{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T14:15:37Z","timestamp":1783433737816,"version":"3.54.6"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:00:00Z","timestamp":1773792000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:00:00Z","timestamp":1773792000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004359","name":"Vetenskapsr\u00e5det","doi-asserted-by":"publisher","award":["2023-01934"],"award-info":[{"award-number":["2023-01934"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002794","name":"Cancerfonden","doi-asserted-by":"publisher","award":["23 2681 Pj"],"award-info":[{"award-number":["23 2681 Pj"]}],"id":[{"id":"10.13039\/501100002794","id-type":"DOI","asserted-by":"publisher"}]},{"name":"ALF-grant","award":["40305"],"award-info":[{"award-number":["40305"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Tumor deposits (TDs) are a negative prognostic factor in colorectal cancer, independent of lymph node metastasis (LNM). This study aimed to investigate the ability of pre-operative MRI to identify TDs and differentiate them from LNM in rectal cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>Patients with histopathological N1-N2 rectal cancer with and without TDs who underwent curative-intent primary surgery between 2013 and 2023 were retrospectively included. Three radiologists independently reviewed pre-operative MR images for the presence of TDs and LNM. Histopathology served as the reference standard from which interobserver agreement by Cohen\u2019s kappa (\u03ba) was calculated. Unblinded node-to-node comparison of MRI and histopathological images was used to identify sources of discrepancies between the modalities. Post hoc analysis stratified on nodal size (&gt;\u2009or \u2264 5\u2009mm) was performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eighty-eight patients (50% with TDs on histopathology, 74% male, median age 70 [20\u201389] years) were included, of whom 27 were excluded due to poor image quality. Agreement between MRI and histopathology (p), both for TD-presence (\u03ba\u2009=\u2009\u22120.04) and LNM-presence (\u03ba\u2009=\u20090.16), was low. In the node-by-node comparison, 43 out of 50 pTDs (86%) measured \u2264 5\u2009mm, and 131 of 167 pLNM (78%) measured \u2264 5\u2009mm. In post hoc analysis of smaller (\u2264\u20095\u2009mm) nodules, no pTDs and 3% of pLNM were diagnosed using MRI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>MRI demonstrated limited ability in detecting and differentiating TDs and LNM in pre-operative low-risk patients. Diagnostic performance was particularly poor for nodules \u2264 5\u2009mm, which constituted 174 out of 217 (80%) pathological nodular structures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Questions<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Tumor deposits and lymph node metastasis are important factors for staging rectal cancer, but the ability of pre-operative MRI to detect and differentiate them remains unclear<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>In low-risk rectal cancer patients treated with primary surgery, tumor deposits and lymph node metastasis are often small (\u2264\u20095\u2009mm) and not detected by MRI<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>MRI has a limited ability to identify and differentiate small (\u2264\u20095\u2009mm) tumor deposits and lymph node metastasis in rectal cancer, which must be considered during pre-operative staging and neoadjuvant treatment planning<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-026-12467-x","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T16:17:25Z","timestamp":1773850645000},"page":"6428-6437","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Tumor deposits on MRI in rectal cancer\u2014detection and differentiation from lymph nodes with histopathological correlation"],"prefix":"10.1007","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5602-7128","authenticated-orcid":false,"given":"Simon","family":"Lundstr\u00f6m","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2825-1859","authenticated-orcid":false,"given":"Staffan","family":"T\u00e4ckstr\u00f6m","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4437-5686","authenticated-orcid":false,"given":"Peder","family":"Wiklund","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7019-9011","authenticated-orcid":false,"given":"Maja","family":"Hask\u00e5","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4463-2336","authenticated-orcid":false,"given":"Erik","family":"Agger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1716-2439","authenticated-orcid":false,"given":"Lennart","family":"Nedar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6407-5552","authenticated-orcid":false,"given":"Pamela","family":"Buchwald","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"key":"12467_CR1","doi-asserted-by":"crossref","unstructured":"Lundstr\u00f6m