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Rectal cancer at the peritoneal reflection. Preoperative MRI accuracy and histophatologic correlation. Prospective
Eduardo Álvarez Sarrado1, Francisco Giner Segura2, Adela Batista Domenech3
1Unidad de Coloproctología, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
Introduction:
To investigate magnetic resonance imaging (MRI) accuracy for determining the location of rectal tumors with respect to the peritoneal reflection (PR) and its potential involvement.
Methods:
Prospective study of 161 patients ongoing surgery for rectal cancer. A double-ink method has been aplied to examine surgical specimen, orange ink for the serosal surface and indian ink for the mesorrectal margin, and assess preoperative MRI accuracy.
Results:
Twenty-two tumors were located above, 65 at and 74 below PR. MRI accuracy was 90.6% for determining tumor's location with respect to the PR and 80.5% for defining peritoneal involvement. For classifying tumors according to their intra or extraperitoneal location an accuracy of 92.5% was set for MRI. Histophatologic peritoneal involvement was found in 28.7% of tumors located above or at the PR.
Conclusions:
Magnetic resonance imaging accurately predicts the location of rectal tumors with respect to the PR and its potential involvement. The double-ink method is useful to assess serosal involvement (pT4a) and to distinguish mesorrectal fascia from the peritonealized surface.
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