Accuracy and clinical impact of persistent disease diagnosed on diffusion-weighted imaging and accuracy of pelvic nodal assessment on magnetic resonance imaging for squamous cell carcinoma of the anus in the 6-month interval post chemoradiotherapy Journal Article
| Authors: | Fernandes, M. C.; Charbel, C.; Romesser, P. B.; Ucpinar, B. A.; Homsi, M. E.; Yildirim, O.; Fuqua, J. L.; Rodriguez, L. A.; Zheng, J.; Capanu, M.; Gollub, M. J.; Horvat, N. |
| Article Title: | Accuracy and clinical impact of persistent disease diagnosed on diffusion-weighted imaging and accuracy of pelvic nodal assessment on magnetic resonance imaging for squamous cell carcinoma of the anus in the 6-month interval post chemoradiotherapy |
| Abstract: | Purpose: To evaluate the diagnostic performance of diffusion-weighted imaging (DWI) in the 6-month interval post chemoradiation therapy (CRT) in determining persistent disease and whether persistent diffusion restriction on DWI at 6 months is associated with overall survival; and secondarily, to investigate the accuracy of pelvic lymph node assessment on T2-weighted imaging and DWI in the 6-month interval post CRT, in patients with squamous cell carcinoma of the anus. Methods and Materials: This retrospective study included patients with squamous cell carcinoma of the anus who underwent CRT followed by restaging rectal MRI from January 2010 to April 2020, with ≥1 year of follow-up after CRT. DW images were qualitatively evaluated by 2 junior and 2 senior abdominal radiologists to determine anal persistent disease. The reference standard for anal persistent disease was digital rectal examination/endoscopy and histopathology. Diagnostic performance was estimated using sensitivity, specificity, negative predictive value, and positive predictive value. Survival outcomes were evaluated via Kaplan-Meier analysis, and associations between survival outcomes and DWI status were tested for significance using the log-rank test. Additionally, DW and T2-weighted images were evaluated to determine lymph node status. Results: Among 84 patients (mean age, 63 ± 10.2 years; 64/84 [76%] female), 14 of 84 (17%) had confirmed persistent disease. Interreader agreement on DWI between all 4 radiologists was moderate (Light's κ = 0.553). Overall, DWI had a sensitivity of 71.4%, specificity of 72.1%, positive predictive value of 34.5%, and negative predictive value of 92.5%. Patients with a negative DWI showed better survival than patients with a positive DWI (3-year overall survival of 92% vs 79% and 5-year overall survival of 87% vs 74%), although the difference did not reach statistical significance (P =.063). All patients with suspicious lymph nodes (14/14, 100%) showed negative pathology or decreased size during follow-up. Conclusions: At 6 months post CRT, DWI showed value in excluding anal persistent disease. Persistent diffusion restriction on DWI was not significantly associated with overall survival. Pelvic nodal assessment on DWI and T2-weighted imaging was limited in predicting persistent nodal metastases. © 2024 Elsevier Inc. |
| Keywords: | adult; cancer survival; controlled study; aged; middle aged; retrospective studies; major clinical study; overall survival; histopathology; mortality; squamous cell carcinoma; carcinoma, squamous cell; cancer patient; nuclear magnetic resonance imaging; follow up; magnetic resonance imaging; lymph node metastasis; antineoplastic agent; cancer diagnosis; lymph nodes; lymphatic metastasis; pelvis; diagnostic accuracy; sensitivity and specificity; diffusion; pathology; diagnostic imaging; retrospective study; time factors; lymph node; diagnosis; disease control; endoscopy; diffusion weighted imaging; diffusion magnetic resonance imaging; negative predictive value; therapy; predictive value; chemoradiotherapy; digital rectal examination; diagnostic test accuracy study; anus neoplasms; anus tumor; time factor; procedures; diagnostic performance; humans; human; male; female; article; persistent disease; chemoradiation therapies; anal squamous cell carcinoma; t2-weighted imaging; t2 weighted imaging; diffusion restrictions |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 120 |
| Issue: | 1 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2024-09-01 |
| Start Page: | 120 |
| End Page: | 129 |
| Language: | English |
| DOI: | 10.1016/j.ijrobp.2024.02.056 |
| PUBMED: | 38462017 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledge in the PDF -- Corresponding authors is MSK author: Natally Horvat -- Source: Scopus |
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