MRI tumour regression grade in locally recurrent rectal cancer

Eva L K Voogt; Stefi Nordkamp; Desley M G I van Zoggel; Alette W Daniëls-Gooszen; Grard A P Nieuwenhuijzen; Johanne G Bloemen; Geert-Jan Creemers; Jeltsje S Cnossen; Gesina van Lijnschoten; Jacobus W A Burger; Harm J T Rutten; Joost Nederend

doi:10.1093/bjsopen/zrac033

MRI tumour regression grade in locally recurrent rectal cancer

Eva L K Voogt^*, Stefi Nordkamp, Desley M G I van Zoggel, Alette W Daniëls-Gooszen, Grard A P Nieuwenhuijzen, Johanne G Bloemen, Geert-Jan Creemers, Jeltsje S Cnossen, Gesina van Lijnschoten, Jacobus W A Burger, Harm J T Rutten, Joost Nederend

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: This study aimed to investigate the agreement between magnetic resonance tumour regression grade (mrTRG) and pathological regression grade (pTRG) in patients with locally recurrent rectal cancer (LRRC). Also, the reproducibility of mrTRG was investigated.

METHODS: All patients with LRRC who underwent a resection between 2010 and 2018 after treatment with induction chemotherapy and neoadjuvant chemo(re)irradiation in whom a restaging MRI was available were retrospectively selected. All MRI scans were reassessed by two independent radiologists using the mrTRG, and the pTRG was reassessed by an independent pathologist. The interobserver agreement between the radiologists as well as between the radiologists and the pathologist was assessed with the weighted kappa test. A subanalysis was performed to evaluate the influence of the interval between imaging and surgery.

RESULTS: Out of 313 patients with LRRC treated during the study interval, 124 patients were selected. Interobserver agreement between the radiologists was fair (k = 0.28) using a two-tier grading system (mrTRG 1-2 versus mrTRG 3-5). For the lead radiologist, agreement with pTRG was moderate (k = 0.52; 95 per cent c.i. 0.36 to 0.68) when comparing good (mrTRG 1-2 and Mandard 1-2) and intermediate/poor responders (mrTRG 3-5 and Mandard 3-5), and the agreement was fair between the other abdominal radiologist and pTRG (k = 0.39; 95 per cent c.i. 0.22 to 0.56). A shorter interval (less than 7 weeks) between MRI and surgery resulted in an improved agreement (k = 0.69), compared with an interval more than 7 weeks (k = 0.340). For the lead radiologist, the positive predictive value for predicting good responders was 95 per cent (95 per cent c.i. 71 per cent to 99 per cent), whereas this was 56 per cent (95 per cent c.i. 44 per cent to 66 per cent) for the other radiologist.

CONCLUSION: This study showed that, in LRRC, the reproducibility of mrTRG among radiologists is limited and the agreement of mrTRG with pTRG is low. However, a shorter interval between MRI and surgery seems to improve this agreement and, if assessed by a dedicated radiologist, mrTRG could predict good responders.

Original language	English
Article number	zrac033
Number of pages	8
Journal	BJS Open
Volume	6
Issue number	3
DOIs	https://doi.org/10.1093/bjsopen/zrac033
Publication status	Published - 2 May 2022

Keywords

Humans
Magnetic Resonance Imaging
Neoadjuvant Therapy/methods
Rectal Neoplasms/drug therapy
Reproducibility of Results
Retrospective Studies
SURGERY
SURVIVAL
MANAGEMENT
CHEMORADIOTHERAPY
MULTIDISCIPLINARY TEAM
CHEMORADIATION
QUALITY-OF-LIFE
OUTCOMES

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10.1093/bjsopen/zrac033Licence: CC BY-NC

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Voogt, E. L. K., Nordkamp, S., van Zoggel, D. M. G. I., Daniëls-Gooszen, A. W., Nieuwenhuijzen, G. A. P., Bloemen, J. G., Creemers, G.-J., Cnossen, J. S., van Lijnschoten, G., Burger, J. W. A., Rutten, H. J. T., & Nederend, J. (2022). MRI tumour regression grade in locally recurrent rectal cancer. BJS Open, 6(3), Article zrac033. https://doi.org/10.1093/bjsopen/zrac033

