Magnetic resonance imaging-based lymph node radiomics for predicting the metastasis of evaluable lymph nodes in rectal cancer

BACKGROUND Lymph node(LN)staging in rectal cancer(RC)affects treatment decisions and patient prognosis.For radiologists,the traditional preoperative assessment of LN metastasis(LNM)using magnetic resonance imaging(MRI)poses a challenge.AIM To explore the value of a nomogram model that combines Conventional MRI and radiomics features from the LNs of RC in assessing the preoperative metastasis of evaluable LNs.METHODS In this retrospective study,270 LNs(158 nonmetastatic,112 metastatic)were randomly split into training(n=189)and validation sets(n=81).LNs were classified based on pathology-MRI matching.Conventional MRI features[size,shape,margin,T2-weighted imaging(T2WI)appearance,and CE-T1-weighted imaging(T1WI)enhancement]were evaluated.Three radiomics models used 3D features from T1WI and T2WI images.Additionally,a nomogram model combining conventional MRI and radiomics features was developed.The model used univariate analysis and multivariable logistic regression.Evaluation employed the receiver operating characteristic curve,with DeLong test for comparing diagnostic performance.Nomogram performance was assessed using calibration and decision curve analysis.RESULTS The nomogram model outperformed conventional MRI and single radiomics models in evaluating LNM.In the training set,the nomogram model achieved an area under the curve(AUC)of 0.92,which was significantly higher than the AUCs of 0.82(P<0.001)and 0.89(P<0.001)of the conventional MRI and radiomics models,respectively.In the validation set,the nomogram model achieved an AUC of 0.91,significantly surpassing 0.80(P<0.001)and 0.86(P<0.001),respectively.CONCLUSION The nomogram model showed the best performance in predicting metastasis of evaluable LNs.

Significance and prognostic value of increased serum direct bilirubin level for lymph node metastasis in Chinese rectal cancer patients

AIM: To determine the significance of increased serum direct bilirubin level for lymph node metastasis(LNM) in Chinese rectal cancer patients, after those with known hepatobiliary and pancreatic diseases were excluded.METHODS: A cohort of 469 patients, who were treated at the China-Japan Friendship Hospital, Ministry of Health(Beijing, China), in the period from January 2003 to June 2011, and with a pathological diagnosis of rectal adenocarcinoma, were recruited. They included 231 patients with LNM(49.3%) and 238 patients without LNM. Follow-up for these patients was taken through to December 31, 2012.RESULTS: The baseline serum direct bilirubin concentration was(median/inter-quartile range) 2.30/1.60-3.42 μmol/L. Univariate analysis showed that compared with patients without LNM, the patients with LNM had an increased level of direct bilirubin(2.50/1.70-3.42 vs 2.10/1.40-3.42, P = 0.025). Multivariate analysis showed that direct bilirubin wasindependently associated with LNM(OR = 1.602; 95%CI: 1.098-2.338, P = 0.015). Moreover, we found that:(1) serum direct bilirubin differs between male and female patients; a higher concentration was associated with poor tumor classification;(2) as the baseline serum direct bilirubin concentration increased, the percentage of patients with LNM increased; and(3) serum direct bilirubin was associated with the prognosis of rectal cancer patients and higher values indicated poor prognosis.CONCLUSION: Higher serum direct bilirubin concentration was associated with the increased risk of LNM and poor prognosis in our rectal cancers.

Radiomics for differentiating tumor deposits from lymph node metastasis in rectal cancer

