CRM (T stage) Low rectal cancer Nodal disease Risk Factors for Loc recurrence.

CRM (T stage)

Low rectal cancer

Nodal disease

Risk Factors for Loc recurrence

Wang et al. Langenbecks Arch Surg 2005; 91: 167-172

Size as a criterium?

Based on Wang et al. Langenbecks Arch Surg 2005

0.0 0.2 0.4 0.6 0.8 1.0

1 - Specificity

0.0

0.2

0.4

0.6

0.8

1.0

Se

ns

itiv

ity

ROC Curve

Size as a criterium?

Lahaye, Beets-Tan et al. Semin US CT MR 2005

AUC 0.96

USPIO MRI

Nodal detection

> 2 mm

</= 2 mm LOCALLY ADVANCED

N2

N1

NO

EARLY TUMOR

Distaal

Mid rectaal

Hoog rectaal

NON LOCALLY ADVANCED

LOCALLY ADVANCED

LOCALLY ADVANCED

T3

T1-2

Hoog/mid rectaal

Distaal

CRM EARLY TUMOR

LOCALLY ADVANCED

NON LOCALLY ADVANCED

BeetsTan, vd Velde, Beets et al. Maastricht MR multicenter study

MR stratifies patients into a tailored RX multicenter study

LOCALLY ADVANCED

EARLY TUMOR

NON LOCALLY ADVANCED

TME (local excision)

5x5 Gy + TME

Chemoradiation + surgery*

* 2nd MRI before surgery

2003-2008: n=319 university hospital, 3 regional hospitals Each MRI prospective reading by local radiologist Each MRI double read by expert center:

Rx stratification

Maastricht MR multicenter study

Rx stratification based on MRI prospective multicenter study

2003-2008: n=319 university hospitals, 3 regional hospitals Each MRI prospective reading by local radiologist Each MRI double read by expert center:Rx stratification

Loc Recurrence, OS, DFS, death # complete resections Accuracy MRI in expert vs general centers Impact of double reading setting on

radiologists performance

Maastricht MR multicenter study

Rx stratification based on MRI prospective multicenter study

2003-2008: n=319 university hospitals, 3 regional hospitals Each MRI prospective reading by local radiologist Each MRI double read by expert center:Rx stratification

Loc Recurrence, OS, DFS, death # complete resections Accuracy MRI in expert vs general centers Impact of double reading setting on

radiologists performance

Maastricht MR multicenter study

Rx stratification based on MRI prospective multicenter study

No USPIO

General Expert

Sens 0.62 0.90

Spec 0.83 0.53

PPV 0.62 0.47

NPV 0.83 0.92

MRI for nodal disease

No USPIO WITH USPIO

General

ExpertGenera

lExpert

Sens 0.62 0.90 0.92 0.95

Spec 0.83 0.53 0.69 0.81

PPV 0.62 0.47 0.57 0.70

NPV 0.83 0.92 0.95 0.97

MRI for nodal disease

Maastricht MR multicenter study

Conventional MRI not reliable for detection of tumor less than 5 mm

Lessons to learn

Maastricht MR multicenter study

Conventional MRI not reliable for detection of tumor less than 5 mm

USPIO MRI selects N0

Lessons to learn

Maastricht MR multicenter study

Conventional MRI not reliable for detection of tumor less than 5 mm

USPIO MRI selects N0

MR stratification also in general hands

Lessons to learn

Conventional MRI not reliable for detection of tumor less than 5 mm

USPIO MRI selects N0

MR stratification also in general hands

USPIO not on the market

Maastricht MR multicenter study

Lessons to learn

Maastricht MR multicenter study

MS 325 enhanced MRI

n= 132 lymph nodes

(15/132 N+)

Sensitivity 93 % (14/14 +1)

Specificity 97 % (113/113+4)

PPV 78 % (14/14+4)

NPV 99 % (113/113+1)

Maastricht MR multicenter study

MS 325 MRI for nodal disease