Prospective evaluation of MR-TRG (Tumor Regression Grade) in esophageal cancer after neo-adjuvant therapy: Preliminary results

• Published in: European journal of radiology 2024-02, Vol.171, p.111263-111263, Article 111263
• Main Authors: Chapellier, Pauline, Fasquelle, François, Saglietti, Chiara, Kinj, Rémy, Mantziari, Styliani, Schäfer, Markus, Haefliger, Laura, Jreige, Mario, Vietti Violi, Naïk, Sempoux, Christine, Dromain, Clarisse
• Format: Article
• Language: English
• Subjects: Chemoradiotherapy; Chemoradiotherapy - methods; Esophageal Neoplasms - diagnostic imaging; Esophageal Neoplasms - therapy; Esophagus; Histopathology; Humans; Magnetic Resonance Imaging; Magnetic Resonance Imaging - methods; Magnetic Resonance Spectroscopy; Neoadjuvant Therapy; Neoplasms; Rectal Neoplasms - pathology; Retrospective Studies; Treatment Outcome
• ISSN: 0720-048X; 1872-7727
• DOI: 10.1016/j.ejrad.2023.111263

•MR and pathological Tumor Regression Grades are significantly correlated.•MRI might be accurate to assess esophageal tumor response to chemoradiotherapy.•MR Tumor Regression Grade could provide information before surgery.•MR Tumor Regression Grade could help in therapeutic decisions with early staging. To develop MRI-based criteria to assess tumor response to neoadjuvant therapies (NAT) of esophageal cancers (EC) and to evaluate its diagnostic performance in predicting the pathological Tumor Regression Grade (pTRG). From 2018 to 2022, patients with newly diagnosed locally advanced EC underwent MRI examinations for initial staging and restaging after NAT. Magnetic Resonance TRG (MR-TRG), equivalent to the Mandard and Becker classifications, were developed and independently assessed by two radiologists, blinded to pTRG, using T2W and DW-MR Images. All patients underwent surgery and benefited from a blinded pTRG evaluation by two pathologists. The agreement between readers and between MR-TRG and pTRG were assessed with Cohen’s Kappa. The correlation of MR-TRG and pTRG was determined using Spearman’s correlation. 28 patients were included. Interrater agreement was substantial between radiologists, improved when grouping grade 1 and 2 (κ = 0.78 rose to 0,84 for Mandard and 0.68 to 0,78 for Becker score). Agreement between pTRG and MR-TRG was moderate with a percentaged agreement (p) = 87.5 %, kappa (κ) = 0.54 and p = 83.3 %, κ = 0.49 for Mandard and Becker, respectively. Agreement was improved to substantial when grouping grades 1–2 for Mandard and 1a-1b for Becker with p = 89.3 %, κ = 0.65 and p = 85.2 %, κ = 0.65 respectively. Sensitivity and specificity of MR-TRG in predicting pTRG were 88.2 % and 72.7 % for Mandard system (scores 1–2 versus 3–5), and 83.3 % and 80 % for Becker system (scores 1a-1b versus 2–3). A substantial agreement between MR-TRG and pTRG was achieved when grouping grade 1–2. Hence, MR-TRG could be used as a surrogate of complete and near-complete pTRG.