BACKGROUND Tumor deposits(TDs)are not equivalent to lymph node(LN)metastasis(LNM)but have become independent adverse prognostic factors in patients with rectal cancer(RC).Although preoperatively differentiating TDs and LNMs is helpful in designing individualized treatment strategies and achieving improved prognoses,it is a challenging task.AIM To establish a computed tomography(CT)-based radiomics model for preoperatively differentiating TDs from LNM in patients with RC.METHODS This study retrospectively enrolled 219 patients with RC[TDs+LNM-(n=89);LNM+TDs-(n=115);TDs+LNM+(n=15)]from a single center between September 2016 and September 2021.Single-positive patients(i.e.,TDs+LNM-and LNM+TDs-)were classified into the training(n=163)and validation(n=41)sets.We extracted numerous features from the enhanced CT(region 1:The main tumor;region 2:The largest peritumoral nodule).After deleting redundant features,three feature selection methods and three machine learning methods were used to select the best-performing classifier as the radiomics model(Rad-score).After validating Rad-score,its performance was further evaluated in the field of diagnosing double-positive patients(i.e.,TDs+LNM+)by outlining all peritumoral nodules with diameter(short-axis)>3 mm.RESULTS Rad-score 1(radiomics signature of the main tumor)had an area under the curve(AUC)of 0.768 on the training dataset and 0.700 on the validation dataset.Rad-score 2(radiomics signature of the largest peritumoral nodule)had a higher AUC(training set:0.940;validation set:0.918)than Radscore 1.Clinical factors,including age,gender,location of RC,tumor markers,and radiological features of the largest peritumoral nodule,were excluded by logistic regression.Thus,the combined model was comprised of Rad-scores of 1 and 2.Considering that the combined model had similar AUCs with Rad-score 2(P=0.134 in the training set and 0.594 in the validation set),Rad-score 2 was used as the final model.For the diagnosis of double-positive patients in the mixed group[TDs+LNM+(n=15);single-positive(n=15)],Rad-score 2 demonstrated moderate performance(sensitivity,73.3%;specificity,66.6%;and accuracy,70.0%).CONCLUSION Radiomics analysis based on the largest peritumoral nodule can be helpful in preoperatively differentiating between TDs and LNM.

T1 rectal mucinous adenocarcinoma with bilateral enlarged lateral lymph nodes and unilateral metastasis:A case report

BACKGROUND There are a few cases of lateral lymph node(LLN)metastasis(LLNM)of T1 rectal cancer.Moreover,LLNM is easily missed,especially in patients with early-stage rectal cancer.To our knowledge,the possibility of bilateral LLNM before surgery has not been reported in previous studies.CASE SUMMARY A 36-year-old woman underwent endoscopic submucosal dissection at a local hospital owing to a clinical diagnosis of a rectal polyp.The pathology report showed a diagnosis of T1 rectal mucinous adenocarcinoma.She was considered to have bilateral LLNM after the examination at our hospital.Laparoscopic total mesorectal excision plus bilateral LLN dissection was performed and the pathological outcomes indicated unilateral LLNM.The patient received longcourse adjuvant chemoradiotherapy with no recurrence or metastasis observed during the 1-year follow-up period.CONCLUSION T1 rectal cancer could lead to LLNM and possibly,bilateral LLNM.Therefore,adequate clinical evaluation is essential for these patients.

Risk factors of lymph node metastasis in rectal neuroendocrine tumors

Objective The aim of this study was to investigate the risk factors of lymph node metastasis in rectal neuroendocrine neoplasms(RNENs).Methods We enrolled 168 patients with RNENs as the research object,and their clinicopathological and survival data were collected.The risk factors affecting lymph node metastasis were analyzed retrospectively,and independent risk factors affecting prognosis were evaluated.Results Analysis showed that age,tumor diameter,tumor function,grade,and T stage were correlated with lymph node metastasis(P<0.05).Multiple logistic regression analysis showed that tumor size,grade,and T stage were independent risk factors for lymph node metastasis in patients with RNENs.Kaplan-Meier analysis showed that the 5-year overall survival(OS)of patients with lymph node metastasis was 40.0%(10/25),and that of patients without lymph node metastasis was 93.0%(133/143).The prognosis of RNENs patients with lymph node metastasis along with patients with large tumor diameter and high grade was poor.Cox multivariate analysis showed that tumor diameter(HR=1.985,P=0.008),grade(HR=3.416,P=0.004),T stage(HR=2.413,P=0.014),and lymph node metastasis(HR=3.119,P=0.000)were independent risk factors affecting the prognosis of patients with RNENs.Conclusion Tumor size,grade,and T stage are the main risk factors for lymph node metastasis and prognosis in patients with RNENs.These risk factors should be fully evaluated before surgery.