S, Agger E, Lydrup M-L, J\u00f6rgren F, Buchwald P (2025) Tumour deposit count is an independent prognostic factor in colorectal cancer\u2014a population-based cohort study. Br J Surg 112:znae309","DOI":"10.1093\/bjs\/znaf149.053"},{"key":"12467_CR2","doi-asserted-by":"crossref","unstructured":"Lundstr\u00f6m S, Agger E, Lydrup ML, J\u00f6rgren F, Buchwald P (2023) Adverse impact of tumor deposits in lymph node negative rectal cancer\u2014a national cohort study. Int J Colorectal Dis 38:66","DOI":"10.1007\/s00384-023-04365-1"},{"key":"12467_CR3","doi-asserted-by":"publisher","first-page":"zrad122","DOI":"10.1093\/bjsopen\/zrad122","volume":"7","author":"F J\u00f6rgren","year":"2023","unstructured":"J\u00f6rgren F, Agger E, Lydrup M-L, Buchwald P (2023) Tumour deposits in colon cancer predict recurrence and reduced survival in a nationwide population-based study. BJS Open 7:zrad122","journal-title":"BJS Open"},{"key":"12467_CR4","doi-asserted-by":"crossref","unstructured":"Agger E, J\u00f6rgren F, J\u00f6ud A Lydrup ML, Buchwald P (2023) Negative prognostic impact of tumor deposits in rectal cancer: a national study cohort. Ann Surg 278:e526\u2013e533","DOI":"10.1097\/SLA.0000000000005755"},{"key":"12467_CR5","doi-asserted-by":"crossref","unstructured":"Brierley J, Gospodarowicz MK, Wittekind C (2017) TNM classification of malignant tumours, 8th edn. Wiley-Blackwell, Chichester","DOI":"10.1002\/9780471420194.tnmc26.pub3"},{"key":"12467_CR6","doi-asserted-by":"publisher","first-page":"1465","DOI":"10.1007\/s00330-017-5026-2","volume":"28","author":"RGH Beets-Tan","year":"2018","unstructured":"Beets-Tan RGH, Lambregts DMJ, Maas M et al (2018) Magnetic resonance imaging for clinical management of rectal cancer: updated recommendations from the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. Eur Radiol 28:1465\u20131475","journal-title":"Eur Radiol"},{"key":"12467_CR7","doi-asserted-by":"publisher","first-page":"4080","DOI":"10.1007\/s00330-025-11361-2","volume":"35","author":"MK Ruteg\u00e5rd","year":"2025","unstructured":"Ruteg\u00e5rd MK, B\u00e5tsman M, Blomqvist L et al (2025) Evaluation of MRI characterisation of histopathologically matched lymph nodes and other mesorectal nodal structures in rectal cancer. Eur Radiol 35:4080\u20134090","journal-title":"Eur Radiol"},{"key":"12467_CR8","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1097\/SLA.0000000000004499","volume":"276","author":"AC Lord","year":"2022","unstructured":"Lord AC, D\u2019Souza N, Shaw A et al (2022) MRI-diagnosed tumor deposits and EMVI status have superior prognostic accuracy to current clinical TNM staging in rectal cancer. Ann Surg 276:334\u2013344","journal-title":"Ann Surg"},{"key":"12467_CR9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ejca.2019.12.025","volume":"128","author":"AC Lord","year":"2020","unstructured":"Lord AC, Knijn N, Brown G, Nagtegaal ID (2020) Pathways of spread in rectal cancer: a reappraisal of the true routes to distant metastatic disease. Eur J Cancer 128:1\u20136","journal-title":"Eur J Cancer"},{"key":"12467_CR10","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2025.111954","volume":"184","author":"T Hu","year":"2025","unstructured":"Hu T, Rong Z, Cai C et al (2025) Impact of MRI risk assessment on the survival benefits of neoadjuvant chemoradiotherapy in patients with stage II-III rectal cancer: a retrospective cohort study. Eur J Radiol 184:111954","journal-title":"Eur J Radiol"},{"key":"12467_CR11","doi-asserted-by":"crossref","unstructured":"Lord AC, Graham Mart\u00ednez C, D\u2019Souza N, Pucher PH, Brown G, Nagtegaal ID (2019) The significance of tumour deposits in rectal cancer after neoadjuvant therapy: a systematic review and meta-analysis. Eur J Cancer 122:1\u20138","DOI":"10.1016\/j.ejca.2019.08.020"},{"key":"12467_CR12","unstructured":"Regional Cancer Centres of Sweden (2025) Nationella v\u00e5rdprogrammet f\u00f6r tjock- och \u00e4ndtarmscancer; version 4.0. Available via https:\/\/kunskapsbanken.cancercentrum.se\/globalassets\/cancerdiagnoser\/tjock--och-andtarm-anal\/vardprogram\/nationellt-vardprogram-tjock-andtarmscancer.pdf. Accessed 10 Dec 2025"},{"key":"12467_CR13","doi-asserted-by":"crossref","unstructured":"Sobin LH, Gospodarowicz MK, Wittekind C (2009) TNM classification of malignant tumours, 7th edn. Wiley-Blackwell, Chichester","DOI":"10.1002\/9780471420194.tnmc26.pub2"},{"key":"12467_CR14","doi-asserted-by":"publisher","first-page":"276","DOI":"10.11613\/BM.2012.031","volume":"22","author":"ML