1. The sigmoid take-off as a landmark to distinguish rectal from sigmoid tumours on MRI
- Author
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Nino Bogveradze, Doenja M.J. Lambregts, Najim el Khababi, Raphaëla C. Dresen, Monique Maas, Miranda Kusters, Pieter J. Tanis, Regina G.H. Beets-Tan, Femke Alberts, Frans C.H. Bakers, Nino Batiashvili, Geerard L. Beets, Shira de Bie, Gerlof Bosma, Vincent C. Cappendijk, Francesca Castagnoli, Ana Daushvili, Pascal Doornebosch, Remy Geenen, Brechtje Grotenhuis, Tedo Jokharidze, Max J. Lahaye, Federica Landolfi, Marjolein Leeuwenburgh, Peter Neijenhuis, Gerald Peterson, Ernst J.A. Steller, Cornelis J. Veeken, Sofie De Vuysere, Maarten Vermaas, Roy F.A. Vliegen, Albert Wolthuis, Surgery, CCA - Imaging and biomarkers, CCA - Cancer Treatment and Quality of Life, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, School Office GROW, RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, Faculteit FHML Centraal, MUMC+: DA BV Medisch Specialisten Radiologie (9), and RS: GROW - R1 - Prevention
- Subjects
Male ,Colorectal cancer ,Sigmoid cancer ,Neoadjuvant treatment ,80 and over ,Medicine ,Rectal cancer ,Sigmoid take-off ,Colectomy ,Aged, 80 and over ,Observer Variation ,Potential impact ,Proctectomy ,Carcinoma/diagnostic imaging ,Anatomic Variation ,General Medicine ,Chemoradiotherapy ,Middle Aged ,Magnetic Resonance Imaging ,CANCER ,Neoadjuvant Therapy ,medicine.anatomical_structure ,Oncology ,Female ,Radiology ,Anatomic Landmarks ,MRI ,Adult ,medicine.medical_specialty ,Rectum ,COLON ,MANAGEMENT ,Humans ,Aged ,PREOPERATIVE RADIOTHERAPY ,Reproducibility ,Rectal Neoplasms ,business.industry ,Carcinoma ,Expert consensus ,Reproducibility of Results ,Sigmoid function ,medicine.disease ,Sigmoid Neoplasms ,Rectal Neoplasms/diagnostic imaging ,Surgery ,Sigmoid Neoplasms/diagnostic imaging ,business ,CONSENSUS ,POSTOPERATIVE CHEMORADIOTHERAPY - Abstract
PURPOSE: The 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.METHODS: Eleven 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. .RESULTS: Interobserver 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.CONCLUSIONS: Good 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.
- Published
- 2022