Lateral pelvic lymph nodes for rectal cancer:A review of diagnosis and management

The current status and future prospects for diagnosis and treatment of lateral pelvic lymph node(LPLN)metastasis of rectal cancer are described in this review.Magnetic resonance imaging(MRI)is recommended for the diagnosis of LPLN metastasis.A LPLN-positive status on MRI is a strong risk factor for metastasis,and evaluation by MRI is important for deciding treatment strategy.LPLN dissection(LPLD)has an advantage of reducing recurrence in the lateral pelvis but also has a disadvantage of complications;therefore,LPLD may not be appropriate for cases that are less likely to have LPLN metastasis.Radiation therapy(RT)and chemoradiation therapy(CRT)have limited effects in cases with suspected LPLN metastasis,but a combination of preoperative CRT and LPLD may improve the treatment outcome.Thus,RT and CRT plus selective LPLD may be a rational strategy to omit unnecessary LPLD and produce a favorable treatment outcome.

Metastasis and micrometastasis in ultra-low rectal cancer

Objective:The aim of our study was to investigate the lymph node metastasis of mesorectum and ischiorectal foss in ultra-low rectal cancer and its influence on the surgical procedure selection.Methods:Large slices and tissue microarray technology were used to detect metastasis lymph nodes from 23 dissected specimens of ultra-low rectal cancer.Results:415 lymph nodes were detected in the 23 specimens.169 and 59 lymph nodes were metastasis and micrometastasis, respectively.Twelve specimens were diagnosed with lymph node metastasis, while other 4 specimens were with lymph node micro-metastasis.There were 29.0% (49/169) and 17.2% (29/169) metastatic lymph nodes located in the outer and anterior region of mesorectum.There were 2 cases with ischiorectal fossa lymph node metastasis and 1 case with micrometastasis.The 3 metastatic cases were only 13% (13/23) of all the 23 cases.Conclusion:There is regional lymph node metastasis existing in ultra-low rectal cancer.The metastatic incidences in distal mesorectum and ischiorectal fossa are relatively low.Considering Miles operation as the standard surgical procedure for ultra-low rectal cancer should be evaluated renewedly.

Selective lateral lymph node dissection after neoadjuvant chemoradiotherapy in rectal cancer

BACKGROUND Lateral lymph node metastasis is one of the leading causes of local recurrence in patients with advanced mid or low rectal cancer.Neoadjuvant chemoradiotherapy(NCRT)can effectively reduce the postoperative recurrence rate;thus,NCRT with total mesorectal excision(TME)is the most widely accepted standard of care for rectal cancer.The addition of lateral lymph node dissection(LLND)after NCRT remains a controversial topic.AIM To investigate the surgical outcomes of TME plus LLND,and the possible risk factors for lateral lymph node metastasis after NCRT.METHODS This retrospective study reviewed 89 consecutive patients with clinical stage II-III mid or low rectal cancer who underwent TME and LLND from June 2016 to October 2018.In the NCRT group,TME plus LLND was performed in patients with short axis(SA)of the lateral lymph node greater than 5 mm.In the non-NCRT group,TME plus LLND was performed in patients with SA of the lateral lymph node greater than 10 mm.Data regarding patient demographics,clinical workup,surgical procedure,complications,and outcomes were collected.Multivariate logistic regression analysis was performed to evaluate the possible risk factors for lateral lymph node metastasis in NCRT patients.RESULTS LLN metastasis was pathologically confirmed in 35 patients(39.3%):26(41.3%)in the NCRT group and 9(34.6%)in the non-NCRT group.The most common site of metastasis was around the obturator nerve(21/35)followed by the internal iliac artery region(12/35).In the NCRT patients,46%of patients with SA of LLN greater than 7 mm were positive.The postoperative 30-d mortality rate was 0%.Two(2.2%)patients suffered from lateral local recurrence in the 2-year follow up.Multivariate analysis showed that cT4 stage(odds ratio[OR]=5.124,95%confidence interval[CI]:1.419-18.508;P=0.013),poor differentiation type(OR=4.014,95%CI:1.038-15.520;P=0.044),and SA≥7 mm(OR=7.539,95%CI:1.487-38.214;P=0.015)were statistically significant risk factors associated with LLN metastasis.CONCLUSION NCRT is not sufficient as a stand-alone therapy to eradicate LLN metastasis in lower rectal cancer patients and surgeons should consider performing selective LLND in patients with greater LLN SA diameter,poorer histological differentiation,or advanced T stage.Selective LLND for NCRT patients can have a favorable oncological outcome.

