"skipMainNavigation"
closeDrawerMenuopenDrawerMenu
Search
Quick Search in Journals
Quick Search anywhere
Advanced Search
Radiology
Menu
  • Information
    • Previous
    Next
    Gastrointestinal Imaging

    Morphologic Predictors of Lymph Node Status in Rectal Cancer with Use of High-Spatial-Resolution MR Imaging with Histopathologic Comparison

    Published Online:May 1 2003https://doi.org/10.1148/radiol.2272011747

    Abstract

    PURPOSE: To evaluate signal intensity and border characteristics of lymph nodes at high-spatial-resolution magnetic resonance (MR) imaging in patients with rectal cancer and to compare these findings with size in prediction of nodal status.

    MATERIALS AND METHODS: Forty-two patients who underwent total mesorectal excision of the rectum to determine if they had rectal carcinoma were studied with preoperative thin-section MR imaging. Lymph nodes were harvested from 42 transversely sectioned surgical specimens. The slice of each lymph node was carefully matched with its location on the corresponding MR images. Nodal size, border contour, and signal intensity on MR images were characterized and related to histologic involvement with metastases. Differences in sensitivity and specificity with border or signal intensity were calculated with CIs by using method 10 of Newcombe.

    RESULTS: Of the 437 nodes harvested, 102 were too small (<3 mm) to be depicted on MR images, and only two of these contained metastases. In 15 (68%) of 22 patients with nodal metastases, the size of normal or reactive nodes was equal to or greater than that of positive nodes in the same specimen. Fifty-one nodes were above the area imaged, and seven of these contained metastases. The diameter of benign and malignant nodes was similar; therefore, size was a poor predictor of nodal status. If a node was defined as suspicious because of an irregular border or mixed signal intensity, a superior accuracy was obtained and resulted in a sensitivity of 51 (85%) of 60 (95% CI: 74%, 92%) and a specificity of 216 (97%) of 221 (95% CI: 95%, 99%).

    CONCLUSION: Prediction of nodal involvement in rectal cancer with MR imaging is improved by using the border contour and signal intensity characteristics of lymph nodes instead of size criteria.

