직장암에서 수술 전 자기공명 영상의 술 후 전층 절편 병리 조직 검사 비교를 통한 TNM 병기와 측방 절제연 측정의 정확도 산출
Accuracy of Magnetic Resonance Imaging in Predicting TNM Staging and Circumferential Resection Margin Compared with Pathologic Assessment on Whole-mount Section in Rectal Cancer
김영완, 김남규, 민병소, 표주연, 김호근, 김명진, 차승환, 백승혁, 이강영, 손승국, 조장환,
소속 상세정보
김영완 ( Kim Young-Wan )
연세대학교 의과대학 외과학교실
김남규 ( Kim Nam-Kyu )
연세대학교 의과대학 외과학교실
민병소 ( Min Byung-Soh )
연세대학교 의과대학 외과학교실
표주연 ( Pyo Ju-Yeon )
연세대학교 의과대학 병리학교실
김호근 ( Kim Ho-Guen )
연세대학교 의과대학 병리학교실
김명진 ( Kim Myung-Jin )
연세대학교 의과대학 영상의학교실
차승환 ( Cha Seung-Hwan )
연세대학교 의과대학 영상의학교실
백승혁 ( Paik Seung-Hyuk )
연세대학교 의과대학 외과학교실
이강영 ( Rhee Kang-Young )
연세대학교 의과대학 외과학교실
손승국 ( Sohn Seung-Kook )
연세대학교 의과대학 외과학교실
조장환 ( Cho Jang-Hwan )
연세대학교 의과대학 외과학교실
KMID : 0356720060220060402
Abstract
Purpose: Recently, magnetic resonance imaging (MRI) has become the preferred diagnostic tool for preoperative assessment of TNM staging and circumferential resection margin (CRM) in patients with rectal cancer. The aim of this study is to evaluate the accuracy of preoperative MR imaging in the prediction of T, N stage and CRM compared with pathologic results on whole- mount sections.
Methods: Thirty-five consecutive patients with rectal cancer were enrolled between Dec. 2005 and Apr. 2006. 1.5-T MR imaging, was performed, and pathologic results were investigated on whole-mount sections. The agreement between MR imaging and pathologic examination for the assessment of T, N stage and status of CRM were analyzed using kappa statistics.
Results: The accuracy of MR imaging compared with pathologic assessment of T stage was 82.9% (κ=0.56), and that of N stage was 74.3% (κ= 0.31). Of the MR imaging planes, the oblique axial plane showed the most accurate prediction of CRM, regardless of tumor position within the circumference of the rectum. The accuracy of MR imaging in the oblique axial plane for predicting the CRM was 81.0% (κ=0.62) in anterior and posterior rectal tumors and 71.4% (κ=0.43) in laterally located rectal tumors. With a different CRM criteria for the measured distance in MR imaging, the accuracy of the 2-mm CRM criterion was 77.1% (κ=0.53).
Conclusion: MR imaging in predicting T stage showed fair agreement according to kappa statistics. Of the MR imaging planes, the oblique axial plane provided the most accurate CRM information compared with pathologic examination. The actual measured distance of the CRM in MR imaging can be applied to the pathologic CRM. J Korean Soc Coloproctol 2006;22:402-410
키워드
전층 절편 조직검사;자기공명 영상;직장암
Whole-mount section;Magnetic resonance imaging;Rectal cancer
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