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Diagnostic Accuracy of MRI for Assessment of T Category, Lymph Node Metastases, and Circumferential Resection Margin Involvement in Patients with Rectal Cancer: A Systematic Review and Meta-analysis

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Magnetic resonance imaging (MRI) is increasingly being used for rectal cancer staging. The purpose of this study was to determine the accuracy of phased array MRI for T category (T1–2 vs. T3–4), lymph node metastases, and circumferential resection margin (CRM) involvement in primary rectal cancer.

Methods

Medline, Embase, and Cochrane databases were searched using combinations of keywords relating to rectal cancer and MRI. Reference lists of included articles were also searched by hand. Inclusion criteria were: (1) original article published January 2000–March 2011, (2) use of phased array coil MRI, (3) histopathology used as reference standard, and (4) raw data available to create 2 × 2 contingency tables. Patients who underwent preoperative long-course radiotherapy or chemoradiotherapy were excluded. Two reviewers independently extracted data. Sensitivity, specificity, and diagnostic odds ratio were estimated for each outcome using hierarchical summary receiver–operating characteristics and bivariate random effects modeling.

Results

Twenty-one studies were included in the analysis. There was notable heterogeneity among studies. MRI specificity was significantly higher for CRM involvement [94%, 95% confidence interval (CI) 88–97] than for T category (75%, 95% CI 68–80) and lymph nodes (71%, 95% CI 59–81). There was no significant difference in sensitivity between the three elements as a result of wide overlapping CIs. Diagnostic odds ratio was significantly higher for CRM (56.1, 95% CI 15.3–205.8) than for lymph nodes (8.3, 95% CI 4.6–14.7) but did not differ significantly from T category (20.4, 95% CI 11.1–37.3).

Conclusions

MRI has good accuracy for both CRM and T category and should be considered for preoperative rectal cancer staging. In contrast, lymph node assessment is poor on MRI.

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Acknowledgment

We thank Marina Englesakis for her assistance with the literature review. Supported in part by a grant from Cancer Services Innovation Partnership (a joint initiative of Cancer Care Ontario and the Canadian Cancer Society).

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Authors and Affiliations

  1. Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada

    Eisar Al-Sukhni MD, Selina Schmocker BSc, Robin McLeod MD & Erin Kennedy MD, PhD

  2. University of Toronto, Toronto, ON, Canada

    Eisar Al-Sukhni MD, Laurent Milot MD, MSc, Robin McLeod MD & Erin Kennedy MD, PhD

  3. Zane Cohen Centre for Digestive Diseases, Toronto, ON, Canada

    Eisar Al-Sukhni MD, Selina Schmocker BSc, Robin McLeod MD & Erin Kennedy MD, PhD

  4. Department of Diagnostic Imaging, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Laurent Milot MD, MSc

  5. Department of Diagnostic Imaging, St. Joseph’s Health Centre, Toronto, ON, Canada

    Mark Fruitman MD

  6. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada

    Joseph Beyene PhD

  7. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada

    J. Charles Victor MSc

  8. Department of Radiology, Royal Marsden Hospital, Sutton, Surrey, UK

    Gina Brown MD

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  1. Eisar Al-Sukhni MD
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Correspondence to Erin Kennedy MD, PhD.

Appendices

 

Appendix A Medline search strategy
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Appendix B Quality assessment items and their criteria
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Al-Sukhni, E., Milot, L., Fruitman, M. et al. Diagnostic Accuracy of MRI for Assessment of T Category, Lymph Node Metastases, and Circumferential Resection Margin Involvement in Patients with Rectal Cancer: A Systematic Review and Meta-analysis. Ann Surg Oncol 19, 2212–2223 (2012). https://doi.org/10.1245/s10434-011-2210-5

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  • DOI: https://doi.org/10.1245/s10434-011-2210-5

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