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MRI assessment of rectal cancer response to neoadjuvant therapy: a multireader study.

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Title: MRI assessment of rectal cancer response to neoadjuvant therapy: a multireader study.
Authors: Yuval, Jonathan B.1,2 (AUTHOR), Patil, Sujata3 (AUTHOR), Gangai, Natalie4 (AUTHOR), Omer, Dana M.1 (AUTHOR), Akselrod, Dmitriy G.5 (AUTHOR), Fung, Alice6 (AUTHOR), Harmath, Carla B.7 (AUTHOR), Kampalath, Rony8 (AUTHOR), Krehbiel, Kyle9 (AUTHOR), Lee, Sonia8 (AUTHOR), Liu, Peter S.10 (AUTHOR), Millet, John D.11 (AUTHOR), O'Malley, Ryan B.12 (AUTHOR), Purysko, Andrei S.10 (AUTHOR), Veniero, Joseph C.10 (AUTHOR), Wasnik, Ashish P.11 (AUTHOR), Garcia-Aguilar, Julio1 (AUTHOR), Gollub, Marc J.4 (AUTHOR) gollubm@mskcc.org
Source: European Radiology. Aug2023, Vol. 33 Issue 8, p5761-5768. 8p. 6 Charts, 1 Graph.
Subjects: Rectal cancer, Neoadjuvant chemotherapy, Magnetic resonance imaging, Preservation of organs, tissues, etc., Image analysis, Lymph nodes
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. [ABSTRACT FROM AUTHOR]
Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: MRI assessment of rectal cancer response to neoadjuvant therapy: a multireader study.
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  Data: <searchLink fieldCode="AR" term="%22Yuval%2C+Jonathan+B%2E%22">Yuval, Jonathan B.</searchLink><relatesTo>1,2</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Patil%2C+Sujata%22">Patil, Sujata</searchLink><relatesTo>3</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Gangai%2C+Natalie%22">Gangai, Natalie</searchLink><relatesTo>4</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Omer%2C+Dana+M%2E%22">Omer, Dana M.</searchLink><relatesTo>1</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Akselrod%2C+Dmitriy+G%2E%22">Akselrod, Dmitriy G.</searchLink><relatesTo>5</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Fung%2C+Alice%22">Fung, Alice</searchLink><relatesTo>6</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Harmath%2C+Carla+B%2E%22">Harmath, Carla B.</searchLink><relatesTo>7</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Kampalath%2C+Rony%22">Kampalath, Rony</searchLink><relatesTo>8</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Krehbiel%2C+Kyle%22">Krehbiel, Kyle</searchLink><relatesTo>9</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Lee%2C+Sonia%22">Lee, Sonia</searchLink><relatesTo>8</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Liu%2C+Peter+S%2E%22">Liu, Peter S.</searchLink><relatesTo>10</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Millet%2C+John+D%2E%22">Millet, John D.</searchLink><relatesTo>11</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22O'Malley%2C+Ryan+B%2E%22">O'Malley, Ryan B.</searchLink><relatesTo>12</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Purysko%2C+Andrei+S%2E%22">Purysko, Andrei S.</searchLink><relatesTo>10</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Veniero%2C+Joseph+C%2E%22">Veniero, Joseph C.</searchLink><relatesTo>10</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Wasnik%2C+Ashish+P%2E%22">Wasnik, Ashish P.</searchLink><relatesTo>11</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Garcia-Aguilar%2C+Julio%22">Garcia-Aguilar, Julio</searchLink><relatesTo>1</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Gollub%2C+Marc+J%2E%22">Gollub, Marc J.</searchLink><relatesTo>4</relatesTo> (AUTHOR)<i> gollubm@mskcc.org</i>
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  Data: <searchLink fieldCode="JN" term="%22European+Radiology%22">European Radiology</searchLink>. Aug2023, Vol. 33 Issue 8, p5761-5768. 8p. 6 Charts, 1 Graph.
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  Data: <searchLink fieldCode="DE" term="%22Rectal+cancer%22">Rectal cancer</searchLink><br /><searchLink fieldCode="DE" term="%22Neoadjuvant+chemotherapy%22">Neoadjuvant chemotherapy</searchLink><br /><searchLink fieldCode="DE" term="%22Magnetic+resonance+imaging%22">Magnetic resonance imaging</searchLink><br /><searchLink fieldCode="DE" term="%22Preservation+of+organs%2C+tissues%2C+etc%2E%22">Preservation of organs, tissues, etc.</searchLink><br /><searchLink fieldCode="DE" term="%22Image+analysis%22">Image analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Lymph+nodes%22">Lymph nodes</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: 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. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1007/s00330-023-09480-9
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        Text: English
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      – SubjectFull: Rectal cancer
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      – SubjectFull: Neoadjuvant chemotherapy
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      – SubjectFull: Magnetic resonance imaging
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