Pathological study of distal mesorectal cancer spread to determine a proper distal resection margin

AIM: Local recurrence after curative surgical resection for rectal cancer remains a major problem. Several studies have shown that incomplete removal of cancer deposits in the distal mesorectum contributes a great share to this dismal result. Clinicopathologic examination of distal mesorectum in lower rectal cancer was performed in the present study to assess the incidence and extent of distal mesorectal spread and to determine an optimal distal resection margin in sphincter-saving procedure.METHODS: We prospectively examined sepecimens from 45 patients with lower rectal cancer who underwent curative surgery. Large-mount sections were performed to microscopically observe the distal mesorectal spread and to measure the extent of distal spread. Tissue shrinkage ratio was also considered. Patients with involvement in the distal mesorectum were compared with those without involvement with regard to clinicopathologic features.RESULTS: Mesorectal cancer spread was observed in 21patients (46.7%), 8 of them (17.8%) had distal mesorectal spread. Overall, distal intramural and/or mesorectal spreads were observed in 10 patients (22.2%) and the maximum extent of distal spread in situ was 12 mm and 36 mm respectively. Eight patients with distal mesorectal spread showed a significantly higher rate of lymph node metastasis compared with the other 37 patients without distal mesorectal spread (P = 0.043).CONCLUSION: Distal mesorectal spread invariably occurs in advanced rectal cancer and has a significant relationship with lymph node metastasis. Distal resection margin of 1.5 cm for the rectal wall and 4 cm for the distal mesorectum is proper to those patients who are arranged to receive operation with a curative sphincter-saving procedure for lower rectal cancer.

核磁共振诊断直肠癌盆腔侧方淋巴结转移价值的Meta分析

目的系统评价磁共振成像(MRI)对直肠癌盆腔侧方淋巴结转移的诊断价值。方法计算机检索EMbase、PubMed、The Cochrane Library、CNKI和WanFang Data数据库,搜集磁共振诊断直肠癌盆腔侧方淋巴结转移的相关文献,检索时限均从建库至2019年3月。由两位研究者独立筛选文献、提取资料和评价偏倚风险后,采用Stata 15软件进行统计分析,计算其合并敏感度(Sen合并)、特异性(Spe合并)、诊断比值比(DOR)等,绘制汇总受试者工作特征(SROC)曲线并计算曲线下面积(AUC)。结果共纳入11个研究,包含1059例患者。Meta分析结果显示,磁共振诊断侧方淋巴结转移的合并Sen、Spe、+LR、–LR、DOR分别为0.77(95%CI:0.38~0.88)、0.77(95%CI:0.69~0.83)、3.3(95%CI:2.4~4.5)、0.3(95%CI:0.23~0.41)、11(95%CI:6~18),SROC曲线下面积为0.83(95%CI:0.80~0.86)。结论以淋巴结短径为诊断标准,MRI诊断直肠癌侧方淋巴结转移的敏感度和特异性一般;但在没有更佳的影像学筛查条件下,MRI仍然是被推荐的检查手段。

