高分辨MRI對直腸癌TNM分期及環周切緣的評估_《中國普外基礎與臨床雜志》

作者：

叢冠寧 ^1,2 , 秦明偉 ¹ , 賀丹 ¹ , 肖毅 ³ , 邱輝忠 ³ , 吳斌 ³ , 林國樂 ³

1.中國醫學科學院北京協和醫學院北京協和醫院放射科(北京 100730);;
2.中國中醫科學院廣安門醫院放射科(北京 100053);;
3.中國醫學科學院北京協和醫學院北京協和醫院基本外科(北京 100730);

關鍵詞：

高分辨磁共振 TNM分期系統環周切緣直腸固有筋膜直腸癌

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目的探討高分辨MRI對直腸癌術前T、N分期及環周切緣評估的準確性。
方法選取北京協和醫院2006年9月至2009年5月期間42例經結腸鏡活檢并組織病理學證實的直腸癌患者，術前行MRI分期。檢查后1周內，按照全直腸系膜切除原則行直腸癌切除手術。手術后標本根據2002年美國癌癥學會(AJCC)結直腸癌分期標準行腫瘤及淋巴結病理學分期。影像學和病理學對腫瘤(T)分期、淋巴結(N)分期與環周切緣受累評估的一致性采用Kappa檢驗。
結果對T分期，MRI正確分期36例，過低分期3例，過高分期3例，統計學分析顯示病理學和影像學對T分期具有較好的一致性(Kappa=0.731，P=0.000)。對N分期，術前MRI正確分期31例，過低分期5例，過高分期6例，統計學分析顯示兩者具有中度一致性(Kappa=0.410，P=0.009)。對環周切緣的評估，術前MRI能夠正確評估40例，統計學分析顯示兩者對直腸固有筋膜的評估具有很好的一致性(Kappa=0.829，P=0.000)。
結論高分辨MRI對直腸癌術前T分期具有較好的準確性，對N分期具有中度的準確性，對直腸固有筋膜能夠提供準確的評估,有助于挑選出能夠受益于術前新輔助治療的患者。

引用本文： 叢冠寧,秦明偉,賀丹,肖毅,邱輝忠,吳斌,林國樂. 高分辨MRI對直腸癌TNM分期及環周切緣的評估. 中國普外基礎與臨床雜志, 2010, 17(9): 894-900. doi: 復制

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28.	Koh DM, Brown G, Temple L, et al. Rectal cancer: mesorectal lymph nodes at MR imaging with USPIO versus histopathologic findings－initial observations [J]. Radiology, 2004; 231(1): 9199.
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31.	Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery－the clue to pelvic recurrence? [J] Br J Surg, 1982; 69(10): 613616.
32.	Dixon AR, Maxwell WA, Holmes JT. Carcinoma of the rectum: a 10year experience [J]. Br J Surg, 1991; 78(3): 308311.
33.	Enker WE, Thaler HT, Cranor ML, et al. Total mesorectal excision in the operative treatment of carcinoma of the rectum [J]. J Am Coll Surg, 1995; 181(4): 335346.
34.	McCall JL, Cox MR, Wattchow DA. Analysis of local recurrence rates after surgery alone for rectal cancer [J]. Int J Colorectal Dis, 1995; 10(3): 126132.
35.	Wibe A, Rendedal PR, Svensson E, et al. Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer [J]. Br J Surg, 2002; 89(3): 327334.

1. Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2009 [J]. CA Cancer J Clin, 2009; 59(4): 225249.
2. Smith RA, Cokkinides V, Brawley OW. Cancer screening in the United States, 2008: a review of current American Cancer Society guidelines and cancer screening issues [J]. CA Cancer J Clin, 2008; 58(3): 161179.
3. Sung JJ, Lau JY, Goh KL, et al. Increasing incidence of colorectal cancer in Asia: implications for screening [J]. Lancet Oncol, 2005; 6(11): 871876.
4. Cawthorn SJ, Parums DV, Gibbs NM, et al. Extent of mesorectal spread and involvement of lateral resection margin as prognostic factors after surgery for rectal cancer [J]. Lancet, 1990; 335(8697): 10551059.
5. Lindmark G, Gerdin B, Pahlman L, et al. Prognostic predictors in colorectal cancer [J]. Dis Colon Rectum, 1994; 37(12): 12191227.
6. Heald RJ, Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer [J]. Lancet, 1986; 1(8496): 14791482.
7. MacFarlane JK, Ryall RD, Heald RJ. Mesorectal excision for rectal cancer [J]. Lancet, 1993; 341(8843): 457460.
8. Adam IJ, Mohamdee MO, Martin IG, et al. Role of circumferential margin involvement in the local recurrence of rectal cancer [J]. Lancet, 1994; 344(8924): 707711.
9. Williamson PR, Hellinger MD, Larach SW, et al. Endorectal ultrasound of T3 and T4 rectal cancers after preoperative chemoradiation [J]. Dis Colon Rectum, 1996; 39(1): 4549.
10. Chari RS, Tyler DS, Anscher MS, et al. Preoperative radiation and chemotherapy in the treatment of adenocarcinoma of the rectum [J]. Ann Surg, 1995; 221(6): 778786.
11. Birbeck KF, Macklin CP, Tiffin NJ, et al. Rates of circumferential resection margin involvement vary between surgeons and predict outcomes in rectal cancer surgery [J]. Ann Surg, 2002; 235(4): 449457.
12. Quirke P, Durdey P, Dixon MF, 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.
13. Nagtegaal ID, Marijnen CA, Kranenbarg EK, et al. Circumferential margin involvement is still an important predictor of local recurrence in rectal carcinoma: not one millimeter but two millimeters is the limit [J]. Am J Surg Pathol, 2002; 26(3): 350357.
14. Frykholm GJ, Glimelius B, Pahlman L. Preoperative or postoperative irradiation in adenocarcinoma of the rectum: final treatment results of a randomized trial and an evaluation of late secondary effects [J]. Dis Colon Rectum, 1993; 36(6): 564572.
15. SebagMontefiore D, Stephens RJ, Steele R, et al. Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCICCTG C016): a multicentre, randomised trial [J]. Lancet, 2009; 373(9666): 811820.
16. Brown G, Richards CJ, Newcombe RG, et al. Rectal carcinoma: thinsection MR imaging for staging in 28 patients [J]. Radiology, 1999; 211(1): 215222.
17. Brown G, Kirkham A, Williams GT, et al. Highresolution MRI of the anatomy important in total mesorectal excision of the rectum [J]. AJR Am J Roentgenol, 2004; 182(2): 431439.
18. Bissett IP, Fernando CC, Hough DM, et al. Identification of the fascia propria by magnetic resonance imaging and its relevance to preoperative assessment of rectal cancer [J]. Dis Colon Rectum, 2001; 44(2): 259265.
19. Gualdi GF, Casciani E, Guadalaxara A, et al. Local staging of rectal cancer with transrectal ultrasound and endorectal magnetic resonance imaging: comparison with histologic findings [J]. Dis Colon Rectum, 2000; 43(3): 338345.
20. Hanski C. Is mucinous carcinoma of the colorectum a distinct genetic entity? [J]. Br J Cancer, 1995; 72(6): 13501356.
21. Low RN, McCue M, Barone R, et al. MR staging of primary colorectal carcinoma: comparison with surgical and histopathologic findings [J]. Abdom Imaging, 2003; 28(6):784793.
22. Akasu T, Iinuma G, Fujita T, et al. Thinsection MRI with a phasedarray coil for preoperative evaluation of pelvic anatomy and tumor extent in patients with rectal cancer [J]. AJR Am J Roentgenol, 2005; 184(2): 531538.
23. Branagan G, Chave H, Fuller C, et al. Can magnetic resonance imaging predict circumferential margins and TNM stage in rectal cancer? [J]. Dis Colon Rectum, 2004; 47(8): 13171322.
24. BeetsTan RG, Beets GL, Vliegen RF, et al. Accuracy of magnetic resonance imaging in prediction of tumourfree resection margin in rectal cancer surgery [J]. Lancet, 2001; 357(9255): 497504.
25. Simunovic M, Smith AJ, Heald RJ. Rectal cancer surgery and regional lymph nodes [J]. J Surg Oncol, 2009; 99(4): 256259.
26. Koh DM, Brown G, Temple L, et al. Distribution of mesorectal lymph nodes in rectal cancer: in vivo MR imaging compared with histopathological examination. Initial observations [J]. Eur Radiol, 2005; 15(8): 16501657.
27. Brown G, Richards CJ, Bourne MW, et al. Morphologic predictors of lymph node status in rectal cancer with use of highspatialresolution MR imaging with histopathologic comparison [J]. Radiology, 2003; 227(2): 371377.
28. Koh DM, Brown G, Temple L, et al. Rectal cancer: mesorectal lymph nodes at MR imaging with USPIO versus histopathologic findings－initial observations [J]. Radiology, 2004; 231(1): 9199.
29. Monig SP, Baldus SE, Zirbes TK, et al. Lymph node size and metastatic infiltration in colon cancer [J]. Ann Surg Oncol, 1999; 6(6): 579581.
30. Kim JH, Beets GL, Kim MJ, et al. Highresolution MR imaging for nodal staging in rectal cancer: are there any criteria in addition to the size? [J]. Eur J Radiol, 2004; 52(1): 7883.
31. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery－the clue to pelvic recurrence? [J] Br J Surg, 1982; 69(10): 613616.
32. Dixon AR, Maxwell WA, Holmes JT. Carcinoma of the rectum: a 10year experience [J]. Br J Surg, 1991; 78(3): 308311.
33. Enker WE, Thaler HT, Cranor ML, et al. Total mesorectal excision in the operative treatment of carcinoma of the rectum [J]. J Am Coll Surg, 1995; 181(4): 335346.
34. McCall JL, Cox MR, Wattchow DA. Analysis of local recurrence rates after surgery alone for rectal cancer [J]. Int J Colorectal Dis, 1995; 10(3): 126132.
35. Wibe A, Rendedal PR, Svensson E, et al. Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer [J]. Br J Surg, 2002; 89(3): 327334.

《中國普外基礎與臨床雜志》

高分辨MRI對直腸癌TNM分期及環周切緣的評估

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《中國普外基礎與臨床雜志》

高分辨MRI對直腸癌TNM分期及環周切緣的評估

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

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