Valor de la elastografía por patrones de colores en la reestadificación del cáncer de recto / Value of elastography by color patterns in the restaging of rectal cancer i: en

Introducción: La elastografía cualitativa por ecografía endoscópica es una técnica para examinar las propiedades elásticas de los tejidos, que puede distinguir la fibrosis del tumor mediante patrones de colores. Objetivo: Determinar el valor de la elastografía por patrones de colores en la reestadificación del cáncer de recto. Métodos: Se efectuó un estudio observacional y descriptivo (serie de casos) de 54 pacientes con cáncer de recto atendidos en el Centro Nacional de Cirugía de Mínimo Acceso, en La Habana, entre septiembre del 2018 y diciembre del 2022, a quienes se les realizó elastografía por ecografía endoscópica para la reevaluación del tumor. Para determinar el valor de dicha técnica se calculó la sensibilidad, la especificidad, los valores predictivos positivo y negativo, las razones de verosimilitud positiva y negativa, así como el índice de Youden. Se estableció la concordancia diagnóstica según el índice kappa y el estudio histológico de la muestra tomada fue el estándar de referencia. Resultados: La concordancia de la elastografía con el resultado anatomopatológico fue buena (κ=0,84). La especificidad y el índice de validez resultaron ser de 91,7 y 94,4 %, respectivamente; mientras que el valor predictivo negativo fue de 84,6 %. Los 16 pacientes con patrón elastográfico mixto (ye3) tenían tumor residual localizado en alguna de las capas de la pared del recto. El índice de Youden alcanzó valores cercanos a 1. Conclusiones: El valor de esta técnica radica en su especificidad diagnóstica y en el valor predictivo negativo al diferenciar la fibrosis del tumor residual en la pared rectal.

Introduction: The qualitative elastography by endoscopic echography is a technique to examine the elastic properties of tissues that can distinguish the fibrosis of the tumor by means of color patterns. Objective: To determine the value of elastography by color patterns in the reestadification of the rectum cancer. Methods: An observational and descriptive study (serial cases) of 54 patients with rectum cancer was carried out, who were assisted in the National Center of Minimum Access Surgery, in Havana, between September, 2018 and December, 2022 to whom elastography by endoscopic echography were carried out for the reevaluation of the tumor. To determine the value of this technique the sensibility, specificity, the predictive positive and negative values, the positive and negative true ratio, as well as the index of Youden were calculated. The diagnostic consistency was established according to the kappa index and the histologic study of the sample was the reference standard. Results: The elastography consistency with the pathologic result was good (ĸ=0.84). The specificity and the index of validity were 91.7 and 94.4%, respectively; while the negative predictive value was 84.6%. The 16 patients with mixed elastographic pattern (ye3) had residual tumor located in some of the layers of the rectum wall. The Youden index reached values close to 1. Conclusions: The value of this technique resides in its diagnostic specificity and negative predictive value when differentiating fibrosis from the residual tumor in the rectal wall.

Recent advances in delineation of clinical target volume in radiotherapy for rectal cancer / 中华放射肿瘤学杂志

The delineation of clinical target volume (CTV) is a critical step in planning conformal radiotherapy for rectal cancer.Several guidelines suggest different subvolumes and anatomical boundaries in radiotherapy for rectal cancer, potentially leading to a misunderstanding of CTV definition.This article reviews recent advances in the delineation of CTV in radiotherapy for rectal cancer.

Recent advances in preoperative intensity-modulated radiation therapy ( IMRT) for rectal cancer / 中华放射肿瘤学杂志

More than 20 studies published during the past 10 years concerning preoperative radiotherapy in rectal cancer were reviewed carefully. And we evaluated the role of IMRT being routinely used in preoperative treatment of rectal cancer.