@article{2912a70aa7cf44bfa710403c50e7daae,

title = "MRI tumour regression grade in locally recurrent rectal cancer",

abstract = "BACKGROUND: This study aimed to investigate the agreement between magnetic resonance tumour regression grade (mrTRG) and pathological regression grade (pTRG) in patients with locally recurrent rectal cancer (LRRC). Also, the reproducibility of mrTRG was investigated.METHODS: All patients with LRRC who underwent a resection between 2010 and 2018 after treatment with induction chemotherapy and neoadjuvant chemo(re)irradiation in whom a restaging MRI was available were retrospectively selected. All MRI scans were reassessed by two independent radiologists using the mrTRG, and the pTRG was reassessed by an independent pathologist. The interobserver agreement between the radiologists as well as between the radiologists and the pathologist was assessed with the weighted kappa test. A subanalysis was performed to evaluate the influence of the interval between imaging and surgery.RESULTS: Out of 313 patients with LRRC treated during the study interval, 124 patients were selected. Interobserver agreement between the radiologists was fair (k = 0.28) using a two-tier grading system (mrTRG 1-2 versus mrTRG 3-5). For the lead radiologist, agreement with pTRG was moderate (k = 0.52; 95 per cent c.i. 0.36 to 0.68) when comparing good (mrTRG 1-2 and Mandard 1-2) and intermediate/poor responders (mrTRG 3-5 and Mandard 3-5), and the agreement was fair between the other abdominal radiologist and pTRG (k = 0.39; 95 per cent c.i. 0.22 to 0.56). A shorter interval (less than 7 weeks) between MRI and surgery resulted in an improved agreement (k = 0.69), compared with an interval more than 7 weeks (k = 0.340). For the lead radiologist, the positive predictive value for predicting good responders was 95 per cent (95 per cent c.i. 71 per cent to 99 per cent), whereas this was 56 per cent (95 per cent c.i. 44 per cent to 66 per cent) for the other radiologist.CONCLUSION: This study showed that, in LRRC, the reproducibility of mrTRG among radiologists is limited and the agreement of mrTRG with pTRG is low. However, a shorter interval between MRI and surgery seems to improve this agreement and, if assessed by a dedicated radiologist, mrTRG could predict good responders.",

keywords = "Humans, Magnetic Resonance Imaging, Neoadjuvant Therapy/methods, Rectal Neoplasms/drug therapy, Reproducibility of Results, Retrospective Studies, SURGERY, SURVIVAL, MANAGEMENT, CHEMORADIOTHERAPY, MULTIDISCIPLINARY TEAM, CHEMORADIATION, QUALITY-OF-LIFE, OUTCOMES",

author = "Voogt, {Eva L K} and Stefi Nordkamp and {van Zoggel}, {Desley M G I} and Dani{\"e}ls-Gooszen, {Alette W} and Nieuwenhuijzen, {Grard A P} and Bloemen, {Johanne G} and Geert-Jan Creemers and Cnossen, {Jeltsje S} and {van Lijnschoten}, Gesina and Burger, {Jacobus W A} and Rutten, {Harm J T} and Joost Nederend",

note = "{\textcopyright} The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd.",

year = "2022",

month = may,

day = "2",

doi = "10.1093/bjsopen/zrac033",

language = "English",

volume = "6",

journal = "BJS Open",

issn = "2474-9842",

publisher = "John Wiley & Sons Inc.",

number = "3",

}

TY - JOUR

T1 - MRI tumour regression grade in locally recurrent rectal cancer

AU - Voogt, Eva L K

AU - Nordkamp, Stefi

AU - van Zoggel, Desley M G I

AU - Daniëls-Gooszen, Alette W

AU - Nieuwenhuijzen, Grard A P

AU - Bloemen, Johanne G

AU - Creemers, Geert-Jan

AU - Cnossen, Jeltsje S

AU - van Lijnschoten, Gesina

AU - Burger, Jacobus W A

AU - Rutten, Harm J T

AU - Nederend, Joost

N1 - © The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd.

