or without hypertrophic cardiomyopathy complicated by microvascular dysfunction [J]. Journal of Jilin University(Medicine Edition), 2025, 51(6): 1630-1637.
[2]	Hongli LI,Mengyao WANG,Yangyang LIU,Hui ZHANG,Li LI. Effect of KHSRP on biological behavior of colorectal cancer cells through activation of JAK/STAT signaling pathway [J]. Journal of Jilin University(Medicine Edition), 2025, 51(4): 996-1006.
[3]	Chong LIU,Boyuan WANG,Yang JIANG,Aizhuo SONG,Minghe LI. Clinical analysis on temporomandibular joint disc anchorage for treatment of irretrievable forward displacement of temporomandibular joint disc [J]. Journal of Jilin University(Medicine Edition), 2025, 51(3): 770-777.
[4]	Fanjun SUN,Xingchen PAN,Dan TONG. Research progress in MRI neuroimaging for patients with functional gastrointestinal diseases and inflammatory bowel disease [J]. Journal of Jilin University(Medicine Edition), 2025, 51(2): 541-548.
[5]	Zilong GAO,Biao LIU,Le QI,Jingyu LANG,Yan LIU. Giant cell-rich osteosarcoma with special imaging findings： A case report and literature review [J]. Journal of Jilin University(Medicine Edition), 2025, 51(1): 222-227.
[6]	Bingbing HU,Kangning LUO,Su PENG,Yuzhong ZHOU,Maoliang CHEN,Changhua LIU. Improvement effect of down-regulation of miR-208a on 5-FU resistance in colorectal cancer cells through targeting SFRP1 for mediating Wnt signaling pathway [J]. Journal of Jilin University(Medicine Edition), 2024, 50(4): 947-955.
[7]	Aiying CHEN,Jinwen JIANG,Hui ZHANG. Network pharmacology and molecular docking analysis based on mechanism of Huangqin Tang in treatment of colorectal cancer [J]. Journal of Jilin University(Medicine Edition), 2024, 50(1): 208-220.
[8]	Meng LIU,Xiaodong HUANG,Zheng HAN,Qingxi ZHU,Jie TAN,Xia TIAN. Effect of cadherin-17 on proliferation and apoptosis of colorectal cancer cells and its PI3K/AKT/mTOR signaling pathway regulatory mechanism [J]. Journal of Jilin University(Medicine Edition), 2023, 49(4): 1008-1017.
[9]	Shan LIU,Zhaodong XING,Ping HUANG. Effect of expression of miR-17-5p in exosomes derived from colorectal cancer cells on chemosensitivity of colorectal cancer cells and its mechanism [J]. Journal of Jilin University(Medicine Edition), 2023, 49(4): 975-984.
[10]	Shengyu YAN,Changhua LIU,Zhijie XU,Yating DING,Yafeng XIE,Qiao ZHANG,Wanying LIU. Effect of lncRNA PAX8-AS1 on proliferation, apoptosis and invasion of colorectal cancer cells and its mechanism [J]. Journal of Jilin University(Medicine Edition), 2023, 49(3): 656-664.
[11]	Jinjin YUE,Yixin PANG,Xiumei ZHANG. Regulatory effect of silent information regulator 2 on aerobic glycolysis and growth and proliferation of colorectal cancer cells and its mechanism [J]. Journal of Jilin University(Medicine Edition), 2023, 49(2): 385-394.
[12]	Shengnan YANG,Xue WANG,Xuefeng WANG,Tianyu ZHAO,Ying PAN,Dayong DING. Retroperitoneal giant lymphangioma: A case report and literature review [J]. Journal of Jilin University(Medicine Edition), 2023, 49(2): 508-513.
[13]	Yan SUN,Xinhua DONG,Dongying LI,Qingfen ZHENG,Huiyu YANG,Bingrong LIU. Investigation and analysis on cognition of first-degree relatives of patients with colorectal cancer on colorectal cancer screening [J]. Journal of Jilin University(Medicine Edition), 2022, 48(4): 1065-1070.
[14]	Qiuting CAO,Jingchun HAN,Xiaofei ZHANG. Effect of silencing helicase BLM gene on chemotherapy sensitivity of irinotecan in colorectal cancer cells and its mechanism [J]. Journal of Jilin University(Medicine Edition), 2022, 48(3): 657-667.
[15]	Junjie HOU,Xuguang MI,Xiaonan LI,Xiaonan LI,Ying YANG,Xianzhuo JIANG,Ying ZHOU,Zhiqiang NI,Ningyi JIN,Yanqiu FANG. Treatment of advanced rectal cancer with rectovaginal fistula through bevacizumab combined with FOLFIRI regimen: A case report and literature review [J]. Journal of Jilin University(Medicine Edition), 2022, 48(3): 790-795.

Diagnostic values of three-dimensional transrectal ultrasound and MRI in diagnosis of T substages and circumferential resection margin of patients with middle and lower rectal cancer

RichHTML

PDF (PC)

Like

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 9

References

Related Articles 15

Metrics

Comments

Recommended 10