MRI surveillance for the detection of local recurrence in rectal cancer after transanal endoscopic microsurgery

Britt J. P. Hupkens; Monique Maas; Milou H. Martens; Willem M. L. L. G. Deserno; Jeroen W. A. Leijtens; Patty J. Nelemans; Frans C. H. Bakers; Doenja M. J. Lambregts; Geerard L. Beets; Regina G. H. Beets-Tan

doi:10.1007/s00330-017-4853-5

MRI surveillance for the detection of local recurrence in rectal cancer after transanal endoscopic microsurgery

Britt J. P. Hupkens, Monique Maas^*, Milou H. Martens, Willem M. L. L. G. Deserno, Jeroen W. A. Leijtens, Patty J. Nelemans, Frans C. H. Bakers, Doenja M. J. Lambregts, Geerard L. Beets, Regina G. H. Beets-Tan

^*Corresponding author for this work

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Abstract

To evaluate diagnostic performance of follow-up MRI for detection of local recurrence of rectal cancer after transanal endoscopic microsurgery (TEM).

Between January 2006 and February 2014, 81 patients who underwent TEM were included. Two expert readers (R1 and R2), independently evaluated T2-weighted (T2W) MRI and diffusion-weighted (DWI) MRI for the detection of local recurrence, retrospectively, and recorded confidence on a five-point scale. Diagnostic performance of follow-up MRI was assessed using ROC-curve analysis and kappa statistics for the reproducibility between readers.

293 MRIs were performed, 203 included DWI. 18 (22%) patients developed a local recurrence: luminal 11, nodal two and both five. Areas under the curve (AUCs) for local recurrence detection were 0.72 (R1) and 0.80 (R2) for T2W-MRI. For DWI, AUCs were 0.70 (R1) and 0.89 (R2). For nodal recurrence AUCs were 0.72 (R1) and 0.80 (R2) for T2W-MRI. Reproducibility was good for T2W-MRI (kappa 0.68 for luminal and kappa 0.71 for nodal recurrence) and moderate for DWI (kappa 0.57). AUCs and reproducibility for recurrence detection increased during follow-up.

Follow-up with MRI after TEM for rectal cancer is feasible. Postoperative changes can be confusing at the first postoperative MRI, but during follow-up diagnostic performance and reproducibility increase.

aEuro cent Follow-up with MRI is feasible for follow-up after TEM for rectal cancer.

aEuro cent DWI-MRI is a useful addition to detect recurrences after TEM.

aEuro cent Postoperative changes can be confusing and can lead to underestimation of recurrence.

aEuro cent Appearance of intermediate signal at T2W-MRI is suspicious for recurrence.

aEuro cent Nodal staging remains challenging.

Original language	English
Pages (from-to)	4960-4969
Number of pages	10
Journal	European Radiology
Volume	27
Issue number	12
DOIs	https://doi.org/10.1007/s00330-017-4853-5
Publication status	Published - Dec 2017

Keywords

Magnetic resonance imaging
Rectal neoplasms
Transanal endoscopic microsurgery
Follow-up
Diffusion-weighted magnetic resonance imaging
TERM-FOLLOW-UP
CHEMORADIOTHERAPY
CHEMORADIATION
EXPERIENCE
TEM

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Cite this

Hupkens, B. J. P., Maas, M., Martens, M. H., Deserno, W. M. L. L. G., Leijtens, J. W. A., Nelemans, P. J., Bakers, F. C. H., Lambregts, D. M. J., Beets, G. L., & Beets-Tan, R. G. H. (2017). MRI surveillance for the detection of local recurrence in rectal cancer after transanal endoscopic microsurgery. European Radiology, 27(12), 4960-4969. https://doi.org/10.1007/s00330-017-4853-5

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title = "MRI surveillance for the detection of local recurrence in rectal cancer after transanal endoscopic microsurgery",

abstract = "To evaluate diagnostic performance of follow-up MRI for detection of local recurrence of rectal cancer after transanal endoscopic microsurgery (TEM).Between January 2006 and February 2014, 81 patients who underwent TEM were included. Two expert readers (R1 and R2), independently evaluated T2-weighted (T2W) MRI and diffusion-weighted (DWI) MRI for the detection of local recurrence, retrospectively, and recorded confidence on a five-point scale. Diagnostic performance of follow-up MRI was assessed using ROC-curve analysis and kappa statistics for the reproducibility between readers.293 MRIs were performed, 203 included DWI. 18 (22%) patients developed a local recurrence: luminal 11, nodal two and both five. Areas under the curve (AUCs) for local recurrence detection were 0.72 (R1) and 0.80 (R2) for T2W-MRI. For DWI, AUCs were 0.70 (R1) and 0.89 (R2). For nodal recurrence AUCs were 0.72 (R1) and 0.80 (R2) for T2W-MRI. Reproducibility was good for T2W-MRI (kappa 0.68 for luminal and kappa 0.71 for nodal recurrence) and moderate for DWI (kappa 0.57). AUCs and reproducibility for recurrence detection increased during follow-up.Follow-up with MRI after TEM for rectal cancer is feasible. Postoperative changes can be confusing at the first postoperative MRI, but during follow-up diagnostic performance and reproducibility increase.aEuro cent Follow-up with MRI is feasible for follow-up after TEM for rectal cancer.aEuro cent DWI-MRI is a useful addition to detect recurrences after TEM.aEuro cent Postoperative changes can be confusing and can lead to underestimation of recurrence.aEuro cent Appearance of intermediate signal at T2W-MRI is suspicious for recurrence.aEuro cent Nodal staging remains challenging.",

