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Session: ePoster Monitor 6-Rectal Cancer 1

eP213 - Pathologic Correlation Required: Assessing the Accuracy of Pelvic Magnetic Resonance Imaging in Rectal Cancer

Sunday, June 2, 2024
9:00 AM – 9:05 AM ET, USA
Location: Baltimore Convention Center, Room 318-320

    ePoster Presenter(s)

  • Andrea Lin, MD

    Resident
    University of Alberta
    University of Alberta
    Edmonton, AB, Canada

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • CN

    Carmen Ng, BSc, MSc

    Medical Student
    University of Alberta
    Edmonton, Alberta, Canada

    Disclosure information not submitted.

  • NF

    Nolan R. Frymire, BSc. (Hons)

    Medical Student
    University of Alberta
    Edmonton, Alberta, Canada

    Disclosure information not submitted.

  • SM

    Susan Muncner, MD

    Resident Physician - General Surgery
    University of Alberta
    Edmonton, Alberta, Canada

    Disclosure information not submitted.

  • JD

    Jaspreet Dosanjh, n/a

    Assistant Teaching Lecturer
    University of Alberta
    Edmonton, Alberta, Canada

    Disclosure information not submitted.

  • MD

    Mark Dykstra, MD, MSc, FRCSC

    Assistant Professor of Surgery
    University of Alberta
    Edmonton, Alberta, Canada

    Disclosure information not submitted.

  • RS

    Ryan Snelgrove, MD

    Associate Professor
    University of Alberta Hospital
    Edmonton, Alberta, Canada

    Disclosure information not submitted.

  • AR

    Abhilash Rakkunedeth Hareendranathan, PhD

    Assistant Professor
    University of Alberta
    Edmonton, Alberta, Canada

    Disclosure information not submitted.

  • JJ

    Jacob L. Jaremko, MD, PhD, FRCPC

    Professor and Canada CIFAR AI Chair
    University Of Alberta
    Edmonton, Alberta, Canada

    Disclosure information not submitted.

    • Senior Author(s)

  • HW

    Haili Wang, MD, MSc, FRCSC

    Associate professor
    University of Alberta
    Edmonton, Alberta, Canada

    Disclosure information not submitted.

Purpose/Background: Local staging of rectal cancer relies on pelvic magnetic resonance imaging (MRI). Over-staging of rectal cancer could mean unnecessary neoadjuvant radiation with long-term consequences, such as anal and urinary incontinence. Under-staging of rectal cancer could result in higher risk of local recurrence, or an unexpected need for adjuvant therapy. Post-operative radiation has higher risk of long-term complications than neoadjuvant radiation, including anastomotic strictures, damage to healthy tissue, and anorectal dysfunction.At our center, most rectal cancer MRIs are reviewed at Multidisciplinary Tumour Boards before a final decision is made between proceeding directly to surgery or first to neoadjuvant therapy. We compared initial MRI interpretation, Tumour Board multidisciplinary MRI review, and final surgical pathology to evaluate preoperative staging accuracy.Methods/Interventions: This was a cross-sectional study of patients with rectal cancer who underwent elective oncologic rectal cancer surgery at a single center between November 2018 and February 2023 who either went straight to surgery or received neoadjuvant short course radiation therapy followed closely with surgery. The T and N stage of the initial MRI interpretation, Tumour Board interpretation, and final pathology results were compared.Results/Outcomes: Forty-nine patients were included in our study. Six patients received surgery without MRI review at Tumour Boards. 33% (2/6) of these patients were upstaged after surgery and received adjuvant therapy. Eighteen patients received surgery without neoadjuvant therapy. 50% (9/18) had congruent Tumour Board MRI and pathology results, 33% (6/18) were upstaged post-operatively, and 17% (3/18) had a lower pathologic stage than Tumour Board MRI staging. All 6 patients upstaged post-operatively were referred for adjuvant therapy. Of these 6 patients, the initial MRI interpretation of one patient was more accurate than the Tumour Board interpretation. In 5/9 patients with congruent MRI and pathology results, the Tumour Board interpretation had changed the patient to the correct management. Twenty-five patients underwent short-course neoadjuvant radiation followed by surgery. 32% (8/25) of patients had congruent MRI and pathology readings and received the correct management, while 32% (8/25) were upstaged post-operatively, and 36% (9/25) were downstaged after surgery. Of the 8 upstaged patients, all received adjuvant therapy, and one had initial MRI interpretation more accurate in comparison with the final pathology than the Tumour Board interpretation. In 4/8 patients with congruent MRI and pathology evaluations, the decision at Tumour Boards changed the patient to the correct management. Of the 9 patients who were downstaged post-operatively, 7 received unnecessary radiation and 2 had initial MRIs that were more accurate compared with the final pathology than the Tumour Board evaluation.Conclusion/

Discussion: 57% (28/49) of patients undergoing rectal cancer surgery had significant discrepancies between their pre-operative radiographic staging and post-operative pathologic staging. In 45% (22/49) of patients, this resulted in unnecessary neoadjuvant therapy or unplanned adjuvant therapy. 12% (6/49) of patients had incongruencies but still received the correct overall management. Strategies to improve the accuracy of pre-operative MRI interpretation would be beneficial in improving patient care and outcomes in rectal cancer.