McHugh","year":"2012","unstructured":"McHugh ML (2012) Interrater reliability: the kappa statistic. Biochem Med 22:276\u2013282","journal-title":"Biochem Med"},{"key":"12467_CR15","doi-asserted-by":"publisher","first-page":"e033395","DOI":"10.1136\/bmjopen-2019-033395","volume":"10","author":"AC Lord","year":"2020","unstructured":"Lord AC, Moran B, Abulafi M et al (2020) Can extranodal tumour deposits be diagnosed on MRI? Protocol for a multicentre clinical trial (the COMET trial). BMJ Open 10:e033395","journal-title":"BMJ Open"},{"key":"12467_CR16","doi-asserted-by":"crossref","unstructured":"Lundstr\u00f6m S, Agger E, Lydrup M-L J\u00f6rgren F, Buchwald P (2025) Rethinking TNM: tumor deposit-based prognostic models may improve N-staging in colorectal cancer. Eur J Surg Oncol 51:110420","DOI":"10.1016\/j.ejso.2025.110420"},{"key":"12467_CR17","doi-asserted-by":"publisher","first-page":"1119","DOI":"10.1200\/JCO.2016.68.9091","volume":"35","author":"ID Nagtegaal","year":"2017","unstructured":"Nagtegaal ID, Knijn N, Hugen N et al (2017) Tumor deposits in colorectal cancer: improving the value of modern staging\u2014a systematic review and meta-analysis. J Clin Oncol 35:1119\u20131127","journal-title":"J Clin Oncol"},{"key":"12467_CR18","doi-asserted-by":"publisher","first-page":"570","DOI":"10.1093\/bjs\/znac059","volume":"109","author":"R Ros\u00e9n","year":"2022","unstructured":"Ros\u00e9n R, Nilsson E, Rahman M, R\u00f6nnow C-F (2022) Accuracy of MRI in early rectal cancer: national cohort study. Br J Surg 109:570\u2013572","journal-title":"Br J Surg"},{"key":"12467_CR19","doi-asserted-by":"crossref","unstructured":"Dahlb\u00e4ck C, Korsbakke K, Alshibiby Bergman, Zaki J, Zackrisson S, Buchwald P (2022) Accuracy of magnetic resonance imaging staging of tumour and nodal stage in rectal cancer treated by primary surgery: a population-based study. Colorectal Dis 24:1047\u20131053","DOI":"10.1111\/codi.15905"},{"key":"12467_CR20","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1097\/DCR.0000000000000004","volume":"57","author":"JS Park","year":"2014","unstructured":"Park JS, Jang Y-J, Choi G-S et al (2014) Accuracy of preoperative MRI in predicting pathology stage in rectal cancers: node-for-node matched histopathology validation of MRI features. Dis Colon Rectum 57:32\u201338","journal-title":"Dis Colon Rectum"}],"container-title":["European Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-026-12467-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00330-026-12467-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-026-12467-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T13:32:58Z","timestamp":1783431178000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00330-026-12467-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,18]]},"references-count":20,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["12467"],"URL":"https:\/\/doi.org\/10.1007\/s00330-026-12467-x","relation":{},"ISSN":["1432-1084"],"issn-type":[{"value":"1432-1084","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,18]]},"assertion":[{"value":"8 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 February 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 February 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 March 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The scientific guarantor of this publication is Pamela Buchwald.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Guarantor"}},{"value":"Lennart Nedar is a co-founder of Collective Minds AB (\n                      \n                      ) but does not hold a position on the company\u2019s board. The current project does not involve any marketing of Collective Minds. The platform is used solely to facilitate digital analysis within a shared environment. The remaining authors declare no conflict of interest.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Anna \u00c5kesson, statistician at Clinical Studies Sweden, Forum South, Sk\u00e5ne University Hospital, kindly provided statistical advice for this manuscript.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"All patients registered in the SCRCR are provided informed consent before inclusion. Patients can at any time withdraw their consent and have all health data permanently removed.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"Institutional Review Board approval was obtained from the Swedish Ethical Review Authority (DNR: 2023-06664-02) approved the study.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"No overlap.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}