Impact of Surgical Evaluation of Additional Cine Magnetic Resonance Imaging for Advanced Thymoma with Infiltration of Adjacent Structures: The Thoracic Surgeon's View

Abstract

Background Preoperative radiological assessment is important for clarification of surgical operability for advanced thymic tumors. Objective was to determine the feasibility of magnetic resonance imaging (MRI) with cine sequences for evaluation of cardiovascular tumor invasion.

Patients and Methods This prospective study included patients with advanced thymoma, who underwent surgical resection. All patients received preoperative computed tomography (CT) scan and cine MRI.

Results Tumor infiltration was surgically confirmed in the pericardium (n = 12), myocardium (n = 1), superior caval vein (SCV; n = 3), and aorta (n = 2). A macroscopic complete resection was possible in 10 patients, whereas 2 patients with aortic or myocardial tumor invasion had R2 resection. The positive predictive value (PPV) was 50% for cine MRI compared with 0% for CT scan regarding myocardial tumor infiltration. The PPV for tumor infiltration of the aorta was 50%, with a higher sensitivity for the CT scan (100 vs. 50%). Infiltration of the SCV could be detected slightly better with cine MRI (PPV 75 vs. 66.7%).

Conclusion Cine MRI seems to improve the accuracy of preoperative staging of advanced thymoma regarding infiltration of cardiovascular structures and supports the surgical approach.

Keywords

cine magnetic resonance imaging - thymoma - thymic carcinoma - cardiovascular infiltration

• References

• 1 Detterbeck FC, Parsons AM. Thymic tumors. Ann Thorac Surg 2004; 77 (5) 1860-1869
• 2 Venuta F, Anile M, Diso D , et al. Thymoma and thymic carcinoma. Eur J Cardiothorac Surg 2010; 37 (1) 13-25
• 3 Rosai J, Sobin L. Histological typing of tumours of the thymus. In: World Health Organization, ed. International Histological Classification of Tumours. Heidelberg: Springer; 1999: 1-16
• 4 Hosaka Y, Tsuchida M, Toyabe S, Umezu H, Eimoto T, Hayashi J. Masaoka stage and histologic grade predict prognosis in patients with thymic carcinoma. Ann Thorac Surg 2010; 89 (3) 912-917
• 5 Detterbeck FC, Nicholson AG, Kondo K, Van Schil P, Moran C. The Masaoka-Koga stage classification for thymic malignancies: clarification and definition of terms. J Thorac Oncol 2011; 6 (7) (Suppl. 03) S1710-S1716
• 6 Rajan A, Giaccone G. Treatment of advanced thymoma and thymic carcinoma. Curr Treat Options Oncol 2008; 9 (4–6): 277-287
• 7 Cardillo G, Carleo F, Giunti R , et al. Predictors of survival in patients with locally advanced thymoma and thymic carcinoma (Masaoka stages III and IVa). Eur J Cardiothorac Surg 2010; 37 (4) 819-823
• 8 Marom EM. Imaging thymoma. J Thorac Oncol 2010; 5 (10) (Suppl. 04) S296-S303
• 9 Benveniste MF, Rosado-de-Christenson ML, Sabloff BS, Moran CA, Swisher SG, Marom EM. Role of imaging in the diagnosis, staging, and treatment of thymoma. Radiographics 2011; 31 (7) 1847-1861 , discussion 1861–1863
• 10 Maher MM, Shepard JA. Imaging of thymoma. Semin Thorac Cardiovasc Surg 2005; 17 (1) 12-19
• 11 Marom EM. Advances in thymoma imaging. J Thorac Imaging 2013; 28 (2) 69-80 , quiz 81–83
• 12 Carter BW, Benveniste MF, Truong MT, Marom EM. State of the Art: MR imaging of thymoma. Magn Reson Imaging Clin N Am 2015; 23 (2) 165-177
• 13 Thompson BH, Stanford W. MR imaging of pulmonary and mediastinal malignancies. Magn Reson Imaging Clin N Am 2000; 8 (4) 729-739
• 14 Lederlin M, Corneloup O, Latrabe V, Montaudon M, Laurent F. MRI and the thorax [in French]. Rev Mal Respir 2010; 27 (4) 395-402
• 15 Ried M, Potzger T, Sziklavari Z , et al. Extended surgical resections of advanced thymoma Masaoka stages III and IVa facilitate outcome. Thorac Cardiovasc Surg 2014; 62 (2) 161-168
• 16 Wright CD. Extended resections for thymic malignancies. J Thorac Oncol 2010; 5 (10) (Suppl. 04) S344-S347
• 17 Marulli G, Lucchi M, Margaritora S , et al. Surgical treatment of stage III thymic tumors: a multi-institutional review from four Italian centers. Eur J Cardiothorac Surg 2011; 39 (3) e1-e7
• 18 Modh A, Rimner A, Allen PK , et al. Treatment modalities and outcomes in patients with advanced invasive thymoma or thymic carcinoma: a retrospective multicenter study. Am J Clin Oncol 2016; 39 (2) 120-125
• 19 Carter BW, Okumura M, Detterbeck FC, Marom EM. Approaching the patient with an anterior mediastinal mass: a guide for radiologists. J Thorac Oncol 2014; 9 (9) (Suppl. 02) S110-S118
• 20 Rosado-de-Christenson ML, Strollo DC, Marom EM. Imaging of thymic epithelial neoplasms. Hematol Oncol Clin North Am 2008; 22 (3) 409-431
• 21 Takahashi K, Al-Janabi NJ. Computed tomography and magnetic resonance imaging of mediastinal tumors. J Magn Reson Imaging 2010; 32 (6) 1325-1339
• 22 Detterbeck FC, Stratton K, Giroux D , et al; Staging and Prognostic Factors Committee; Members of the Advisory Boards; Participating Institutions of the Thymic Domain. The IASLC/ITMIG Thymic Epithelial Tumors Staging Project: proposal for an evidence-based stage classification system for the forthcoming (8th) edition of the TNM classification of malignant tumors. J Thorac Oncol 2014; 9 (9) (Suppl. 02) S65-S72
• 23 Marom EM, Milito MA, Moran CA , et al. Computed tomography findings predicting invasiveness of thymoma. J Thorac Oncol 2011; 6 (7) 1274-1281
• 24 Seo JS, Kim YJ, Choi BW, Choe KO. Usefulness of magnetic resonance imaging for evaluation of cardiovascular invasion: evaluation of sliding motion between thoracic mass and adjacent structures on cine MR images. J Magn Reson Imaging 2005; 22 (2) 234-241
• 25 Attaran S, Acharya M, Anderson JR, Punjabi PP. Does surgical debulking for advanced stages of thymoma improve survival?. Interact Cardiovasc Thorac Surg 2012; 15 (3) 494-497