Risk of nodal disease in patients with MRI-detected extramural vascular invasion in rectal cancer: a systematic review and meta-analysis

Tumori. 2021 Dec;107(6):564-570. doi: 10.1177/0300891620975867. Epub 2020 Nov 26.


Background: The impact of magnetic resonance imaging-detected extramural vascular invasion (mrEMVI) in distant metastasis is well known but its correlation with prevalence of lymph node metastasis is less studied. The aim of this systematic review and meta-analysis was to assess the prevalence of nodal disease in mrEMVI-positive and negative cases in rectal cancer.

Methods: Following guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a systematic literature search in PubMed, Web of Science, Cochrane Library, and EMBase was carried out to identify relevant studies published up to May 2019.

Results: Our literature search generated 10 studies (863 and 1212 mrEMVI-positive and negative patients, respectively). The two groups (mrEMVI-positive and negative) were significantly different in terms of nodal disease status (odds ratio [OR] 3.15; 95% confidence interval [CI] 2.12-4.67; p < 0.001). The prevalence of nodal disease was 75.90% vs 52.56% in the positive mrEMVI vs negative mrEMVI group, respectively (p < 0.001). The prevalence of positive lymph node in positive mrEMVI patients treated with neoadjuvant/adjuvant chemoradiotherapy (nCRT/CRT) (OR 2.47; 95% CI 1.65-3.69; p < 0.001) was less compared with the patients who underwent surgery alone (OR 6.25; 95% CI 3.74-10.44; p < 0.001).

Conclusion: The probability of positive lymph nodes in cases of positive mrEMVI is distinctly greater compared with negative cases in rectal cancer. Positive mrEMVI indicates risk of nodal disease prevalence increased by threefold in rectal cancer.

Keywords: MRI-detected extramural vascular invasion; lymph node metastasis; mrEMVI; nodal disease; rectal cancer.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Humans
  • Lymphatic Metastasis
  • Magnetic Resonance Imaging* / methods
  • Neoplasm Invasiveness
  • Prevalence
  • Prognosis
  • Rectal Neoplasms / diagnostic imaging*
  • Rectal Neoplasms / epidemiology
  • Rectal Neoplasms / pathology*