Endoscopy and MRI for restaging early rectal cancer after neoadjuvant treatment

Rutger C.H. Stijns; Jeroen Leijtens; Eelco de Graaf; Simon P. Bach; Geerard Beets; Andre J.A. Bremers; Regina G.H. Beets-Tan; Johannes H.W. de Wilt

doi:10.1111/codi.16341

Endoscopy and MRI for restaging early rectal cancer after neoadjuvant treatment

Rutger C.H. Stijns^*, Jeroen Leijtens, Eelco de Graaf, Simon P. Bach, Geerard Beets, Andre J.A. Bremers, Regina G.H. Beets-Tan, Johannes H.W. de Wilt

^*Corresponding author for this work

Cancer and Genomic Sciences

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Abstract

Aim: Chemoradiotherapy (CRT) has great potential to downstage rectal cancer. Response assessment has been investigated in locally advanced rectal cancer but not in early stage rectal cancer. The aim is to characterize the diagnostic accuracy of endoscopy performed by surgical endoscopists compared to (diffusion-weighted, DWI) MRI only and a multimodal approach combining (DWI-)MRI and endoscopic information both analysed by an abdominal radiologist for response assessment in early rectal cancer after neoadjuvant CRT.

Materials and methods: Patients treated with neoadjuvant CRT for early distal rectal cancer (cT1–3 N0) followed by transanal endoscopic microsurgery were included. Three separate reassessment groups were analysed for response assessment using endoscopic evaluation alone versus (DWI-)MRI alone versus the combination of endoscopy with (DWI-)MRI with a focus on sensitivity and specificity and analysis using receiver operating characteristic curves.

Results: Three cohorts (N = 36, N = 25 and N = 25, respectively) were analysed for response assessment. Of the endoscopy cohort, 16 of the 36 patients had a complete response. Area under the curve was 0.69 (0.66–0.74; pooled sensitivity 55.3%, pooled specificity 80.0%). Agreement for scoring separate endoscopic features was poor to moderate. Of the (DWI-)MRI cohort, 11 of the 25 patients had a complete response. Area under the curve for (DWI-)MRI alone was 0.55 (sensitivity 72.7%, specificity 42.9%). The areas under the receiver operating characteristic curve improved to 0.68 (sensitivity 90.9%, specificity 75.0%) when (DWI-)MRI was combined with endoscopic information, with 11 out of 25 patients with a complete response. The most accurate response assessment was made by combining endoscopy and (DWI-)MRI with a high negative predictive value (90.9%).

Conclusion: Good and complete responders after chemoradiation of early stage rectal cancer can be best assessed using a multimodality approach combining endoscopy and (DWI-)MRI.

Original language	English
Journal	Colorectal Disease
Early online date	14 Sept 2022
DOIs	https://doi.org/10.1111/codi.16341
Publication status	E-pub ahead of print - 14 Sept 2022

Bibliographical note

Publisher Copyright:
© 2022 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.

Keywords

chemoradiotherapy
diffusion-weighted imaging
early rectal cancer
endoscopy
magnetic resonance imaging
response assessment

ASJC Scopus subject areas

Gastroenterology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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@article{883ca05d0aaa434687c679001b4cbb40,

title = "Endoscopy and MRI for restaging early rectal cancer after neoadjuvant treatment",

abstract = "Aim: Chemoradiotherapy (CRT) has great potential to downstage rectal cancer. Response assessment has been investigated in locally advanced rectal cancer but not in early stage rectal cancer. The aim is to characterize the diagnostic accuracy of endoscopy performed by surgical endoscopists compared to (diffusion-weighted, DWI) MRI only and a multimodal approach combining (DWI-)MRI and endoscopic information both analysed by an abdominal radiologist for response assessment in early rectal cancer after neoadjuvant CRT. Materials and methods: Patients treated with neoadjuvant CRT for early distal rectal cancer (cT1–3 N0) followed by transanal endoscopic microsurgery were included. Three separate reassessment groups were analysed for response assessment using endoscopic evaluation alone versus (DWI-)MRI alone versus the combination of endoscopy with (DWI-)MRI with a focus on sensitivity and specificity and analysis using receiver operating characteristic curves. Results: Three cohorts (N = 36, N = 25 and N = 25, respectively) were analysed for response assessment. Of the endoscopy cohort, 16 of the 36 patients had a complete response. Area under the curve was 0.69 (0.66–0.74; pooled sensitivity 55.3%, pooled specificity 80.0%). Agreement for scoring separate endoscopic features was poor to moderate. Of the (DWI-)MRI cohort, 11 of the 25 patients had a complete response. Area under the curve for (DWI-)MRI alone was 0.55 (sensitivity 72.7%, specificity 42.9%). The areas under the receiver operating characteristic curve improved to 0.68 (sensitivity 90.9%, specificity 75.0%) when (DWI-)MRI was combined with endoscopic information, with 11 out of 25 patients with a complete response. The most accurate response assessment was made by combining endoscopy and (DWI-)MRI with a high negative predictive value (90.9%). Conclusion: Good and complete responders after chemoradiation of early stage rectal cancer can be best assessed using a multimodality approach combining endoscopy and (DWI-)MRI.",

keywords = "chemoradiotherapy, diffusion-weighted imaging, early rectal cancer, endoscopy, magnetic resonance imaging, response assessment",

author = "Stijns, {Rutger C.H.} and Jeroen Leijtens and {de Graaf}, Eelco and Bach, {Simon P.} and Geerard Beets and Bremers, {Andre J.A.} and Beets-Tan, {Regina G.H.} and {de Wilt}, {Johannes H.W.}",

note = "Publisher Copyright: {\textcopyright} 2022 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.",

year = "2022",

month = sep,

day = "14",

doi = "10.1111/codi.16341",

language = "English",

journal = "Colorectal Disease",

issn = "1462-8910",

publisher = "Wiley",

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T1 - Endoscopy and MRI for restaging early rectal cancer after neoadjuvant treatment

AU - Stijns, Rutger C.H.