Clinical impact of atypical endoscopic features in rectal neuroendocrine tumors

AIM: To validate the association between atypical endoscopic features and lymph node metastasis(LNM).METHODS: A total of 247 patients with rectal neuroendocrine tumors(NETs) were analyzed. Endoscopic images were reviewed independently by two endoscopists, each of whom classified tumors by sized and endoscopic features, such as shape, color, and surface change(kappa coefficient 0.76 for inter-observer agreement). All of patients underwent computed tomography scans of abdomen and pelvis for evaluation of LNM. Univariate and multivariate analyses were performed to identify the factors associated with LNM. Additionally, the association between endoscopic atypical features and immunohistochemical staining of tumors was analyzed.RESULTS: Of 247 patients, 156(63.2%) were male and 15(6.1%) were showed positive for LNM. On univariate analysis, tumor size(P < 0.001), shape(P < 0.001), color(P < 0.001) and surface changes(P < 0.001) were significantly associated with LNM. On multivariate analysis, tumor size(OR = 11.53, 95%CI: 2.51-52.93, P = 0.002) and atypical surface(OR = 27.44, 95%CI: 5.96-126.34, P < 0.001) changes were independent risk factors for LNM. The likelihood of atypical endoscopic features increased as tumor size increased. Atypical endoscopic features were associated with LNM in rectal NETs < 10 mm(P = 0.005) and 10-19 mm(P = 0.041) in diameter. Immunohistochemical staining showed that the rate of atypical endoscopic features was higher in non L-cell tumors.CONCLUSION: Atypical endoscopic features as well as tumor size are predictive factors of LNM in patients with rectal NETs.

血清AREG水平及CT定量参数与直肠癌脉管侵犯、淋巴结转移的相关性及预测价值研究

目的:探讨血清外周血双调蛋白(AREG)水平及CT定量参数与直肠癌脉管侵犯、淋巴结转移的相关性及预测价值。方法:回顾性分析我院87例直肠癌患者的临床及影像资料,根据病理结果是否发生脉管侵犯与淋巴结转移进行分组,分别为脉管侵犯阳性(A组)与阴性(B组),淋巴结转移阳性(C组)与阴性(D组)。对比各组患者血清AREG浓度水平、CT定量参数,分析以上指标与脉管侵犯、淋巴结转移的相关性。结果:病理结果显示87例患者中32例为直肠癌脉管侵犯阳性,55例脉管侵犯阴性;46例淋巴结转移阳性,41例淋巴结转移阴性。t检验与Logistic回归模型分析结果显示,血清AREG水平、静脉期无水碘密度、静脉期Eff-Z值与直肠癌脉管侵犯相关,血清AREG水平、静脉期Eff-Z值与淋巴结转移相关。血清AREG水平、静脉期无水碘密度值、静脉期Eff-Z值及三者联合预测脉管侵犯的AUC分别为0.772、0.784、0.738、0.901,血清AREG水平、静脉期Eff-Z值、两者联合预测淋巴结转移的AUC分别为0.707、0.709、0.716。结论:血清AREG水平及CT定量参数中静脉期无水碘密度值、静脉期Eff-Z值与直肠癌脉管侵犯相关,血清AREG水平、CT定量参数中静脉期Eff-Z值与淋巴结转移相关。血清AREG水平及CT定量参数对预测直肠癌脉管侵犯、淋巴结转移具有一定价值。