    © RSNA, 2003

    References

    • 1 Wolmark N, Fisher B, Wieand HS. The prognostic value of the modifications of the Dukes’ C class of colorectal cancer: an analysis of the NSABP clinical trials. Ann Surg 1986; 203:115-122. Crossref, Medline, Google Scholar
    • 2 Tang R, Wang JY, Chen JS, et al. Survival impact of lymph node metastasis in TNM stage III carcinoma of the colon and rectum. J Am Coll Surg 1995; 180:705-712. Medline, Google Scholar
    • 3 Adam IJ, Mohamdee MO, Martin IG, et al. Role of circumferential margin involvement in the local recurrence of rectal cancer. Lancet 1994; 344:707-711. Crossref, Medline, Google Scholar
    • 4 Billingham RP. Extended lymphadenectomy for rectal cancer: cure vs quality of life. Int Surg 1994; 79:11-22. Medline, Google Scholar
    • 5 Suzuki K, Muto T, Sawada T. Prevention of local recurrence by extended lymphadenectomy for rectal cancer. Surg Today 1995; 25:795-801. Crossref, Medline, Google Scholar
    • 6 Moreira LF, Hizuta A, Iwagaki H, Tanaka N, Orita K. Lateral lymph node dissection for rectal carcinoma below the peritoneal reflection. Br J Surg 1994; 81:293-296. Crossref, Medline, Google Scholar
    • 7 Okizuka H, Sugimura K, Yoshizako T, Kaji Y, Wada A. Rectal carcinoma: prospective comparison of conventional and gadopentetate dimeglumine enhanced fat-suppressed MR imaging. J Magn Reson Imaging 1996; 6:465-471. Crossref, Medline, Google Scholar
    • 8 Vogl TJ, Pegios W, Mack MG, et al. Accuracy of staging rectal tumors with contrast-enhanced transrectal MR imaging. AJR Am J Roentgenol 1997; 168:1427-1434. Crossref, Medline, Google Scholar
    • 9 Zerhouni EA, Rutter C, Hamilton SR, et al. CT and MR imaging in the staging of colorectal carcinoma: report of the Radiology Diagnostic Oncology Group II. Radiology 1996; 200:443-451. Link, Google Scholar
    • 10 Schnall MD, Furth EE, Rosato EF, Kressel HY. Rectal tumor stage: correlation of endorectal MR imaging and pathologic findings. Radiology 1994; 190:709-714. Link, Google Scholar
    • 11 Hildebrandt U, Klein T, Feifel G, et al. Endosonography of pararectal lymph nodes: in vitro and in vivo evaluation. Dis Colon Rectum 1990; 33:863-868. Crossref, Medline, Google Scholar
    • 12 Hildebrandt U, Feifel G. Importance of endoscopic ultrasonography staging for treatment of rectal cancer. Gastrointest Endosc Clin N Am 1995; 5:843-849. Crossref, Medline, Google Scholar
    • 13 Sobin L, Wittekind C. TNM classification of malignant tumors New York, NY: Wiley, 1997; 227. Google Scholar
    • 14 Wilson EB. Probable inference, the law of succession, and statistical inference. J Am Stat Assoc 1927; 22:209-212. Crossref, Google Scholar
    • 15 Newcombe RG. Interval estimation for the difference between independent proportions: comparison of eleven methods. Stat Med 1998; 17:873-890. Crossref, Medline, Google Scholar
    • 16 Newcombe RG. Simultaneous comparison of sensitivity and specificity of two tests in the paired design: a straightforward graphical approach. Stat Med 2001; 20:907-915. Crossref, Medline, Google Scholar
    • 17 Altman DG. Inter-rater agreement In: Practical statistics for medical research. London, England: Chapman & Hall, 1990; 403-407. Google Scholar
    • 18 Kusunoki M, Yanagi H, Kamikonya N, et al. Preoperative detection of local extension of carcinoma of the rectum using magnetic resonance imaging. J Am Coll Surg 1994; 179:653-656. Medline, Google Scholar
    • 19 Indinnimeo M, Grasso RF, Cicchini C, et al. Endorectal magnetic resonance imaging in the preoperative staging of rectal tumors. Int Surg 1996; 81:419-422. Medline, Google Scholar
    • 20 Detry RJ, Kartheuser AH, Lagneaux G, Rahier J. Preoperative lymph node staging in rectal cancer: a difficult challenge. Int J Colorectal Dis 1996; 11:217-221. Crossref, Medline, Google Scholar
    • 21 Dworak O. Morphology of lymph nodes in the resected rectum of patients with rectal carcinoma. Pathol Res Pract 1991; 187:1020-1024. Crossref, Medline, Google Scholar
    • 22 Dworak O. Number and size of lymph nodes and node metastases in rectal carcinomas. Surg Endosc 1989; 3:96-99. Crossref, Medline, Google Scholar
    • 23 Spinelli P, Schiavo M, Meroni E, et al. Results of EUS in detecting perirectal lymph node metastases of rectal cancer: the pathologist makes the difference. Gastrointest Endosc 1999; 49:754-748. Crossref, Medline, Google Scholar
    • 24 Hildebrandt U, Klein T, Feifel G, et al. Endosonography of pararectal lymph nodes: in vitro and in vivo evaluation. Dis Colon Rectum 1990; 33:863-868. Crossref, Medline, Google Scholar
    • 25 Hildebrandt U, Feifel G. Importance of endoscopic ultrasonography staging for treatment of rectal cancer. Gastrointest Endosc Clin N Am 1995; 5:843-849. Crossref, Medline, Google Scholar
    • 26 Katsura Y, Yamada K, Ishizawa T, Yoshinaka H, Shimazu H. Endorectal ultrasonography for the assessment of wall invasion and lymph node metastasis in rectal cancer. Dis Colon Rectum 1992; 35:362-368. Crossref, Medline, Google Scholar
    • 27 Lee AS, Weissleder R, Brady TJ, Wittenberg J. Lymph nodes: microstructural anatomy at MR imaging. Radiology 1991; 178:519-522. Link, Google Scholar
    • 28 Swedish Rectal Cancer Trial. Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med 1997; 336:980-987. Crossref, Medline, Google Scholar
    • 29 Kapiteijn E, Marijnen CA, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001; 345:638-646. Crossref, Medline, Google Scholar

    Article History

    Published in print: May 2003