A prognostic analysis of patients with pathologic complete response after preoperative neoadjuvant chemoradiotherapy for locally advanced rectal cancer / 中华放射肿瘤学杂志

Objective To analyze the clinical factors for pathologic complete response ( pCR) after preoperative neoadjuvant chemoradiotherapy ( neo?CRT) for locally advanced rectal cancer. Methods From 2005 to 2012, 297 patients with locally advanced rectal cancer and complete clinical data were enrolled as subjects. Those patients were diagnosed with biopsy and treated with neo?CRT ( radiotherapy by 3?dimonsional conformal radiotherapy or volumetric?modulated arc therapy) followed by radical surgery. The logistic regression model was used for the multivariate analyses of the correlation of pCR with age, gender, distance between tumor and the anal verge, serum level of carcinoembryonic antigen ( CEA ) before treatment, hemoglobin level before treatment, cT staging, and cN staging. Results In all patients, 78 ( 26?7%) patients had pCR after treatment. The numbers of patients with pCR were 42( 34?4%) in patients with stage T1?T3 disease and 37(21?1%) in patients with stage T4 disease. In the patients with serum CEA levels no higher than 5?33 ng/ml, 55(36?4%) had pCR after treatment, while in the patients with serum CEA levels higher than 5?33 ng/ml, only 24( 16?4%) had pCR. The univariate analysis revealed that age, gender, distance between tumor and the anal verge, anemia before treatment, or cN staging were not related to pCR. The multivariate analysis showed that stage cT1?T3 and a serum CEA level no higher than 5?33 ng/ml before treatment were influencing factors for pCR after neo?CRT for locally advanced rectal cancer ( P=0?031,P=0?000) . Conclusions The clinical staging and the serum CEA level before treatment are influencing factors for pCR after neo?CRT for locally advanced rectal cancer. The serum CEA level before treatment can be considered as a predictor of pCR after neo?CRT for locally advanced rectal cancer.

The expression of N-cadherin and vimentin in rectum adenocarcinoma and their clinical value / 重庆医学

Objective To observe the expression of neuronal cadherin (N-cadherin) and vimentin in primary rectum adenocarci-noma tissues and their clinical value .Methods 58 cases of primary rectum adenocarcinoma tissues after surgical resection and con-firmed by pathology ,and normal rectum tissues that at lest 5 cm away from the tumor were selected .The immunohistochemical SP method was used to detect the expression of N-cadherin and vimentin and analyzed their correlation .Results In rectum adenocarci-noma tissues ,the positive expression rate of N-cadherin and vimentin[53 .4% (31/58) ,46 .6% (27/58)]were significantly higher than those of in normal rectum mucosa tissues[3 .4% (2/58) ,1 .7% (1/58)] ,(P0 .05) .Conclusion N-cadherin and vim-entin have close relationships with metastasis of rectum adenocarcinoma ,to detect the expressions of N-cadherin and vimentin is of a effective method to judge the metastasis and prognosis of rectum adenocarcinoma .

Protocolo eletrônico de coleta de dados clínicos da microcirurgia endoscópica transanal (TEM): desenvolvimento e aplicação / Electronic protocol of clinical data collection in transanal endoscopic microsurgery (TEM): development and application

INTRODUÇÃO: A coleta de dados na forma prospectiva melhora a assistência ao paciente e o acesso à informação. Os registros feitos em prontuários de papel geralmente não trazem informação satisfatória, pois os dados acabam sendo perdidos ou não coletados adequadamente. A informática na saúde possibilita o melhor uso da informação, servindo, inclusive, como suporte para pesquisas científicas. OBJETIVOS: 1 - Criar, informatizar e armazenar uma base de dados clínicos da Microcirurgia Endoscópica Transanal (TEM), incorporando-a ao SINPE© e realizando coleta de dados; 2 - apresentar estudo descritivo dos resultados da coleta de dados realizada em 59 pacientes submetidos a TEM. MÉTODOS: Primeiro foi realizada a criação da base teórica de dados da TEM, que foi a seguir informatizada e incorporando-a ao SINPE© e realizou-se a coleta de dados. Segundo, efetuou-se estudo descritivo com interpretação das informações obtidas através de estatísticas e gráficos pelo módulo SINPE©Analisador. RESULTADOS: A utilização do software possibilitou a criação do protocolo da TEM. Os dados armazenados pela coleta de 59 pacientes submetidos ao procedimento cirúrgico foram resgatados e analisados pelo módulo SINPE Analisador©, gerando gráficos e estudos descritivos automaticamente. Verificou-se que 74,55 por cento (41) dos pacientes apresentavam, antes do procedimento operatório, o diagnóstico de adenoma. No estadiamento pré-operatório realizado por ultrassonografia transrretal, notou-se que a maioria dos tumores apresentaram estadiamento pré-operatório de adenoma (uT0). Em relação ao acometimento linfonodal dois foram avaliados no ultrassom como comprometidos. Quanto à profundidade de ressecção da parede retal verificou-se que mais de 60 por cento dos pacientes submetidos à TEM realizaram ressecção em bloco de toda a parede retal, ou seja, até a gordura perirretal. Verificou-se, que o número total de pacientes portadores de adenocarcinoma foi maior no estudo histopatológico...