腹膜返折以下直肠癌患者侧方淋巴结转移情况预测模型的构建

目的探究腹膜返折以下直肠癌患者侧方淋巴结转移情况并构建预测模型。方法纳入2020年1月至2023年4月该院收治的102例腹膜返折以下直肠癌患者作为研究对象。根据是否存在侧方淋巴结转移(LLNM)分为转移组(n=31)与未转移组(n=71)。对比两组患者一般临床资料、肿瘤病理特征及实验室检验指标[癌胚抗原(CEA)、糖类抗原199(CA199)、中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、转化生长因子(TGF)-α、TGF-β1]的差异。通过Spearman相关性分析及Logistic回归分析筛选出腹膜反折以下直肠癌患者合并LLNM的危险因素,构建预测模型并评价模型的效能。结果转移组患者平均肿瘤最大径、侧方淋巴结短径、低分化患者比例、T3~T4分期患者比例均显著高于未转移组患者(P<0.05),转移组患者平均TGF-α、TGF-β1、NLR水平均显著高于未转移组患者(P<0.05);Spearman相关性分析、单因素及多因素Logistic回归分析表明,低分化、T3~T4分期、肿瘤最大径及侧方淋巴结短径较长、TGF-α、TGF-β1、NLR水平较高均是腹膜返折以下直肠癌患者发生LLNM的独立危险因素(P<0.05);受试者工作特征(ROC)曲线分析表明,基于上述危险因素构建的预测模型曲线下面积(AUC)为0.915(95%CI:0.847~0.984),具有较高的预测效能。结论发生LLNM的腹膜返折以下直肠癌患者往往肿瘤最大径、侧方淋巴结短径较长,同时患者TGF-α、TGF-β1、NLR水平较高,针对具有上述特征的患者应积极开展侧方淋巴结清扫,并及时监测是否在术后仍存在淋巴结转移,为提高腹膜返折以下直肠癌LLNM的诊断提供一定临床依据。

正电子发射计算机断层扫描联合磁共振成像对直肠癌淋巴结转移的诊断价值

目的探讨正电子发射计算机断层扫描(PET-CT)联合MRI对直肠癌淋巴结转移的诊断价值。方法回顾性分析2019年1月至2022年1月江西省人民医院/南昌医学院第一附属医院收治的80例直肠癌淋巴结转移患者的临床资料,以病理检查结果为金标准,根据淋巴结是否转移分为观察组(淋巴结转移)及对照组(非淋巴结转移),每组40 例。两组术前均接受PET-CT及MRI检查,比较两组PET-CT、MRI、PET-CT联合MRI检查结果,分析PET-CT、MRI、PET-CT联合MRI与病理检查结果的一致性及诊断直肠癌淋巴结转移的价值。结果观察组PET-CT的SUVmax、SUVmin及平均值均高于对照组,MRI的ADCstandard、ADCslow、ADCfast均低于对照组,PET-CT联合MRI检查的长径、短径均长于对照组,差异有统计学意义(P<0.05)。PET-CT、MRI、PET-CT 联合MRI 与病理检查结果的一致性分别为82.50%、77.50%及97.50%。PETCT、MRI、PET-CT联合MRI检查的灵敏度、准确度比较差异有统计学意义(P<0.05);PET-CT联合MRI检查的灵敏度、准确度均高于MRI单独检查,差异有统计学意义(P<0.05),其余两两比较差异无统计学意义。结论PET-CT联合MRI检查在直肠癌淋巴结转移中诊断价值较高,值得临床推广应用。

高分辨MR成像联合ADC值预测直肠癌新辅助放化疗后区域淋巴结转移的价值

目的 探讨高分辨MR成像联合表观扩散系数(ADC)值预测直肠癌新辅助放化疗(nCRT)后区域淋巴结转移的效能。方法纳入青岛大学附属青岛市中心医院2020年5月至2022年5月收治的93局部进展期直肠癌患者为研究对象,于nCRI前、结束时6~8周接受高分辨率MRI T2WI、弥散加权成像检查并在1周内行全直肠系膜切除术。根据术后病理结果分为淋巴结转移组(n=24)和未转移组(n=69)。比较两组nCRT前、后淋巴结短径、长径、ADC值及其变化百分比绝对值(Δ%),分析高分辨MR成像联合ADC值预测直肠癌nCRT后区域淋巴结转移的价值。结果 转移组nCRT前后淋巴结短径均大于非转移组,nCRT前ADC值均小于非转移组(P<0.05);转移组Δ短径%、ΔADC%值均小于非转移组(P<0.05);但两组nCRT前后长径及Δ长径%值比较,差异无统计学意义(P>0.05);经Logistic回归分析显示,Δ短径%、MDC%是直肠癌患者nCRT后区域淋巴结转移的独立预测指标;绘制受试者工作曲线(ROC)显示,Δ短径%、ΔADC%单独及联合预测直肠癌患者nCRT后区域淋巴结转移的曲线下面积(AUC)分别为0.748、0.852、0.879,具有一定预测价值。结论 高分辨MR成像联合ADC值预测直肠癌nCRT后区域淋巴结转移具有一定的价值,其中淋巴结短径与ADC值变化可有效提示nCRT后区域淋巴结转移情况。

