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1.
Chinese Journal of Practical Surgery ; (12): 260-265, 2019.
Article in Chinese | WPRIM | ID: wpr-816383

ABSTRACT

OBJECTIVE: To offer some important insights into clinical decision-making by evaluating endorectal ultrasound and rectal MRI when they were used to predict pathological complete response for rectal cancer patients who were performed neoadjuvant therapy. METHODS: The study was a prospective cohort study which was conducted at a single tertiary care center. Patients diagnosed with mid-low rectal cancer between May 2014 and June 2018 in Peking Union Medical College Hospital were collected in the study. Both of their endorectal ultrasound and rectal MRI were performed to evaluate the tumor stage before their preoperative chemoradiation and were reevaluated at the 6 to 7 th weeks after their preoperative radiation treatment. The pathological preoperative tumor staging achieved by endorectal ultrasound and rectal MRI was compared with postoperative staging by pathologic examination. Sensitivity,specificity,accuracy and Youden index of each evaluation method and their combination were calculated. The ROC curve was administered likewise. RESULTS: A total of 247 patients were enrolled in the study. The sensitivity,specificity,accuracy,positive predictive value,negative predictive value and Youden index for ypT0 N0 separate evaluation of for whom was qualified as compete endorectal ultrasound(163 patients) and of rectal MRI(212 patients) was15.9% and 23.1%,94.0% and 94.9%,77.8% and 83.4%,0.1 and 0.2. Combined two methods,the data were recorded as 13.6%,98.1%,83.6% and 0.1.Area under curve ROC for ultrasound and MRI when using specifically for ypT0 N0 measurement was 0.656 and 0.742.The two modalities showed 0.517 and 0.667 in terms of AUC when comparing with each other. CONCLUSION: The sensitivity of MRI and ERUS as terms of diagnosing complete response is rather unsatisfactory,although they all bear a relatively good specificity. For the patients not diagnosed with clinical response by one of the two methods,radical operations were strongly recommended. For the patients confirmed as complete response by both modalities,there still exists possibilities that residual tumor persists,“watch and wait”approach can be taken cautiously and the patient must be followed up intensely.

2.
Investigative Magnetic Resonance Imaging ; : 51-55, 2017.
Article in English | WPRIM | ID: wpr-109032

ABSTRACT

PURPOSE: Extraosseous Ewing's sarcoma (EOE) of the rectum is extremely rare: only three cases have been reported in the literature and none of these reports described their imaging findings in detail. Herein, we describe the tumor imaging and pathological features in detail. MATERIALS AND METHODS: We report a case of rectal EOE in a 72-year-old female who received local excision and was provisionally diagnosed with a rectal submucosal spindle cell tumor. We used immunohistochemistry, histopathology, and fluorescence in situ hybridization to characterize the tumor and provide a definitive diagnosis of EOE. RESULTS: MRI revealed a well-demarcated submucosal tumor with heterogeneous enhancement and hemorrhagic foci in rectum. EOE was diagnosed by positive staining of tumor cells for CD99 and Fli-1 by immunohistochemistry and the presence of the EWSR1 gene translocation by fluorescence in situ hybridization. Although the patient underwent radiation treatment and surgery, the tumor recurred after 4 months as revealed by computed tomography and magnetic resonance imaging. CONCLUSION: Rectal EOE may present as a rectal submucosal tumor. The understanding of imaging and histological characteristics of this tumor are critical for accurate diagnosis and appropriate aggressive treatment.


Subject(s)
Aged , Female , Humans , Diagnosis , Fluorescence , Immunohistochemistry , In Situ Hybridization , Magnetic Resonance Imaging , Rectum , Sarcoma, Ewing
3.
Rev. argent. radiol ; 73(2): 187-191, abr.-jun. 2009. ilus, tab
Article in Spanish | LILACS | ID: lil-634761

ABSTRACT

Propósito: Determinar si la RM puede predecir el compromiso tumoral del margen de resección circunferencial (MRC) en pacientes con cáncer de recto. Material y Métodos: Entre abril del 2005 y marzo del 2008, se evaluaron por resonancia magnética (RM), en forma consecutiva, 70 pacientes (40 M y 30 H, edad promedio de 64 años, rango de 34-78 años), con diagnóstico endoscópico y por biopsia de cáncer rectal inferior o medio. Se realizó una RM sin contraste E.V. en un equipo Siemens Avanto 1.5T, con bobina phase array de superficie. Se efectuaron secuencias con cortes finos ponderadas en T2 (TR¬-TE 4200-88, espesor de 3mm, gap 0, matriz de 256 x 256, FOV de 150x150 mm) en los planos axial, sagital y coronal. Los pacientes recibieron un enema rectal de 150 ml de glicerina previo al examen. No se realizó insuflación colónica ni administración de antiespasmódicos. Se midió la distancia más corta desde el borde del tumor hasta el MRC. Una distancia ≤ 2 mm en el plano axial se consideró como compromiso del MRC. Resultados: El MRC fue ≤ 2 mm tanto por RM como por anatomía patológica en 26 pacientes. En 8 casos, el MRC fue menor por RM que por anatomía patológica. En 32 pacientes el MRC estaba respetado por ambas metodologías diagnósticas y 4 pacientes fueron considerados positivos para compromiso del MRC en histología pero negativos por RM. La sensibilidad, especificidad, valor predictivo positivo y negativo de la RM para el compromiso tumoral del MRC fue de 86%, 80%, 76% y 88% respectivamente. Conclusión: La RM brinda información confiable del compromiso tumoral del MRC en pacientes con cáncer rectal, aportando una ayuda en la evaluación de este factor pronóstico de riesgo en pacientes previo al tratamiento quirúrgico.


Purpose: To determine whether magnetic resonance imaging (MRI) can predict tumor involvement of the circumferential resection margin (CRM) in patients with rectal cancer. Materials and methods: Between april 2005 and march 2008, 70 consecutive patients (mean age 64, range 34-78 years), 40 F and 30 M, with endoscopy and biopsy- proven middle and lower rectal cancer. Non contrast enhanced MRI was performed on a Siemens Avanto 1.5 T. A phased array coil was used and T2 weighted thin section sequences (TR/TE 4200/88, slice thickness 3mm, gap 0, matrix 256 x 256, field of view 150 x 150 mm) were performed in axial, sagittal and coronal orientations. Patients received a 150 ml glycerin enema before examination. No air insufflations or intramuscular antispasmodic was used. The shortest distance from the tumor edge to the circumferential margin was measured. A distance ≤ 2 mm, analyzed in axial slices, was considered as definition of circumferential margin involvement. Results: The CRM was 2 mm in both MRI and histopathological findings in 26 patients. In 8 cases the CRM was shorter on MRI than in histopathological sections. In 32 patients the CRM was respected in both exams and 4 patients were considered positive on histopathological findings but negative in MRI. The sensitivity, specificity, positive and negative predictive values for prediction of tumor involvement of CRM were 86%, 80%, 76% and 88%, respectively. Conclusions: MRI gives reliable information on tumor involvement of the CRM in patients with rectal cancer. This may provide accurate identification of an important prognostic risk factor in patients prior to surgical treatment.

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