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Apparent diffusion coefficient modifications in assessing gastro-oesophageal cancer response to neoadjuvant treatment: comparison with tumour regression grade at histology

  • Gastrointestinal
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Abstract

Objectives

To assess changes in apparent diffusion coefficient (ΔADC) and volume (ΔV) after neoadjuvant treatment (NT), and tumour regression grade (TRG) in gastro-oesophageal cancers (GEC), and to discriminate responders from non-responders.

Methods

Thirty-two patients with biopsy-proven locally-advanced GEC underwent diffusion weighted magnetic resonance imaging (DWI) pre- and post-NT. Lesion ADC, volume, ΔADC and ΔV were calculated. TRG 1-2-3 patients were classified as R; TRG 4-5 as non-responders. ΔADC-TRG and ΔV-TRG correlations, pre-NT and post-NT ADC, ΔADC and ΔV cut-off values for responders and non-responders were calculated. Two readers measured mean tumour ADCs and interobserver variability was calculated. (Spearman’s and intraclass correlation coefficient [ICC]).

Results

The interobserver reproducibility was very good both for pre-NT (Spearman’s rho = 0.8160; ICC = 0.8993) and post-NT (Spearman’s rho = 0.8357; ICC = 0.8663). Responders showed lower pre-NT ADC (1.32 versus 1.63 × 10−3 mm2/s; P = 0.002) and higher post-NT ADC (2.22 versus 1.51 × 10−3 mm2/s; P = 0.001) than non-responders and ADC increased in responders (ΔADC, 85.45 versus −8.21 %; P = 0.00005). ΔADC inversely correlated with TRG (r = −0.71, P = 0.000004); no difference in ΔV between responders and non-responders (−50.92 % versus −14.12 %; P = 0.068) and no correlation ΔV-TRG (r = 0.02 P = 0.883) were observed.

Conclusions

The ADC can be used to assess gastro-oesophageal tumour response to neoadjuvant treatment as a reliable expression of tumour regression.

Key Points

• DWI is now being used to assess many cancers.

• Change in ADC measurements offer new information about oesophageal tumours.

• ADC changes are more reliable than dimensional criteria in assessing neoadjuvant treatment.

• Such ADC assessment could optimise management of locally advanced gastro-oesophageal cancers.

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Authors and Affiliations

  1. Department of Radiology and Center for Experimental Imaging, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy

    Francesco De Cobelli, Francesco Giganti, Antonio Esposito, Giulia Agostini & Alessandro Del Maschio

  2. Department of Surgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy

    Elena Orsenigo, Carlo Socci & Carlo Staudacher

  3. Department of Radiology, Ospedale Fatebenefratelli e Oftalmico, Milan, Italy

    Michaela Cellina

  4. Pathology Unit, San Raffaele Scientific Institute, Milan, Italy

    Luca Albarello

  5. Department of Oncology, San Raffaele Scientific Institute, Milan, Italy

    Elena Mazza

  6. Neurobiology of Learning Unit, Vita-Salute San Raffaele University, Milan, Italy

    Alessandro Ambrosi

  7. Department of Radiology, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milano, Italy

    Francesco De Cobelli

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  1. Francesco De Cobelli
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Correspondence to Francesco De Cobelli.

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De Cobelli, F., Giganti, F., Orsenigo, E. et al. Apparent diffusion coefficient modifications in assessing gastro-oesophageal cancer response to neoadjuvant treatment: comparison with tumour regression grade at histology. Eur Radiol 23, 2165–2174 (2013). https://doi.org/10.1007/s00330-013-2807-0

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  • DOI: https://doi.org/10.1007/s00330-013-2807-0

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