磁共振成像对直肠癌盆腔侧方淋巴结转移的诊断价值分析

目的:分析磁共振成像(MRI)对直肠癌盆腔侧方淋巴结转移(PLLNM)的诊断价值。方法:选取2020年3月—2022年2月新乡医学院第三附属医院收治的80例直肠癌患者作为研究对象,所有患者术前均接受MRI检查及病理活检确诊,均行直肠癌切除及盆腔淋巴结清扫术。以病理结果为金标准,计算MRI对直肠癌PLLNM的准确度、敏感度、特异度及一致性,比较不同性质淋巴结的MRI图像特征。采用Pearson检验分析MRI图像特征与直肠癌PLLNM的相关性,采用多因素logistic回归分析模型分析影响PLLNM的独立危险因素。结果:80例直肠癌患者经病理诊断共检出PLLNM 29例,未转移51例;MRI诊断共检出PLLNM 35例,未转移45例,两者的诊断一致性良好(Kappa=0.845)。PLLNM患者的边缘模糊及型号不均匀占比显著高于未转移者,淋巴结短径显著长于未转移者,差异有统计学意义(χ^(2)=12.342、8.136;t=13.857,P<0.01)。Pearson相关性分析结果显示,直肠癌PLLNM检出率与淋巴结短径、边缘模糊及信号不均匀具有正相关性(r>0,P<0.001)。多因素logistic回归分析结果显示,淋巴结信号是影响直肠癌PLLNM的独立危险因素。结论:MRI对直肠癌PLLNM的诊断效能较高,不同性质淋巴结的MRI图像特征存在明显差异,其中淋巴结短径、边缘模糊及信号不均匀与PLL-NM密切相关,淋巴结信号是影响直肠癌PLLNM的独立危险因素。用MRI测量淋巴结短径是诊断直肠癌PLLNM的可靠参数,对PLLNM的早期预测具有积极作用。

基于MRI探索用于术前预测直肠癌侧方淋巴结转移的短径截断值

目的:探讨基于侧方淋巴结(lateral pelvic lymph node, LPLN)短径预测术前进行新辅助治疗和未进行新辅助治疗的直肠癌患者LPLN转移的诊断标准。方法:回顾性收集分析自2012年01月至2019年12月中国侧方淋巴结协作组的机构数据库中行全直肠系膜切除术(total mesorectal excision, TME)+侧方淋巴结清扫术(lateral pelvic lymph node metastasis, LPLND)的临床怀疑LPLN肿大的直肠癌患者的临床病理资料。结果:共纳入446例患者,根据不同术前治疗策略,将所有患者分为新辅助治疗组和无新辅助治疗组。新辅助治疗组患者病理pCR/T1(9.0%vs 2.7%,P=0.013)和N0(41.9%vs 55.3%,P<0.001)的比例与无新辅助治疗组患者差异明显。此外,相比于无新辅助治疗组患者,新辅助治疗组患者手术时间明显延长(300.7 vs 277.4 min,P=0.018)。新辅助治疗组与无新辅助治疗组分别有40例(25.8%)和78例(26.8%)患者病理诊断为LPLN转移。髂内淋巴结是新辅助治疗组(16.1%)和无新辅助治疗组(15.8%)患者最常见的LPLN转移位置。新辅助治疗组患者平均转移LPLN短径(1.0 vs 1.4 mm,P=0.015)和无转移LPLN短径(0.6 vs 0.8 mm,P=0.005)明显短于无新辅助治疗组。无新辅助治疗组和新辅助治疗组患者分别以9 mm和7 mm作为LPLN截断值时,AUC值分别为0.817和0.745,有着较好的一致性。结论:接受新辅助治疗和未接受新辅助治疗的患者分别以7 mm和9 mm作为LPLN截断值时,有着最佳的预测LPLN转移的能力。