BACKGROUND: Prospective data collection improves patient care and information access. Written medical records frequently are not well done, due to bad collected data associated to the risk of loosing important items. The use of computer technology in health care system provides better information. OBJECTIVES: To create, computerize and store a clinical database to Transanal Endoscopic Microsurgery (TEM), and it´s incorporation into SINPE© software; to present a descriptive study from 59 patients submitted to TEM. METHODS: Initially was created an Word® questionnaire containing all clinical data concerning to TEM; afterwards, this base was computerized and incorporated into SINPE© and, then, data started to be collected. Later, a descriptive study was done using the database with statistic analysis generated through SINPE©Analisador module. Finally, datamining studies verified patterns and tendencies which could not be visualized from simple data collection. RESULTS: The software allowed creation of TEM protocol. The data stored by collecting 59 patients undergoing the surgical procedure were recovered and analyzed by SINPE©Analisador module, generating charts and statistic automatically. It was found that 74.55 percent (41) of the patients presented with the diagnosis of adenoma before the surgical procedure. Preoperative staging conducted by transrectal ultrasonography defined most tumors as adenomas (uT0). Ultrasound identified that two lymph nodes were involved. With regard to the depth of the rectal wall resection, it was found that over 60 percent of the patients who underwent TEM had a full-thickness resection of all rectal wall, i.e., up to the peri-rectal fat. The total number of adenocarcinoma patients was greater in the histopathological study of the surgical specimen than in the preoperative biopsy. The results for the histopathological staging of the surgical specimen revealed differences between pre- and postoperative staging...

Rectal Teratoma coexistent with an Ovarian Teratoma: A Case Report

We report a case of rectal teratoma coexistent with an ovarian teratoma. To our knowledge, this is the first radiologic report of rectal teratoma. Computed tomography (CT) showed a sharply demarcated cystic and fatty mass with amorphous calcification in the rectum. A double-contrast barium study showed a well-defined intraluminal rectal mass without mucosal destruction. Imaging findings of rectal teratoma allow for correct preoperative diagnosis. CT was helpful in differentiating rectal teratoma from other rectal lesions.

Assessment of the Prognostic Factors for a Local Recurrence of Rectal Cancer: the Utility of Preoperative MR Imaging

OBJECTIVE: To determine the utility of MR imaging in evaluating the prognostic factors for a local recurrence of rectal cancer following a curative resection. MATERIALS AND METHODS: The preoperative MR images obtained from 17 patients with a local recurrence and 54 patients without a local recurrence, who had undergone a curative resection, were independently evaluated by three radiologists. The following findings were analyzed: the direct invasion of the perirectal fat by the primary rectal carcinoma, involvement of the perirectal lymph nodes, perirectal spiculate nodules, perivascular encasement, and an enlargement of the pelvic wall lymph nodes. The clinical and surgical profiles were obtained from the patients' medical records. The association of a local recurrence with the MR findings and the clinicosurgical variables was statistically evaluated. RESULTS: Of the MR findings, the presence of perivascular encasement (p = 0.001) and perirectal spiculate nodules (p = 0.001) were found to be significant prognostic factors for a local recurrence. Of the clinicosurgical profiles, the presence of a microscopic vascular invasion (p = 0.005) and the involvement of the regional lymph nodes (p = 0.006) were associated with a local recurrence. Logistic regression analysis showed that the presence of perirectal spiculate nodules was an independent predictor of a local recurrence (odds ratio, 7.382; 95% confidence interval, 1.438, 37.889; p = 0.017). CONCLUSION: The presence of perirectal spiculate nodules and perivascular encasement on the preoperative MR images are significant predictors of a local recurrence after curative surgery for a rectal carcinoma. This suggests that preoperative MR imaging can provide useful information to help in the planning of preoperative adjuvant therapy.

