叢冠寧 1,2 , 秦明偉 1 , 賀丹 1 , 肖毅 3 , 邱輝忠 3 , 吳斌 3 , 林國樂 3
  • 1.中國醫(yī)學科學院 北京協(xié)和醫(yī)學院 北京協(xié)和醫(yī)院放射科(北京 100730);;
  • 2.中國中醫(yī)科學院 廣安門醫(yī)院放射科(北京 100053);;
  • 3.中國醫(yī)學科學院 北京協(xié)和醫(yī)學院 北京協(xié)和醫(yī)院基本外科(北京 100730);

目的 探討高分辨MRI對直腸癌術(shù)前T、N分期及環(huán)周切緣評估的準確性。
方法 選取北京協(xié)和醫(yī)院2006年9月至2009年5月期間42例經(jīng)結(jié)腸鏡活檢并組織病理學證實的直腸癌患者，術(shù)前行MRI分期。檢查后1周內(nèi)，按照全直腸系膜切除原則行直腸癌切除手術(shù)。手術(shù)后標本根據(jù)2002年美國癌癥學會(AJCC)結(jié)直腸癌分期標準行腫瘤及淋巴結(jié)病理學分期。影像學和病理學對腫瘤(T)分期、淋巴結(jié)(N)分期與環(huán)周切緣受累評估的一致性采用Kappa檢驗。
結(jié)果 對T分期，MRI正確分期36例，過低分期3例，過高分期3例，統(tǒng)計學分析顯示病理學和影像學對T分期具有較好的一致性(Kappa=0.731，P=0.000)。對N分期，術(shù)前MRI正確分期31例，過低分期5例，過高分期6例，統(tǒng)計學分析顯示兩者具有中度一致性(Kappa=0.410，P=0.009)。對環(huán)周切緣的評估，術(shù)前MRI能夠正確評估40例，統(tǒng)計學分析顯示兩者對直腸固有筋膜的評估具有很好的一致性(Kappa=0.829，P=0.000)。
結(jié)論 高分辨MRI對直腸癌術(shù)前T分期具有較好的準確性，對N分期具有中度的準確性，對直腸固有筋膜能夠提供準確的評估,有助于挑選出能夠受益于術(shù)前新輔助治療的患者。

引用本文： 叢冠寧,秦明偉,賀丹,肖毅,邱輝忠,吳斌,林國樂. 高分辨MRI對直腸癌TNM分期及環(huán)周切緣的評估. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(9): 894-900. doi: 復制