中国直肠癌侧方淋巴结转移诊疗专家共识(2024版)

侧方淋巴结是中低位直肠癌常见的转移部位,亦是术后局部复发的主要原因。目前国际上针对直肠癌侧方转移的诊断、治疗尚存争议。本共识在《中国直肠癌侧方淋巴结转移诊疗专家共识(2019版)》的基础上,结合国内外最新研究成果,国内42位结直肠癌研究领域的专家针对直肠癌侧方淋巴结转移的诊断、治疗策略、随诊以及复发处理4个方面进行修订,提出18条侧方淋巴结诊疗相关共识,并采用美国预防医学工作组的评价标准进行等级推荐,旨在进一步规范直肠癌侧方淋巴结转移的诊断标准及治疗策略。在本共识中未解决的相关问题,尚需进一步临床实践,并积极开展高质量的临床研究逐步探索和解决。

高分辨率MRI对直肠癌术前TN分期、环周切缘及壁外血管受侵、淋巴结转移诊断的准确性研究

目的:研究旨在评估3.0T高分辨率磁共振(MRI)的T2WI序列联合DWI序列在直肠癌术前分期中的应用价值,特别是其在TN分期、环周切缘评估、壁外血管受侵及淋巴结转移诊断中的准确性。方法:通过对107例经术后病理证实为直肠癌患者的术前MR影像资料进行回顾性分析,详细观察肿瘤局部浸润和肠系膜淋巴结转移情况。综合运用多种MRI序列和成像方位进行影像学TN分期评估,并与术后病理结果进行对比分析。结果:术前T分期的总准确率为89.7%,与术后病理结果的Kappa值为0.778,显示出良好的一致性。在环周切缘评估中,术前MRI判断为阳性的有53例,而术后病理联合MRI回溯性诊断为阳性的有51例,存在6例误诊。对于直肠壁外血管受侵的判断,术前判断为29例,术后病理确诊为33例,准确率为87.9%。当结合特定的淋巴结影像表现(短径≥5 mm、形态不规则伴边缘毛糙、内部结构不清伴信号不均匀)时,敏感度和特异度相对提高,误诊率和漏诊率降低,与病理结果的一致性最佳,且差异具有统计学意义(P<0.05)。淋巴结N分期的总准确率为86%,与术后病理的Kappa值为0.752,表明一致性良好。结论:3.0T高分辨率MRI通过综合运用T2WI和DWI序列以及多种成像方位,在直肠癌术前分期中显示出较高的准确性,特别是在评估局部侵犯程度和肠周淋巴结转移方面。这为临床医生制定个体化治疗方案提供了有力的影像学支持,为未来进一步探索和优化MRI在直肠癌诊断中的应用提供了有价值的参考。

3.0T MRI T检查对直肠癌盆腔淋巴结转移及N分期的诊断价值

目的探讨3.0T MRI检查对直肠癌盆腔淋巴结转移(PLNM)及N分期的诊断价值。方法选取50例经病理检查确诊的直肠癌患者,全部患者均在术前行3.0T MRI检查。以病理检查结果为金标准,分析MRI检查对直肠癌PLNM和N分期的诊断价值。结果50例患者中,经病理检查确诊发生PLNM 22例为PLNM组,未发生PLNM 28例为非PLNM组。3.0T MRI检查诊断直肠癌PLNM的准确度为88.00%(44/50),特异度为89.29%(25/28),灵敏度为86.36%(19/22),与病理检查结果的一致性较高(Kappa=0.756)。PLNM组患者淋巴结短径明显大于非PLNM组,边缘模糊率和信号不均匀率均明显高于非PLNM组,差异均有统计学意义(P﹤0.01)。3.0T MRI检查对N1、N2期直肠癌的诊断符合率分别为84.62%、88.89%。结论3.0T MRI检查在诊断直肠癌PLNM、N分期中具有一定的应用价值,诊断效能较高,且其MRI征象多表现为淋巴结短径增大、边缘模糊、信号不均匀。