Follow-up Results After Negative Findings on Unenhanced Hepatic MR Imaging for Hepatic Metastasis from Rectal Cancer

OBJECTIVE: To assess the follow-up results after negative findings on unenhanced hepatic MR imaging in rectal cancer patients who have undergone locally curative surgery. MATERIALS AND METHODS: From all pertinent imaging reports and medical records, we selected 255 patients who had negative results on unenhanced hepatic MR imaging. When selecting patients who had undergone curative resection, the following patients were excluded from the study: 1) patients in whom extrahepatic metastases were detected on preoperative staging work-ups, 2) patients in whom the surgery was judged to be non-curative due to peritoneal seeding or local aggressiveness. Cases with follow-up periods of less than 18 months were also excluded, as these cases were considered insufficient to confirm the negative outcomes. Thus, a total of 149 patients were ultimately enrolled in our study. The follow-up results of unenhanced MR imagings were assessed according to the assumption that the newly developed hepatic metastases had been false-negative lesions on preoperative MR image. RESULTS: During a median follow-up period of 29.3 months, 25 hepatic metastases were detected in 13 patients (8.7%), which indicated a negative predictive value of 91.3%. CONCLUSION: Unenhanced hepatic MR imaging provides a high negative predictive value with regard to the detection of hepatic metastasis in the preoperative evaluation of rectal cancer.

CT Findings and Clinical Characteristics of Colorectal Mucinous Adenocarcinoma

PURPOSE: To establish the CT findings and clinical characteristics of colorectal mucinous adenocarcinoma. MATERIALS AND METHODS: The CT features of 26 surgically proven cases of colorectal mucinous adenocarcinoma were reviewed. The subjects were selected from among 262 patients with colorectal cancer, of whom 40 with non-mucinous adenocarcinoma were included as a control group. Contrast-enhaneed CT images were analyzed for tumor location, the presence or absence of tumoral calcification, tumor shape (circumferential or eccentric, polypoid or infiltrative), tumor thickness-to-length ratio, and attenuation and homogeneity. In each group, the TNM stage of pathologic specimens was compared. During follow-up, the incidence of recurrence, and outcome, were also compared. RESULTS: CT images of mucinous adenocarcinoma revealed intratumoral calcification in three patients (12%, p < 0.01). Tumors were eccentric and polypoid-shaped, with a high tumoral thickness/length ratio (p < 0.01). On contrast-enhanced images, most were seen as a heterogenous hypoattenvuted mass. No differences in T-NM stage were found in surgical specimens. In patients with mucinous adenocarcinoma, recurrence during the early follow-up period is more common than in patients with non-mucinous cancer. CONCLUSION: Contrast-enhanced CT reveals mucinous adenocarcinoma as an eccentric polypoid mass with heterogeneous hypoattenuation. In patients with mucinous colorectal cancer, careful follow-up is required because tumors tend to recur early in the follow-up period.

CT Findings and Clinical Characteristics of Colorectal Mucinous Adenocarcinoma

PURPOSE: To establish the CT findings and clinical characteristics of colorectal mucinous adenocarcinoma. MATERIALS AND METHODS: The CT features of 26 surgically proven cases of colorectal mucinous adenocarcinoma were reviewed. The subjects were selected from among 262 patients with colorectal cancer, of whom 40 with non-mucinous adenocarcinoma were included as a control group. Contrast-enhaneed CT images were analyzed for tumor location, the presence or absence of tumoral calcification, tumor shape (circumferential or eccentric, polypoid or infiltrative), tumor thickness-to-length ratio, and attenuation and homogeneity. In each group, the TNM stage of pathologic specimens was compared. During follow-up, the incidence of recurrence, and outcome, were also compared. RESULTS: CT images of mucinous adenocarcinoma revealed intratumoral calcification in three patients (12%, p < 0.01). Tumors were eccentric and polypoid-shaped, with a high tumoral thickness/length ratio (p < 0.01). On contrast-enhanced images, most were seen as a heterogenous hypoattenvuted mass. No differences in T-NM stage were found in surgical specimens. In patients with mucinous adenocarcinoma, recurrence during the early follow-up period is more common than in patients with non-mucinous cancer. CONCLUSION: Contrast-enhanced CT reveals mucinous adenocarcinoma as an eccentric polypoid mass with heterogeneous hypoattenuation. In patients with mucinous colorectal cancer, careful follow-up is required because tumors tend to recur early in the follow-up period.

