Fig. 4.

Incomplete/poor lymph node response. A 65 year-old male presented with a low mrT3b (not shown) mrN1 (arrow in a–c) EMVI− CRM+ rectal cancer. He underwent NAT and was re-staged. Lymph node reduction in size was practically inexistent and post-NAT, short axis was > 5 mm (d). On T2-WI, the lymph node still looked heterogeneous, with areas of intermediate signal intensity (d). High signal intensity on high b value images was less but still present (e) (please note that visibility on high b value post-NAT imaging does not exclude good or even complete response). Patient underwent surgery and no residual lymphoid tissue was found within the lymph node in the pathology specimen, only tumour surrounded by fibrosis, adjacent to a vessel (f)—patient was therefore staged as a ypT3 N1c TRG3 R0