The sigmoid take-off as a landmark to distinguish rectal from sigmoid tumours on MRI: Reproducibility,pitfalls and potential impact on treatment stratification |
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| Affiliation: | 1. Dept. of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands;2. GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, the Netherlands;3. Dept. of Radiology, Acad. F. Todua Medical Center, Research Institute of Clinical Medicine, Tbilisi, Georgia;4. Dept. of Radiology, University Hospitals Leuven, Leuven, Belgium;5. Dept. of Surgery, Amsterdam University Medical Centres, Cancer Centre Amsterdam, the Netherlands;6. Dept. of Radiology, St. Antonius Hospital, Nieuwegein, the Netherlands;7. Dept. of Radiology, Maastricht University Medical Centre, Maastricht, the Netherlands;8. Dept. of Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands;9. Dept. of Radiology, Deventer Ziekenhuis, Deventer, the Netherlands;10. Dept. of Radiology, Elisabeth Tweesteden Hospital, Tilburg, the Netherlands;11. Dept. of Radiology, Jeroen Bosch Hospital, ‘s Hertogenbosch, the Netherlands;12. Dept. of Radiology, University of Brescia, Brescia, Italy;13. Dept. of Radiology, Jerarci Clinic, Tbilisi, Georgia;14. Dept. of Surgery, IJsselland Hospital, Capelle aan den IJssel, the Netherlands;15. Dept. of Radiology, Northwest Clinics, Alkmaar, the Netherlands;p. Dept. of Radiology, Caucasus Medical Center, Tbilisi, Georgia;q. Dept. of Radiology, The Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy;r. Dept. of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands;s. Dept. of Radiology, Spaarne Gasthuis, the Netherlands;t. Dept. of Surgery, Isala Hospital, Zwolle, the Netherlands;u. Dept. of Radiology, IJsselland Hospital, Capelle aan den IJssel, the Netherlands;v. Dept. of Radiology, Imelda Hospital, Bonheiden, Belgium;w. Dept. of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands;x. Dept. of Surgery, University Hospital Leuven, Leuven, Belgium;1. Dept. of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands;2. GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, the Netherlands;3. Dept. of Radiology, Acad. F. Todua Medical Center, Research Institute of Clinical Medicine, Tbilisi, Georgia;4. Dept. of Radiology, University Hospitals Leuven, Leuven, Belgium;5. Dept. of Surgery, Amsterdam University Medical Centres, Cancer Centre Amsterdam, the Netherlands;1. Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, APHP. Centre, Paris, France;2. Paris University, Faculty of Medicine, Paris, France;3. INSERM UMR-S 1124, Université de Paris, Centre Universitaire des Saint-Père, Paris, France;4. Pathology Department, Georges Pompidou European Hospital, APHP. Centre, Paris, France;5. Radiology Department, Georges Pompidou European Hospital, APHP. Centre, Paris, France;6. Oncology Department, Georges Pompidou European Hospital, APHP. Centre, Paris, France;7. INSERM UMR-S 1147, Université de Paris, Centre de Recherche des Cordeliers, Paris, France;1. Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands;2. Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands;3. Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands;4. Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands;5. Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands;6. Department of Surgery, Radboud Medical Center, Nijmegen, the Netherlands;7. Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands;8. Department of Surgery, Isala, Zwolle, the Netherlands;9. Department of Surgery, Máxima Medical Center, Veldhoven, the Netherlands;10. Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands;11. Department of Surgery, Amphia Medical Center, Breda, the Netherlands;12. Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands;13. Department of Surgery, Antoni van Leeuwenhoek – Dutch Cancer Institute, Amsterdam, the Netherlands;14. Department of Surgery, Jeroen Bosch Ziekenhuis, ‘s Hertogenbosch, the Netherlands;15. Department of Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands;p. Department of Surgery, Ijsselland Hospital, Capelle a/d Ijssel, the Netherlands;q. Department of Surgery, Gelderse Vallei, Ede, the Netherlands;r. Department of Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands;s. Department of Surgery, Deventer Hospital, Deventer, the Netherlands;t. Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, the Netherlands;u. Department of Surgery, Meander Medical Centre, Amersfoort, the Netherlands;v. Department of Surgery, OLVG, Amsterdam, the Netherlands;w. Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands;x. Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands;y. Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands;1. Department of Hepatobiliary and Pancreatic Surgery, The Center for Integrated Oncology and Precision Medicine, Affiliated Hangzhou First People''s Hospital, Zhejiang University School of Medicine, Hangzhou, China;2. Zhejiang University Cancer Center, Hangzhou, China;3. Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China;4. National Health Commission (NHC) Key Laboratory of Combined Multi-Organ Transplantation, Hangzhou, China;5. Institute of Organ Transplantation, Zhejiang University, Hangzhou, China;6. Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital, Hangzhou, China;7. Organ Transplantation Center, The Affiliated Hospital of Qingdao University, Qingdao, China;8. Institute of Organ Donation and Transplantation, Department of Medicine, Qingdao University, Qingdao, China;9. Department of Hepatic Surgery and Liver Transplantation Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China;10. Department of General Surgery and Liver Transplant Center, Huashan Hospital, Fudan University, Shanghai, China;11. Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China |
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| Abstract: | PurposeThe sigmoid take-off (STO) was recently introduced as a preferred landmark, agreed upon by expert consensus recommendation, to discern rectal from sigmoid cancer on imaging. Aim of this study was to assess the reproducibility of the STO, explore its potential treatment impact and identify its main interpretation pitfalls.MethodsEleven international radiologists (with varying expertise) retrospectively assessed n = 155 patients with previously clinically staged upper rectal/rectosigmoid tumours and re-classified them using the STO as completely below (rectum), straddling the STO (rectosigmoid) or completely above (sigmoid), after which scores were dichotomized as rectum (below/straddling STO) and sigmoid (above STO), being the clinically most relevant distinction. A random subset of n = 48 was assessed likewise by 6 colorectal surgeons. .ResultsInterobserver agreement (IOA) for the 3-category score ranged from κ0.19–0.82 (radiologists) and κ0.32–0.72 (surgeons), with highest scores for the most experienced radiologists (κ0.69–0.76). Of the 155 cases, 44 (28%) were re-classified by ≥ 80% of radiologists as sigmoid cancers; 36 of these originally received neoadjuvant treatment which in retrospect might have been omitted if the STO had been applied. Main interpretation pitfalls were related to anatomical variations, borderline cases near the STO and angulation of axial imaging planes.ConclusionsGood agreement was reached for experienced radiologists. Despite considerable variation among less-expert readers, use of the STO could have changed treatment in ±1/4 of patients in our cohort. Identified interpretation pitfalls may serve as a basis for teaching and to further optimize MR protocols. |
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| Keywords: | Rectal cancer Sigmoid cancer MRI Sigmoid take-off CRT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0035" }," $$" :[{" #name" :" text" ," _" :" Chemoradiotherapy IOA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0045" }," $$" :[{" #name" :" text" ," _" :" Interobserver agreement STO" },{" #name" :" keyword" ," $" :{" id" :" kwrd0055" }," $$" :[{" #name" :" text" ," _" :" Sigmoid take-off |
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