AU - Leijtens, Jeroen

AU - de Graaf, Eelco

AU - Bach, Simon P.

AU - Beets, Geerard

AU - Bremers, Andre J.A.

AU - Beets-Tan, Regina G.H.

AU - de Wilt, Johannes H.W.

PY - 2022/9/14

Y1 - 2022/9/14

N2 - Aim: Chemoradiotherapy (CRT) has great potential to downstage rectal cancer. Response assessment has been investigated in locally advanced rectal cancer but not in early stage rectal cancer. The aim is to characterize the diagnostic accuracy of endoscopy performed by surgical endoscopists compared to (diffusion-weighted, DWI) MRI only and a multimodal approach combining (DWI-)MRI and endoscopic information both analysed by an abdominal radiologist for response assessment in early rectal cancer after neoadjuvant CRT. Materials and methods: Patients treated with neoadjuvant CRT for early distal rectal cancer (cT1–3 N0) followed by transanal endoscopic microsurgery were included. Three separate reassessment groups were analysed for response assessment using endoscopic evaluation alone versus (DWI-)MRI alone versus the combination of endoscopy with (DWI-)MRI with a focus on sensitivity and specificity and analysis using receiver operating characteristic curves. Results: Three cohorts (N = 36, N = 25 and N = 25, respectively) were analysed for response assessment. Of the endoscopy cohort, 16 of the 36 patients had a complete response. Area under the curve was 0.69 (0.66–0.74; pooled sensitivity 55.3%, pooled specificity 80.0%). Agreement for scoring separate endoscopic features was poor to moderate. Of the (DWI-)MRI cohort, 11 of the 25 patients had a complete response. Area under the curve for (DWI-)MRI alone was 0.55 (sensitivity 72.7%, specificity 42.9%). The areas under the receiver operating characteristic curve improved to 0.68 (sensitivity 90.9%, specificity 75.0%) when (DWI-)MRI was combined with endoscopic information, with 11 out of 25 patients with a complete response. The most accurate response assessment was made by combining endoscopy and (DWI-)MRI with a high negative predictive value (90.9%). Conclusion: Good and complete responders after chemoradiation of early stage rectal cancer can be best assessed using a multimodality approach combining endoscopy and (DWI-)MRI.

AB - Aim: Chemoradiotherapy (CRT) has great potential to downstage rectal cancer. Response assessment has been investigated in locally advanced rectal cancer but not in early stage rectal cancer. The aim is to characterize the diagnostic accuracy of endoscopy performed by surgical endoscopists compared to (diffusion-weighted, DWI) MRI only and a multimodal approach combining (DWI-)MRI and endoscopic information both analysed by an abdominal radiologist for response assessment in early rectal cancer after neoadjuvant CRT. Materials and methods: Patients treated with neoadjuvant CRT for early distal rectal cancer (cT1–3 N0) followed by transanal endoscopic microsurgery were included. Three separate reassessment groups were analysed for response assessment using endoscopic evaluation alone versus (DWI-)MRI alone versus the combination of endoscopy with (DWI-)MRI with a focus on sensitivity and specificity and analysis using receiver operating characteristic curves. Results: Three cohorts (N = 36, N = 25 and N = 25, respectively) were analysed for response assessment. Of the endoscopy cohort, 16 of the 36 patients had a complete response. Area under the curve was 0.69 (0.66–0.74; pooled sensitivity 55.3%, pooled specificity 80.0%). Agreement for scoring separate endoscopic features was poor to moderate. Of the (DWI-)MRI cohort, 11 of the 25 patients had a complete response. Area under the curve for (DWI-)MRI alone was 0.55 (sensitivity 72.7%, specificity 42.9%). The areas under the receiver operating characteristic curve improved to 0.68 (sensitivity 90.9%, specificity 75.0%) when (DWI-)MRI was combined with endoscopic information, with 11 out of 25 patients with a complete response. The most accurate response assessment was made by combining endoscopy and (DWI-)MRI with a high negative predictive value (90.9%). Conclusion: Good and complete responders after chemoradiation of early stage rectal cancer can be best assessed using a multimodality approach combining endoscopy and (DWI-)MRI.

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KW - diffusion-weighted imaging

KW - early rectal cancer

KW - endoscopy

KW - magnetic resonance imaging

KW - response assessment

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DO - 10.1111/codi.16341

M3 - Article

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SN - 1462-8910

JO - Colorectal Disease

JF - Colorectal Disease

ER -

Endoscopy and MRI for restaging early rectal cancer after neoadjuvant treatment

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

UN SDGs

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