PY - 2022/5/2

Y1 - 2022/5/2

N2 - BACKGROUND: This study aimed to investigate the agreement between magnetic resonance tumour regression grade (mrTRG) and pathological regression grade (pTRG) in patients with locally recurrent rectal cancer (LRRC). Also, the reproducibility of mrTRG was investigated.METHODS: All patients with LRRC who underwent a resection between 2010 and 2018 after treatment with induction chemotherapy and neoadjuvant chemo(re)irradiation in whom a restaging MRI was available were retrospectively selected. All MRI scans were reassessed by two independent radiologists using the mrTRG, and the pTRG was reassessed by an independent pathologist. The interobserver agreement between the radiologists as well as between the radiologists and the pathologist was assessed with the weighted kappa test. A subanalysis was performed to evaluate the influence of the interval between imaging and surgery.RESULTS: Out of 313 patients with LRRC treated during the study interval, 124 patients were selected. Interobserver agreement between the radiologists was fair (k = 0.28) using a two-tier grading system (mrTRG 1-2 versus mrTRG 3-5). For the lead radiologist, agreement with pTRG was moderate (k = 0.52; 95 per cent c.i. 0.36 to 0.68) when comparing good (mrTRG 1-2 and Mandard 1-2) and intermediate/poor responders (mrTRG 3-5 and Mandard 3-5), and the agreement was fair between the other abdominal radiologist and pTRG (k = 0.39; 95 per cent c.i. 0.22 to 0.56). A shorter interval (less than 7 weeks) between MRI and surgery resulted in an improved agreement (k = 0.69), compared with an interval more than 7 weeks (k = 0.340). For the lead radiologist, the positive predictive value for predicting good responders was 95 per cent (95 per cent c.i. 71 per cent to 99 per cent), whereas this was 56 per cent (95 per cent c.i. 44 per cent to 66 per cent) for the other radiologist.CONCLUSION: This study showed that, in LRRC, the reproducibility of mrTRG among radiologists is limited and the agreement of mrTRG with pTRG is low. However, a shorter interval between MRI and surgery seems to improve this agreement and, if assessed by a dedicated radiologist, mrTRG could predict good responders.

AB - BACKGROUND: This study aimed to investigate the agreement between magnetic resonance tumour regression grade (mrTRG) and pathological regression grade (pTRG) in patients with locally recurrent rectal cancer (LRRC). Also, the reproducibility of mrTRG was investigated.METHODS: All patients with LRRC who underwent a resection between 2010 and 2018 after treatment with induction chemotherapy and neoadjuvant chemo(re)irradiation in whom a restaging MRI was available were retrospectively selected. All MRI scans were reassessed by two independent radiologists using the mrTRG, and the pTRG was reassessed by an independent pathologist. The interobserver agreement between the radiologists as well as between the radiologists and the pathologist was assessed with the weighted kappa test. A subanalysis was performed to evaluate the influence of the interval between imaging and surgery.RESULTS: Out of 313 patients with LRRC treated during the study interval, 124 patients were selected. Interobserver agreement between the radiologists was fair (k = 0.28) using a two-tier grading system (mrTRG 1-2 versus mrTRG 3-5). For the lead radiologist, agreement with pTRG was moderate (k = 0.52; 95 per cent c.i. 0.36 to 0.68) when comparing good (mrTRG 1-2 and Mandard 1-2) and intermediate/poor responders (mrTRG 3-5 and Mandard 3-5), and the agreement was fair between the other abdominal radiologist and pTRG (k = 0.39; 95 per cent c.i. 0.22 to 0.56). A shorter interval (less than 7 weeks) between MRI and surgery resulted in an improved agreement (k = 0.69), compared with an interval more than 7 weeks (k = 0.340). For the lead radiologist, the positive predictive value for predicting good responders was 95 per cent (95 per cent c.i. 71 per cent to 99 per cent), whereas this was 56 per cent (95 per cent c.i. 44 per cent to 66 per cent) for the other radiologist.CONCLUSION: This study showed that, in LRRC, the reproducibility of mrTRG among radiologists is limited and the agreement of mrTRG with pTRG is low. However, a shorter interval between MRI and surgery seems to improve this agreement and, if assessed by a dedicated radiologist, mrTRG could predict good responders.

KW - Humans

KW - Magnetic Resonance Imaging

KW - Neoadjuvant Therapy/methods

KW - Rectal Neoplasms/drug therapy

KW - Reproducibility of Results

KW - Retrospective Studies

KW - SURGERY

KW - SURVIVAL

KW - MANAGEMENT

KW - CHEMORADIOTHERAPY

KW - MULTIDISCIPLINARY TEAM

KW - CHEMORADIATION

KW - QUALITY-OF-LIFE

KW - OUTCOMES

U2 - 10.1093/bjsopen/zrac033

DO - 10.1093/bjsopen/zrac033

M3 - Article

C2 - 35552373

SN - 2474-9842

VL - 6

JO - BJS Open

JF - BJS Open

IS - 3

M1 - zrac033

ER -

MRI tumour regression grade in locally recurrent rectal cancer

Abstract

Keywords

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