MRI assessment of rectal cancer response to neoadjuvant therapy: A multireader study Journal Article
| Authors: | Yuval, J. B.; Patil, S.; Gangai, N.; Omer, D. M.; Akselrod, D. G.; Fung, A.; Harmath, C. B.; Kampalath, R.; Krehbiel, K.; Lee, S.; Liu, P. S.; Millet, J. D.; O’Malley, R. B.; Purysko, A. S.; Veniero, J. C.; Wasnik, A. P.; Garcia-Aguilar, J.; Gollub, M. J. |
| Article Title: | MRI assessment of rectal cancer response to neoadjuvant therapy: A multireader study |
| Abstract: | Objectives: A watch and wait strategy with the goal of organ preservation is an emerging treatment paradigm for rectal cancer following neoadjuvant treatment. However, the selection of appropriate patients remains a challenge. Most previous efforts to measure the accuracy of MRI in assessing rectal cancer response used a small number of radiologists and did not report variability among them. Methods: Twelve radiologists from 8 institutions assessed baseline and restaging MRI scans of 39 patients. The participating radiologists were asked to assess MRI features and to categorize the overall response as complete or incomplete. The reference standard was pathological complete response or a sustained clinical response for > 2 years. Results: We measured the accuracy and described the interobserver variability of interpretation of rectal cancer response between radiologists at different medical centers. Overall accuracy was 64%, with a sensitivity of 65% for detecting complete response and specificity of 63% for detecting residual tumor. Interpretation of the overall response was more accurate than the interpretation of any individual feature. Variability of interpretation was dependent on the patient and imaging feature investigated. In general, variability and accuracy were inversely correlated. Conclusions: MRI-based evaluation of response at restaging is insufficiently accurate and has substantial variability of interpretation. Although some patients’ response to neoadjuvant treatment on MRI may be easily recognizable, as seen by high accuracy and low variability, that is not the case for most patients. Key Points: • The overall accuracy of MRI-based response assessment is low and radiologists differed in their interpretation of key imaging features. • Some patients’ scans were interpreted with high accuracy and low variability, suggesting that these patients’ pattern of response is easier to interpret. • The most accurate assessments were those of the overall response, which took into consideration both T2W and DWI sequences and the assessment of both the primary tumor and the lymph nodes. © 2023, The Author(s), under exclusive licence to European Society of Radiology. |
| Keywords: | adult; clinical article; controlled study; treatment outcome; middle aged; retrospective studies; fluorouracil; cancer patient; neoadjuvant therapy; cancer staging; nuclear magnetic resonance imaging; magnetic resonance imaging; lymph nodes; neoplasm staging; diagnostic accuracy; sensitivity and specificity; phase 2 clinical trial; randomized controlled trial; pathology; diagnostic imaging; retrospective study; folinic acid; lymph node; remission; remission induction; organ preservation; oxaliplatin; rectal neoplasms; rectum cancer; rectum tumor; mri; chemoradiotherapy; rectal cancer; neoadjuvant treatment; diagnostic test accuracy study; procedures; capecitabine plus oxaliplatin; humans; human; male; female; article; watch and wait |
| Journal Title: | European Radiology |
| Volume: | 33 |
| Issue: | 8 |
| ISSN: | 0938-7994 |
| Publisher: | Springer |
| Date Published: | 2023-08-01 |
| Start Page: | 5761 |
| End Page: | 5768 |
| Language: | English |
| DOI: | 10.1007/s00330-023-09480-9 |
| PUBMED: | 36814032 |
| PROVIDER: | scopus |
| PMCID: | PMC10394731 |
| DOI/URL: | |
| Notes: | Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PubMed and PDF -- MSK corresponding author is Marc Gollub -- Source: Scopus |
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61Gangai -
37Yuval -
32Omer
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