keywords = "Magnetic resonance imaging, Rectal neoplasms, Transanal endoscopic microsurgery, Follow-up, Diffusion-weighted magnetic resonance imaging, TERM-FOLLOW-UP, CHEMORADIOTHERAPY, CHEMORADIATION, EXPERIENCE, TEM",

author = "Hupkens, {Britt J. P.} and Monique Maas and Martens, {Milou H.} and Deserno, {Willem M. L. L. G.} and Leijtens, {Jeroen W. A.} and Nelemans, {Patty J.} and Bakers, {Frans C. H.} and Lambregts, {Doenja M. J.} and Beets, {Geerard L.} and Beets-Tan, {Regina G. H.}",

year = "2017",

month = dec,

doi = "10.1007/s00330-017-4853-5",

language = "English",

volume = "27",

pages = "4960--4969",

journal = "European Radiology",

issn = "0938-7994",

publisher = "Springer, Cham",

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T1 - MRI surveillance for the detection of local recurrence in rectal cancer after transanal endoscopic microsurgery

AU - Hupkens, Britt J. P.

AU - Maas, Monique

AU - Martens, Milou H.

AU - Deserno, Willem M. L. L. G.

AU - Leijtens, Jeroen W. A.

AU - Nelemans, Patty J.

AU - Bakers, Frans C. H.

AU - Lambregts, Doenja M. J.

AU - Beets, Geerard L.

AU - Beets-Tan, Regina G. H.

PY - 2017/12

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N2 - To evaluate diagnostic performance of follow-up MRI for detection of local recurrence of rectal cancer after transanal endoscopic microsurgery (TEM).Between January 2006 and February 2014, 81 patients who underwent TEM were included. Two expert readers (R1 and R2), independently evaluated T2-weighted (T2W) MRI and diffusion-weighted (DWI) MRI for the detection of local recurrence, retrospectively, and recorded confidence on a five-point scale. Diagnostic performance of follow-up MRI was assessed using ROC-curve analysis and kappa statistics for the reproducibility between readers.293 MRIs were performed, 203 included DWI. 18 (22%) patients developed a local recurrence: luminal 11, nodal two and both five. Areas under the curve (AUCs) for local recurrence detection were 0.72 (R1) and 0.80 (R2) for T2W-MRI. For DWI, AUCs were 0.70 (R1) and 0.89 (R2). For nodal recurrence AUCs were 0.72 (R1) and 0.80 (R2) for T2W-MRI. Reproducibility was good for T2W-MRI (kappa 0.68 for luminal and kappa 0.71 for nodal recurrence) and moderate for DWI (kappa 0.57). AUCs and reproducibility for recurrence detection increased during follow-up.Follow-up with MRI after TEM for rectal cancer is feasible. Postoperative changes can be confusing at the first postoperative MRI, but during follow-up diagnostic performance and reproducibility increase.aEuro cent Follow-up with MRI is feasible for follow-up after TEM for rectal cancer.aEuro cent DWI-MRI is a useful addition to detect recurrences after TEM.aEuro cent Postoperative changes can be confusing and can lead to underestimation of recurrence.aEuro cent Appearance of intermediate signal at T2W-MRI is suspicious for recurrence.aEuro cent Nodal staging remains challenging.

AB - To evaluate diagnostic performance of follow-up MRI for detection of local recurrence of rectal cancer after transanal endoscopic microsurgery (TEM).Between January 2006 and February 2014, 81 patients who underwent TEM were included. Two expert readers (R1 and R2), independently evaluated T2-weighted (T2W) MRI and diffusion-weighted (DWI) MRI for the detection of local recurrence, retrospectively, and recorded confidence on a five-point scale. Diagnostic performance of follow-up MRI was assessed using ROC-curve analysis and kappa statistics for the reproducibility between readers.293 MRIs were performed, 203 included DWI. 18 (22%) patients developed a local recurrence: luminal 11, nodal two and both five. Areas under the curve (AUCs) for local recurrence detection were 0.72 (R1) and 0.80 (R2) for T2W-MRI. For DWI, AUCs were 0.70 (R1) and 0.89 (R2). For nodal recurrence AUCs were 0.72 (R1) and 0.80 (R2) for T2W-MRI. Reproducibility was good for T2W-MRI (kappa 0.68 for luminal and kappa 0.71 for nodal recurrence) and moderate for DWI (kappa 0.57). AUCs and reproducibility for recurrence detection increased during follow-up.Follow-up with MRI after TEM for rectal cancer is feasible. Postoperative changes can be confusing at the first postoperative MRI, but during follow-up diagnostic performance and reproducibility increase.aEuro cent Follow-up with MRI is feasible for follow-up after TEM for rectal cancer.aEuro cent DWI-MRI is a useful addition to detect recurrences after TEM.aEuro cent Postoperative changes can be confusing and can lead to underestimation of recurrence.aEuro cent Appearance of intermediate signal at T2W-MRI is suspicious for recurrence.aEuro cent Nodal staging remains challenging.

KW - Magnetic resonance imaging

KW - Rectal neoplasms

KW - Transanal endoscopic microsurgery

KW - Follow-up

KW - Diffusion-weighted magnetic resonance imaging

KW - TERM-FOLLOW-UP

KW - CHEMORADIOTHERAPY

KW - CHEMORADIATION

KW - EXPERIENCE

KW - TEM

U2 - 10.1007/s00330-017-4853-5

DO - 10.1007/s00330-017-4853-5

M3 - Article

C2 - 28667480

VL - 27

SP - 4960

EP - 4969

JO - European Radiology

JF - European Radiology

SN - 0938-7994

IS - 12

ER -