Low Grade MALT Lymphoma of Rectum: A Case Report

We report a case with low-grade MALT lymphoma of the rectum in a 32-year-old man. Primary lymphoma of thecolon is rare and comprises less than 1 % of large bowel malignancies. Recently, large part of colonic lymphomahave been shown to be MALT lymphoma, which is a distinct type of B-cell lymphoma. The radiologic findings of thiscase are mucosal nodularity with shallow ulcers in the rectum, as seen on bar-ium enema, and rectal wallthickening, as seen on CT. There was no evidence of intra-abdominal lym-phadenopathy nor hepatosplenomegaly. Suchradiologic findings are rather similar to the findings in cases of inflammatory bowel disease, rending thedifferential diagnosis difficult.

Early Colon Cancer: Findings on Double Contrast Barium Enema

PURPOSE: To describe the radiologic findings of early colon cancer on double-contrast barium enema. MATERIALS AND METHODS: We retrospectively reviewed the double-contrast barium enemas of eight patients (M:F=6:2;mean age:67yrs;range:48-77 yrs) who were pathologically proven to be early colon cancer. The location, size and grossmorphology of lesions was evaluated using double-con-trast barium enema, while depth of invasion, degree ofdifferentiation, precancerous lesions and lymph node metastasis were evaluated histopathologically. RESULTS:Early colon cancer was found in the rectum(n=4), sigmoid colon (n=3) and ascending colon(n=1). The size of massranged from 2.3-8.3(mean, 4.6)cm. And the polypoid type was most common(n=7);this was subdivided into sessile(IS,n=5), semipedunculated (ISP, n=1) and pedunculated type(Ip, n=1). Another mass was a sessile polypoid combinedwith a flat depressed lesion. In eight cases, four cancers were confined to the mucosa, while the remaining fourhad infiltrated the submucosa. Most cancers arose from villous and villotubular adenoma. All cases werewell-differentiated adenocarcinoma and no metastasis to lymph nodes had occurred. CONCLUSION: In early coloncancer, lesions were mainly polypoid and large. Most arose from villous and villotubular adenoma.

MR Evaluation of Rectal Carcinoma: Pelvic Phased-Array Coil versus Endorectal-Pelvic Phased-Array Coil

PURPOSE: To compare the accuracy of MR imaging using an endorectal-pelvic and a pelvic phased-array coil forpreoperative local staging of rectal carcinoma. MATERIALS AND METHODS: To determine preoperative staging, 38patients with rectal carcinoma underwent MR imaging. All patients were examined with both an endorectal-pelvic anda pelvic phased-array coil. All underwent surgery and staging was pathologically confirmed. Two radiologistsblinded to pathologic stage analyzed perirectal invasion and perirectal node metastasis, and scored according to afour-point scale. Radiologic and pathologic findings were correlated. Receiver operating characteristic (ROC)analysis of Wilcoxon statistic (W values) was used to compare diagnostic accuracy between the two different MRmethods. Interobserver variation was measured using kappa statistics. RESULTS: For perirectal invasion, T1WIendorectal-pelvic phased-array coil images (reader 1: 0.854, reader 2: 0.818) showed higher W values than pelvicphased-array coil images (reader 1: 0.755, reader 2: 0.811). On T2WI, W values were higher according to pelvicphased-array coil images (reader 1: 0.828, reader 2: 0.861) than according to endorectal-pelvic phased-array coilimages (reader 1: 0.813, reader 2: 0.786). For perirectal node metastasis, pelvic phased-array coil images (reader1: 0.745, reader 2: 0.792) showed higher W values than endorectal-pelvic phased-array coil images (reader 1:0.722, reader 2: 0.775), according to both reader 1 and 2. The defference kappa values between the two readers wasless than 0.4 ; agreement between them was poor. CONCLUSION: The use of an endorectal-pelvic phased-array coildid not significantly improve the accuracy of assessment of perirectal invasion and perirectal node metastasis,and in MR imaging of rectal corcinoma, the routine use of an endorectal coil is not advocated.

