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Related Experiment Video

Updated: Jun 6, 2025

Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
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Rectal Cancer and Lateral Lymph Node Staging: Interobserver Agreement and Success in Predicting Locoregional

Hüseyin Akkaya1, Okan Dilek2, Selim Özdemir3

  • 1Department of Radiology, Faculty of Medicine, Ondokuz Mayis University, Atakum 55280, Turkey.

Diagnostics (Basel, Switzerland)
|November 27, 2024
PubMed
Summary

Lateral lymph node (LLN) staging using MRI shows high interobserver agreement and effectively predicts rectal cancer recurrence after neoadjuvant therapy. Positive LLNs in restaging indicate a poor prognosis.

Keywords:
EMVIlateral lymph nodelocally advanced rectal cancerlocoregional recurrencemesorectal fascia

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Area of Science:

  • Radiology and Medical Imaging
  • Oncology
  • Gastroenterology

Background:

  • Accurate rectal cancer staging and restaging are crucial for treatment planning and predicting outcomes.
  • Magnetic resonance imaging (MRI) is a key modality for evaluating rectal cancer, but interobserver agreement can vary.
  • Assessing locoregional recurrence risk after neoadjuvant therapy requires reliable imaging parameters.

Purpose of the Study:

  • To evaluate radiologist agreement in rectal cancer staging and restaging using MRI.
  • To determine if MRI findings can predict locoregional recurrence after neoadjuvant treatment.
  • To assess the utility of lateral lymph node (LLN) staging in predicting recurrence.

Main Methods:

  • Retrospective review of pre- and post-neoadjuvant therapy MRI scans from 239 locally advanced rectal cancer patients by three radiologists.
  • Evaluation of various MRI parameters including tumor involvement, sphincter involvement, lymph node status, and distance to mesorectal fascia (MRF).
  • Analysis of interobserver agreement and correlation with histopathological findings and locoregional recurrence.

Main Results:

  • High interobserver agreement (kappa > 0.81) was observed for most MRI parameters, with moderate agreement for MRI T stage and distance to MRF.
  • Positive LLNs during restaging (OR=2.1) and a tumor-MRF distance < 1 mm (OR=2.1) were significant predictors of locoregional recurrence.
  • LLN staging demonstrated a strong association with locoregional recurrence (p < 0.001), with 89.2% of patients showing increased stage experiencing recurrence.

Conclusions:

  • Lateral lymph node (LLN) staging via MRI is a reliable parameter for predicting locoregional recurrence in rectal cancer patients.
  • High interobserver agreement for LLN staging enhances its clinical utility.
  • The presence of positive LLNs during restaging is a significant indicator of poor prognosis.