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Ritu R Gill
MA 19 - Mesothelioma: Bench to Bedside (ID 680)
- Event: WCLC 2017
- Type: Mini Oral
- Track: Mesothelioma
- Presentations: 1
MA 19.10 - Comparative Value of MR and CT for Tumor Volumetric and Clinical Staging of Malignant Pleural Mesothelioma (ID 10122)
11:00 - 12:30 | Presenting Author(s): Ritu R Gill
Tumor volumetrics is currently being explored as a means of enhancing the accuracy of clinical staging of malignant pleural mesothelioma (MPM). In a recent multicenter study (JTO 2016, 11(8):1335-1344) evaluating feasibility of volume estimation using CT (VolCT), clinical staging by CT was poorly correlated between readers and underestimated pathological stage, but correlation of VolCT estimates between two experienced readers was high (rho = 0.82). MR has been found superior to CT in evaluating certain staging parameters, and may enhance volumetrics based on improved contrast. Here we evaluate the relative performance and reproducibility of MR for volumetrics (VolMR) and clinical staging of MPM in a single institution cohort.
Patients with MPM who underwent surgical resection between 2009 and 2014 with preoperative CT and MR imaging were studied. MR images were acquired using a uniform clinical protocol. VolMR was performed independently by two observers, one an experienced radiologist and one fellow. Vitrea (Vital Images) software was used for volumetric calculations and estimates were compared using Spearman correlation. Clinical staging accuracy (AJCC 7[th] edition criteria; versus pathological stage) and interobserver variability were also evaluated. VolMR and VolCT were performed for all cases by the experienced radiologist and qualitatively compared.
The study cohort comprised 139 patients, 113 (81%) men, median age 68 (30-82), with 74 (53%) epithelioid subtype tumors. Pathological stage was I: 14 (10%); II: 16 (12%); III: 75 (54%); IV: 34 (24%). Clinical staging by MR was concordant between reviewers for 86 (62%) cases, and with pathological stage for 65 (47%) and 63 (45%) respectively. VolMR was significantly correlated both between reviewers (rho = 0.99) and with VolCT (rho = 0.68). VolMR tended to result in higher volume estimates (median 633, IQR 365-885 cc) than VolCT (median 239, IQR 75-597 cc).
VolMR was found to be feasible and reproducible, independent of observer experience. Clinical AJCC staging by MR was found to compare favorably to staging by CT in terms of both interobserver variablilty and prediction of pathological stage. Although MR is not yet universally available and has the disadvantages of higher cost, requirement for optimization and longer scan times, it may neverthheless offer improved accuracy and reproducibility of clinical staging and volumetric analysis. Further evaluation in larger multi-institutional cohorts is warranted.
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