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How reliable is restaging MRI after neoadjuvant therapy in rectal cancer?
Rachel Gefen1,2, Zoe Garoufalia1, Nir Horesh1,3
1Ellen Leifer Shulman and Steven Shulman Digestive Disease Centre, Cleveland Clinic Florida, Weston, Florida, USA.
Summary
Restaging MRI after rectal cancer neoadjuvant therapy shows low accuracy for TN stage and CRM status, especially after total neoadjuvant treatment (TNT). These findings suggest not relying solely on MRI for post-treatment decisions.
Area of Science:
- Oncology
- Radiology
- Gastroenterology
Background:
- Magnetic resonance imaging (MRI) is crucial for rectal cancer staging.
- The reliability of restaging MRI after neoadjuvant therapy remains uncertain.
Purpose of the Study:
- To assess the accuracy of restaging MRI in rectal cancer.
- To compare post-neoadjuvant MRI findings with final pathology reports.
Main Methods:
- Retrospective review of 126 adult rectal cancer patients.
- Comparison of preoperative MRI with final pathology for T stage, N stage, tumor size, and CRM status.
- Analysis conducted between 2016 and 2021 at a NAPRC-certified center.
Main Results:
- Low concordance between restaging MRI and pathology for T stage (kappa -0.316), N stage (kappa -0.11), and CRM status (kappa 0.089).
- Lower concordance observed in patients after total neoadjuvant treatment (TNT) or with low rectal tumors.
- High rate of false negatives for N stage (73% of positive N pathology cases showed negative MRI status).
Conclusions:
- Restaging MRI demonstrates low accuracy for TN stage and CRM status post-neoadjuvant therapy.
- Accuracy is further reduced with TNT regimens and low rectal tumors.
- Sole reliance on restaging MRI for post-neoadjuvant treatment decisions is not recommended, especially with TNT and watch-and-wait strategies.