MRI with Endorectal Coil in Rectal tumor Staging: Is Gadolinium Enhancement Helpful?

PURPOSE: To determine whether gadolinium enhancement is helpful in rectal tumor staging determined by MRI and using an endorectal surface coil. MATERIALS AND METHODS: Between January 1995 and July 1996, we studied 17 MRI scans in which the scanning procedure had involved the use of an endorectal coil ; this was a prostate coil in six patients, and a colon coil in eleven. Eight patients were male and nine were female ; they were aged between 39 and 77 (mean, 59) years, and the tumors which had presented were adenocarcinoma (n=15), lymphoma (n=1) and villous adenoma (n=1). Precontrast scanning showing invasion of the rectal wall and perirectal fat were interpreted, and postcontrast T1WI and pathological findings were then compared. Fifteen patients underwent surgical resection but the other two (one adenocarcinoma and one lymphoma) underwent only an endoscopic biopsy. RESULTS: On precontrast scanning with the prostate coil, accurate staging was possible in three cases (one of stage T2, and two of stage T3) ; we overstaged two cases of stage T2 as stage T3. On postcontrast T1WI, however, we additionally understaged one case of stage T3 as stage T2. In a case of adenocarcinoma proven by biopsy, no definite difference was noted between pre- and postenhanced scan. On precontrast scan using a colon coil, accurate staging was possible in six cases (two of stage T1, one of stage T2 and three of stage T3). We overstaged a case of stage T2 as stage T3 and understaged three cases of stage T3 as stage T2. On postcontrast T1WI, however, we accurately diagnosed one additional case of stage T3, not diagnosed on precontrast scan. In one case of bioptically-proven lymphoma, no definite difference was noted between pre- and postenhanced scan. CONCLUSION: In rectal tumor staging, pre- and postenhanced scans are both 60% accurate. In MRI using an endorectal surface coil, gadolinium enhancement is not, therefore significantly helpful.

CT guided ~(125)Ⅰseed brachytherapy for recurrent rectum cancer / 中华放射肿瘤学杂志

Objective To investigate the technological feasibility,efficacy and morbidity of cr guided ~(125)Ⅰseed implantation for recurrent rectum cancer.Methods Twenty-three patients with recurrent rectum cancer were treated with cr guided interstitial ~(125)Ⅰseed brachytherapy.In 20 patients the procedure was performed under epidural anesthesia and 3 patients under local anesthesia.Treatment planning system was used to calculate the number of seeds,the space distribution and the introduction of the seeding needles.Matched peripheral dose (MPD) of ~(125)Ⅰseed implantation ranged from 90-120 Gy for patients who had had external radiotherapy,and 140- 160Gy for those who had not.The planning target volume(PTV)was clinical target volume(CTV)plus 1 cm margin.The range of radioactivity of the ~(125)Ⅰseeds was 18.5-25.9 MBq.All these 23 patients had CT scan at 5 mm intervals after implantation for quality evaluation,together with routine chest,pelvic X-ray films within 24-48 hours after seed implantation.Three patients received three-dimensioual conformal radiation therapy(3DCRT) to a total dose of45-50 Gy,with 2-3 Gy/f.Follow-up time was from 3 to 28 months.Results All patients was able to tolerate seed implantation well.Complete pain relief was observed in 12/15,and partial relief in 2/15 and no response in 1/15,with a response rate of 93%.The local control rate was 87%.The 1-and 2-year survival rate was 93% and 50% respectively.Two of four patients have died of dissemination to the lung after 8 and 12 months. One seed has migrated into the pelvis without causing any untoward morbidity.Conclusion CT guided ~(125)Ⅰseed implantation for recurrent rectum cancer is safe,minimally invasive,causing only mild morbidity.It possesses a high efficacy,yet it should be given in combination with external beam radiation and chemotherapy,should distant metastasis be observed.