Rectal Tumor Stiffness Quantified by In Vivo Tomoelastography and Collagen Content Estimated by Histopathology Predict Tumor Aggressiveness

PurposeTo investigate the significance of collagen in predicting the aggressiveness of rectal tumors in patients, examined in vivo based on tomoelastography quantified stiffness and ex vivo by histologically measured collagen volume fraction (CVF).Experimental Design170 patients with suspected recta...

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Main Authors: Jiaxi Hu, Jing Guo, Yigang Pei, Ping Hu, Mengsi Li, Ingolf Sack, Wenzheng Li
Format: Article
Language:English
Published: Frontiers Media S.A. 2021-08-01
Series:Frontiers in Oncology
Subjects:
Online Access:https://www.frontiersin.org/articles/10.3389/fonc.2021.701336/full
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author Jiaxi Hu
Jing Guo
Yigang Pei
Ping Hu
Mengsi Li
Ingolf Sack
Wenzheng Li
author_facet Jiaxi Hu
Jing Guo
Yigang Pei
Ping Hu
Mengsi Li
Ingolf Sack
Wenzheng Li
author_sort Jiaxi Hu
collection DOAJ
description PurposeTo investigate the significance of collagen in predicting the aggressiveness of rectal tumors in patients, examined in vivo based on tomoelastography quantified stiffness and ex vivo by histologically measured collagen volume fraction (CVF).Experimental Design170 patients with suspected rectal cancer were prospectively enrolled and underwent preoperative magnetic resonance imaging (MRI) and rectal tomoelastography, a technique based on multifrequency magnetic resonance elastography. Histopathologic analysis identified eighty patients with rectal cancer who were divided into subgroups by tumor-node (TN) stage, prognostic stage, and risk level. Rectal tumor stiffness was correlated with histopathologic CVF. Area-under-the-curve (AUC) and contingency analysis were used to evaluate the performance of rectal stiffness in distinguishing tumor stages which was compared to standard clinical MRIResultsIn vivo tomoelastography revealed that rectal tumor stiffened significantly with increased TN stage (p<0.05). Tumors with poorly differentiated status, perineural and lymphovascular invasion also displayed higher stiffness than well-to-moderately differentiated, noninvasive tumors (all p<0.05). Similar to in vivo stiffness, CVF indicated an abnormally high collagen content in tumors with perineural invasion and poor differentiation status. CVF was also positively correlated with stiffness (p<0.05). Most importantly, both stiffness (AUROC: 0.82) and CVF (AUROC: 0.89) demonstrated very good diagnostic accuracy in detecting rectal tumors that have high risk for progressing to an aggressive state with poorer prognosis.ConclusionIn human rectal carcinomas, overexpression of collagen is correlated with increased tissue stiffness and high risk for tumor advancing more aggressively. In vivo tomoelastography quantifies rectal tumor stiffness which improves the diagnostic performance of standard MRI in the assessment of lymph nodes metastasis. Therefore, in vivo stiffness mapping by tomoelastography can predict rectal tumor aggressiveness and add diagnostic value to MRI.