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27. Brown G, Richards CJ, Bourne MW, et al. Morphologic predictors of lymph node status in rectal cancer with use of highspatialresolution MR imaging with histopathologic comparison [J]. Radiology, 2003; 227(2): 371377.
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29. Monig SP, Baldus SE, Zirbes TK, et al. Lymph node size and metastatic infiltration in colon cancer [J]. Ann Surg Oncol, 1999; 6(6): 579581.
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32. Dixon AR, Maxwell WA, Holmes JT. Carcinoma of the rectum: a 10year experience [J]. Br J Surg, 1991; 78(3): 308311.
33. Enker WE, Thaler HT, Cranor ML, et al. Total mesorectal excision in the operative treatment of carcinoma of the rectum [J]. J Am Coll Surg, 1995; 181(4): 335346.
34. McCall JL, Cox MR, Wattchow DA. Analysis of local recurrence rates after surgery alone for rectal cancer [J]. Int J Colorectal Dis, 1995; 10(3): 126132.
35. Wibe A, Rendedal PR, Svensson E, et al. Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer [J]. Br J Surg, 2002; 89(3): 327334.
  1. 1. Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2009 [J]. CA Cancer J Clin, 2009; 59(4): 225249.
  2. 2. Smith RA, Cokkinides V, Brawley OW. Cancer screening in the United States, 2008: a review of current American Cancer Society guidelines and cancer screening issues [J]. CA Cancer J Clin, 2008; 58(3): 161179.
  3. 3. Sung JJ, Lau JY, Goh KL, et al. Increasing incidence of colorectal cancer in Asia: implications for screening [J]. Lancet Oncol, 2005; 6(11): 871876.
  4. 4. Cawthorn SJ, Parums DV, Gibbs NM, et al. Extent of mesorectal spread and involvement of lateral resection margin as prognostic factors after surgery for rectal cancer [J]. Lancet, 1990; 335(8697): 10551059.
  5. 5. Lindmark G, Gerdin B, Pahlman L, et al. Prognostic predictors in colorectal cancer [J]. Dis Colon Rectum, 1994; 37(12): 12191227.
  6. 6. Heald RJ, Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer [J]. Lancet, 1986; 1(8496): 14791482.
  7. 7. MacFarlane JK, Ryall RD, Heald RJ. Mesorectal excision for rectal cancer [J]. Lancet, 1993; 341(8843): 457460.
  8. 8. Adam IJ, Mohamdee MO, Martin IG, et al. Role of circumferential margin involvement in the local recurrence of rectal cancer [J]. Lancet, 1994; 344(8924): 707711.
  9. 9. Williamson PR, Hellinger MD, Larach SW, et al. Endorectal ultrasound of T3 and T4 rectal cancers after preoperative chemoradiation [J]. Dis Colon Rectum, 1996; 39(1): 4549.
  10. 10. Chari RS, Tyler DS, Anscher MS, et al. Preoperative radiation and chemotherapy in the treatment of adenocarcinoma of the rectum [J]. Ann Surg, 1995; 221(6): 778786.
  11. 11. Birbeck KF, Macklin CP, Tiffin NJ, et al. Rates of circumferential resection margin involvement vary between surgeons and predict outcomes in rectal cancer surgery [J]. Ann Surg, 2002; 235(4): 449457.
  12. 12. Quirke P, Durdey P, Dixon MF, et al. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision [J]. Lancet, 1986; 2(8514): 996999.
  13. 13. Nagtegaal ID, Marijnen CA, Kranenbarg EK, et al. Circumferential margin involvement is still an important predictor of local recurrence in rectal carcinoma: not one millimeter but two millimeters is the limit [J]. Am J Surg Pathol, 2002; 26(3): 350357.
  14. 14. Frykholm GJ, Glimelius B, Pahlman L. Preoperative or postoperative irradiation in adenocarcinoma of the rectum: final treatment results of a randomized trial and an evaluation of late secondary effects [J]. Dis Colon Rectum, 1993; 36(6): 564572.
  15. 15. SebagMontefiore D, Stephens RJ, Steele R, et al. Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCICCTG C016): a multicentre, randomised trial [J]. Lancet, 2009; 373(9666): 811820.
  16. 16. Brown G, Richards CJ, Newcombe RG, et al. Rectal carcinoma: thinsection MR imaging for staging in 28 patients [J]. Radiology, 1999; 211(1): 215222.
  17. 17. Brown G, Kirkham A, Williams GT, et al. Highresolution MRI of the anatomy important in total mesorectal excision of the rectum [J]. AJR Am J Roentgenol, 2004; 182(2): 431439.
  18. 18. Bissett IP, Fernando CC, Hough DM, et al. Identification of the fascia propria by magnetic resonance imaging and its relevance to preoperative assessment of rectal cancer [J]. Dis Colon Rectum, 2001; 44(2): 259265.
  19. 19. Gualdi GF, Casciani E, Guadalaxara A, et al. Local staging of rectal cancer with transrectal ultrasound and endorectal magnetic resonance imaging: comparison with histologic findings [J]. Dis Colon Rectum, 2000; 43(3): 338345.
  20. 20. Hanski C. Is mucinous carcinoma of the colorectum a distinct genetic entity? [J]. Br J Cancer, 1995; 72(6): 13501356.
  21. 21. Low RN, McCue M, Barone R, et al. MR staging of primary colorectal carcinoma: comparison with surgical and histopathologic findings [J]. Abdom Imaging, 2003; 28(6):784793.
  22. 22. Akasu T, Iinuma G, Fujita T, et al. Thinsection MRI with a phasedarray coil for preoperative evaluation of pelvic anatomy and tumor extent in patients with rectal cancer [J]. AJR Am J Roentgenol, 2005; 184(2): 531538.
  23. 23. Branagan G, Chave H, Fuller C, et al. Can magnetic resonance imaging predict circumferential margins and TNM stage in rectal cancer? [J]. Dis Colon Rectum, 2004; 47(8): 13171322.
  24. 24. BeetsTan RG, Beets GL, Vliegen RF, et al. Accuracy of magnetic resonance imaging in prediction of tumourfree resection margin in rectal cancer surgery [J]. Lancet, 2001; 357(9255): 497504.
  25. 25. Simunovic M, Smith AJ, Heald RJ. Rectal cancer surgery and regional lymph nodes [J]. J Surg Oncol, 2009; 99(4): 256259.
  26. 26. Koh DM, Brown G, Temple L, et al. Distribution of mesorectal lymph nodes in rectal cancer: in vivo MR imaging compared with histopathological examination. Initial observations [J]. Eur Radiol, 2005; 15(8): 16501657.
  27. 27. Brown G, Richards CJ, Bourne MW, et al. Morphologic predictors of lymph node status in rectal cancer with use of highspatialresolution MR imaging with histopathologic comparison [J]. Radiology, 2003; 227(2): 371377.
  28. 28. Koh DM, Brown G, Temple L, et al. Rectal cancer: mesorectal lymph nodes at MR imaging with USPIO versus histopathologic findings－initial observations [J]. Radiology, 2004; 231(1): 9199.
  29. 29. Monig SP, Baldus SE, Zirbes TK, et al. Lymph node size and metastatic infiltration in colon cancer [J]. Ann Surg Oncol, 1999; 6(6): 579581.
  30. 30. Kim JH, Beets GL, Kim MJ, et al. Highresolution MR imaging for nodal staging in rectal cancer: are there any criteria in addition to the size? [J]. Eur J Radiol, 2004; 52(1): 7883.
  31. 31. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery－the clue to pelvic recurrence? [J] Br J Surg, 1982; 69(10): 613616.
  32. 32. Dixon AR, Maxwell WA, Holmes JT. Carcinoma of the rectum: a 10year experience [J]. Br J Surg, 1991; 78(3): 308311.
  33. 33. Enker WE, Thaler HT, Cranor ML, et al. Total mesorectal excision in the operative treatment of carcinoma of the rectum [J]. J Am Coll Surg, 1995; 181(4): 335346.
  34. 34. McCall JL, Cox MR, Wattchow DA. Analysis of local recurrence rates after surgery alone for rectal cancer [J]. Int J Colorectal Dis, 1995; 10(3): 126132.
  35. 35. Wibe A, Rendedal PR, Svensson E, et al. Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer [J]. Br J Surg, 2002; 89(3): 327334.