A magnetic resonance imaging (MRI)-based nomogram for predicting lymph node metastasis in rectal cancer: a node-for-node comparative study of MRI and histopathology

Yuan Liu; Lijuan Wan; Wenjing Peng; Shuangmei Zou; Zhaoxu Zheng; Feng Ye; Jun Jiang; Han Ouyang; Xinming Zhao; Hongmei Zhang

doi:10.21037/qims-20-1049

A magnetic resonance imaging (MRI)-based nomogram for predicting lymph node metastasis in rectal cancer: a node-for-node comparative study of MRI and histopathology

Quant Imaging Med Surg. 2021 Jun;11(6):2586-2597. doi: 10.21037/qims-20-1049.

Authors

Affiliations

¹ Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
² Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
³ Department of Colorectal Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Abstract

Background: The aim of the present study was to investigate the potential risk factors for lymph node metastasis (LNM) in rectal cancer using magnetic resonance imaging (MRI), and to construct and validate a nomogram to predict its occurrence with node-for-node histopathological validation.

Methods: Our prediction model was developed between March 2015 and August 2016 using a prospective primary cohort (32 patients, mean age: 57.3 years) that included 324 lymph nodes (LNs) from MR images with node-for-node histopathological validation. We evaluated multiple MRI variables, and a multivariable logistic regression analysis was used to develop the predictive nomogram. The performance of the nomogram was assessed with respect to its calibration, discrimination, and clinical usefulness. The performance of the nomogram in predicting LNM was validated in an independent clinical validation cohort comprising 182 consecutive patients.

Results: The predictors included in the individualized prediction nomogram were chemical shift effect (CSE), nodal border, short-axis diameter of nodes, and minimum distance to rectal cancer or rectal wall. The nomogram showed good discrimination (C-index: 0.947; 95% confidence interval: 0.920-0.974) and good calibration in the primary cohort. Decision curve analysis confirmed the clinical usefulness of the nomogram in predicting the status of each LN. For the prediction of LN status in the clinical validation cohort by readers 1 and 2, the areas under the curves using the nomogram were 0.890 and 0.841, and the areas under the curves of readers using their experience were 0.754 and 0.704, respectively. Diagnostic efficiency was significantly improved by using the nomogram (P<0.001).

Conclusions: The nomogram, which incorporates CSE, nodal location, short-axis diameter, and minimum distance to rectal cancer or rectal wall, can be conveniently applied in clinical practice to facilitate the prediction of LNM in patients with rectal cancer.

Keywords: Rectal cancer; chemical shift effect (CSE); lymph nodes (LNs); magnetic resonance imaging (MRI); nomogram.