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spelling doaj.art-bb9f003304ab4d908439366b8a7368b92022-12-21T20:03:34ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2021-08-011110.3389/fonc.2021.701336701336Rectal Tumor Stiffness Quantified by In Vivo Tomoelastography and Collagen Content Estimated by Histopathology Predict Tumor AggressivenessJiaxi Hu0Jing Guo1Yigang Pei2Ping Hu3Mengsi Li4Ingolf Sack5Wenzheng Li6Department of Radiology, Xiangya Hospital, Central South University, Changsha, ChinaDepartment of Radiology, Charité – Universitätsmedizin Berlin, Berlin, GermanyDepartment of Radiology, Xiangya Hospital, Central South University, Changsha, ChinaDepartment of Radiology, Xiangya Hospital, Central South University, Changsha, ChinaDepartment of Radiology, Xiangya Hospital, Central South University, Changsha, ChinaDepartment of Radiology, Charité – Universitätsmedizin Berlin, Berlin, GermanyDepartment of Radiology, Xiangya Hospital, Central South University, Changsha, ChinaPurposeTo investigate the significance of collagen in predicting the aggressiveness of rectal tumors in patients, examined in vivo based on tomoelastography quantified stiffness and ex vivo by histologically measured collagen volume fraction (CVF).Experimental Design170 patients with suspected rectal cancer were prospectively enrolled and underwent preoperative magnetic resonance imaging (MRI) and rectal tomoelastography, a technique based on multifrequency magnetic resonance elastography. Histopathologic analysis identified eighty patients with rectal cancer who were divided into subgroups by tumor-node (TN) stage, prognostic stage, and risk level. Rectal tumor stiffness was correlated with histopathologic CVF. Area-under-the-curve (AUC) and contingency analysis were used to evaluate the performance of rectal stiffness in distinguishing tumor stages which was compared to standard clinical MRIResultsIn vivo tomoelastography revealed that rectal tumor stiffened significantly with increased TN stage (p<0.05). Tumors with poorly differentiated status, perineural and lymphovascular invasion also displayed higher stiffness than well-to-moderately differentiated, noninvasive tumors (all p<0.05). Similar to in vivo stiffness, CVF indicated an abnormally high collagen content in tumors with perineural invasion and poor differentiation status. CVF was also positively correlated with stiffness (p<0.05). Most importantly, both stiffness (AUROC: 0.82) and CVF (AUROC: 0.89) demonstrated very good diagnostic accuracy in detecting rectal tumors that have high risk for progressing to an aggressive state with poorer prognosis.ConclusionIn human rectal carcinomas, overexpression of collagen is correlated with increased tissue stiffness and high risk for tumor advancing more aggressively. In vivo tomoelastography quantifies rectal tumor stiffness which improves the diagnostic performance of standard MRI in the assessment of lymph nodes metastasis. Therefore, in vivo stiffness mapping by tomoelastography can predict rectal tumor aggressiveness and add diagnostic value to MRI.https://www.frontiersin.org/articles/10.3389/fonc.2021.701336/fulltomoelastographyrectal cancercollagen contenttumor aggressivenessmultifrequency magnetic resonance elastographystiffness
spellingShingle Jiaxi Hu
Jing Guo
Yigang Pei
Ping Hu
Mengsi Li
Ingolf Sack
Wenzheng Li
Rectal Tumor Stiffness Quantified by In Vivo Tomoelastography and Collagen Content Estimated by Histopathology Predict Tumor Aggressiveness
Frontiers in Oncology
tomoelastography
rectal cancer
collagen content
tumor aggressiveness
multifrequency magnetic resonance elastography
stiffness
title Rectal Tumor Stiffness Quantified by In Vivo Tomoelastography and Collagen Content Estimated by Histopathology Predict Tumor Aggressiveness
title_full Rectal Tumor Stiffness Quantified by In Vivo Tomoelastography and Collagen Content Estimated by Histopathology Predict Tumor Aggressiveness
title_fullStr Rectal Tumor Stiffness Quantified by In Vivo Tomoelastography and Collagen Content Estimated by Histopathology Predict Tumor Aggressiveness
title_full_unstemmed Rectal Tumor Stiffness Quantified by In Vivo Tomoelastography and Collagen Content Estimated by Histopathology Predict Tumor Aggressiveness
title_short Rectal Tumor Stiffness Quantified by In Vivo Tomoelastography and Collagen Content Estimated by Histopathology Predict Tumor Aggressiveness
title_sort rectal tumor stiffness quantified by in vivo tomoelastography and collagen content estimated by histopathology predict tumor aggressiveness
topic tomoelastography
rectal cancer
collagen content
tumor aggressiveness
multifrequency magnetic resonance elastography
stiffness
url https://www.frontiersin.org/articles/10.3389/fonc.2021.701336/full
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