Template for Pancreatic Carcinoma Reporting · 2013-12-03 · PANCREATIC CARCINOMA Resectability...
Transcript of Template for Pancreatic Carcinoma Reporting · 2013-12-03 · PANCREATIC CARCINOMA Resectability...
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Radiology Structured Reporting for Pancreatic
Carcinoma
Isaac R. Francis, M.B; B.S University of Michigan Hospitals Ann Arbor, Michigan
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SAMPLE UNSTRUCTURED REPORTS
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Structured Reports Attributes of a “Good” Radiology Report
• Clarity • Correctness • Confidence • Concision • Completeness • Consistency • Communication • Consultation • Timeliness • Standardization
* Reiner BI J Digit Imaging 2009
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RSNA Radiology Reporting Templates Structured Reporting
RSNA Structured Report Initiative (M Heilburn, Univ. of Utah, Salt Lake City, UT)
• PRIMARY TUMOR: • - Size, location, attenuation, size of pancreatic duct • MESENTERIC ARTERIES - Arterial anatomy: Arterial tumor abutment or encasement:
Proximal celiac artery, SMA, and hepatic artery • MESENTERIC VEINS • - Venous tumor abutment or encasement: less than or equal
to 180 degrees or greater than 180 degrees - SMV, SV and Portal venous system • LOCOREGIONAL SPREAD - Lymph nodes, peritoneum, omentum, ascites • DISTANT SPREAD: - Focal liver lesion, lung, etc. * Tolat P et al. Medical College of Wisconsin
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Template for Pancreatic Carcinoma Reporting
Pancreatic Cancer Template Work Group
M Al-Hawary, S Chari, EK Fishman, D Hough, DS Lu, M Macari, AJ Megibow, N Merchant, F Miller, R Minter, K Mortele, D Simeone, D Sahani, EA Tamm Beth Israel Deaconess, Johns Hopkins,
Massachusetts General Hospital, Northwestern University, New York University, MD Anderson, Mayo Clinic, University of Southern California, University of Michigan, Vanderbilt University
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Radiology Reporting Templates
Structured Reporting American Pancreatic Association
• PRIMARY TUMOR: • - Size, location, attenuation, presence of atrophy, MPD, and CBD
diln. • MESENTERIC ARTERIES - Arterial anatomy: Proximal celiac artery, SMA, and hepatic artery - Tumor abutment (less than or equal to 180 degrees or
encasement (greater than 180 degrees) -Distance of tumor involvement of hep. artery from celiac axis • MESENTERIC VEINS • - Venous anatomy: • - SMV, SV and Portal venous system • - Tumor abutment (less than or equal to 180 degrees or
encasement (greater than 180 degrees) • - Distance from tumor to first jejunal vein branch • LOCOREGIONAL SPREAD - Lymph nodes, peritoneum, omentum, ascites • DISTANT SPREAD: - Focal liver lesion, lung, etc. *M Al-Hawary et al ( Work in Progress)
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PANCREATIC CARCINOMA Resectability Criteria
� No distant metastases � No SMV or PV abutment,
distortion, encasement or occlusion/thrombus
� Clear fat planes around the celiac axis, hepatic artery and SMA
* NCCN Guidelines version 2.2012
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Small resectable tumor No abutment/encasement of CA,HA, SMA or SMV and PV
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Radiology Reporting Templates Structured Reporting
American Pancreatic Association • PRIMARY TUMOR
- 2 cm , low density in head with no PD or CBD diln. or upstream atrophy • MESENTERIC ARTERIES - No abutment or encasement of celiac artery, SMA, and
hepatic artery - Standard hepatic arterial anatomy - MESENTERIC VEINS • - No venous tumor abutment or encasement of SMV or PV • LOCOREGIONAL SPREAD - no enlarged lymph nodes. No local tumor extension into
adjacent organs DISTANT SPREAD: - No focal hepatic lesions, omental/peritoneal nodules or
ascites *M Al-Hawary et al ( Work in Progress)
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PANCREATIC CARCINOMA Unesectability Criteria
• HEAD: • Distant metastases, >1800 encasement of
SMA, CA abutment, occluded PV/SMV, aortic invasion
• BODY: • Distant metastases, >1800 encasement of
CA, SMA, occluded SMV/PV, aortic invasion
• TAIL: • Distant metastases, >1800 encasement
of CA, SMA
* NCCN Guidelines version 2.2012
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UNRESECTABLE PANCREATIC CARCINOMA- BODY >180 encasement of CA, HA, SMA and retroperitoneal ext.
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> 180 degrees encasement of SMA
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UNRESECTABLE PANCREATIC CARCINOMA- UNCINATE >180 degrees encasement of SMA-Tethered/occluded SMV
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PANCREATIC CARCINOMA Borderline Resectability Criteria
� No distant metastases � SMV or PV abutment, distortion,
encasement or short segment occlusion/thrombus of SMV or PV but with suitable proximal and distal landing sites for venous reconstruction
� GDA encasement up to origin from HA, and short segment encasement or abutment of HA without CA involvement
� SMA abutment not to exceed 180 degrees
* NCCN Guidelines version 2.2012
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BORDERLINE RESECTABLE PANCREATIC CARCINOMA SHORT SEGMENT CONTACT WITH HA
T T
T T
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Obstacles to use of Structured Reporting
• Time consuming- decreased efficiency and productivity
• Structured reports are difficult to standardize across centers as consensus difficult to achieve
• Even with complex exams as in cardiac imaging (CCTA), SR’s are adapted to suit individual centers • For ex. cardiologists main interest is in the
coronary arteries in a coronary CTA, but radiologists have to interpret the whole exam- so a template suited to the cardiologists may not be ideal for the radiologist
• Benefits mainly are to referring clinicians, and possibly hospital administrator and insurance company
* Bosman JML at al Insights Imaging 2012
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Radiology Reporting Templates Structured Reporting
• PRIMARY TUMOR
• MESENTERIC ARTERIES - CA, HA, SA, SMA - Arterial variants
• MESENTERIC VEINS - SV, SMV, PV • LOCOREGIONAL SPREAD • DISTANT SPREAD