Use of structured reporting in MRI for rectal cancer · The template acts as an aide-memoire for...
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Structured reporting results in comprehensive, consistent reports and gives opportunities for quality assurance and research. Our MRI reporting pro forma has been widely adopted within our department, resulting inclusion of the majority of significant findings. Departmental education will be undertaken with respect to the importance of completion of the minimum data for low rectal tumours. If the pro forma is not used, it can still act as an aide-memoire for the radiologist, prompting inclusion of the relevant imaging features to ensure that all the necessary information is imparted to the referring service in a clear and concise format. Improved report clarity and consistency. The template acts as an aide-memoire for inclusion of the relevant imaging features and ensures that all the necessary information is imparted to the referring service in a clear and concise format. Higher Radiological and end use satisfaction. More efficient workflow. Use of structured reporting in MRI for rectal cancer Dr Dekan Albasha 1 and Dr Catriona Farrell 2 1 Radiology registrar, Mersey school of radiology and 2 Consultant radiologist, The royal liverpool and broadgreen university hospitals Ø Rectal cancer staging MRI plays an essential role in the primary preoperative staging of rectal cancer. The technique has been shown to be accurate in tumor staging and is able to identify imaging features that place the patient at increased risk for local recurrence [1]. Ø The MRI staging helps determine the care plan for the patient. Ø MR provides useful information that determines the surgical approach. Ø Standardized reporting of MRI for rectal cancer staging has been advocated, including in consensus recommendations published by the European Society of Gastrointestinal and Abdominal Radiology [2]. Background Advantages of structured reporting Structured reports achieved significantly higher satisfaction rates with report content and clarity, and included significantly more of the 13 predefined key features compared with FT reports (SRs: mean ± SD, 12.2 ± 4.6 [range, 9–13] versus FT reports: mean ± SD, 9.2 ± 10.8 [range, 5–13]) (P < 0.001). Definite further clinical decision making (surgery vs neoadjuvant radiochemotherapy) was possible in 96% of SRs and only in 60% of FT reports (P < 0.001). In case of surgery, the reported information was considered to be sufficient for surgical planning in 94% of SRs versus only 38% in FT reports (P < 0.001). Structured report received a significantly higher overall report quality rated on a Likert scale from 1 to 6 (1, insufficient; 6, excellent) with a mean of 5.8 ± 0.42 (range, 5–6) in comparison to FT reports with 3.6 ± 1.19 (range, 1–5) (P < 0.001). • To audit our compliance with the structured reporting of MR rectum for the primary diagnosis of rectal cancer. Our aim: Methodology Time period: Ø Database of patients (from CRIS) who underwent MR rectum from 26/05/16 to 21/04/17. Total of 98 patients. Inclusion criteria: Ø MR indication for the primary diagnosis/initial staging for rectal cancer. Total number of scans suitable for study: 39 (n) • Height from the anal verge. • Height above or below puborectalis. • Length of tumour. • Circumferential tumour location e.g. 3 o’clock to 7 o’clock or circumferential. • Tumour relationship to peritoneal reflection. • T stage given • If T3, is the sub-stage given i.e. T3a, T3b, T3c or T3d. • b) Depth of extramural spread in mm. • c) For T4b tumours, which structures are involved. • For low rectal tumours, is the following info available: Involvement of sphincter complex • a) Full/partial thickness internal sphincter • b) Interphincteric plane • c) External sphincter • d) Beyond external sphincter to ischiorectal fat. • Lymph nodes: N staging given • EMVI: EMVI present (small/medium/large vessel involvement) • CRM involved or not (same as TME plane). • a) Minumum tumour distance to mesorectal fascia (in mm). • Peritoneal deposits (evidence or no evidence) • Pelvic side wall lymph nodes: present or not. • a) If present, then location mentioned. • Conclusion: Overall TNM stage given. The following criteria within the report were assessed: Results Numbers completed / numbers applicable to Percentage completed Height from anal verge 39/39 100% Height above or below puborectalis 39/39 100% Length of tumour 39/39 100% Circumferential tumour location ie ‘3 o’clock to 7 o’clock or circumferential’ 39/39 100% Tumour relationship to peritoneal reflection 39/39 100% T stage 39/39 100% If T3, is the substage given ie T3a T3b T3c T3d 21/24 87.5% Depth of extramural spread in mm 26/31 83.9% For T4b tumours, which structures are involved 6/6 100% For lower rectal tumours: Involvement of the sphincter complex 7/18 38.9% Numbers completed / numbers applicable to Percentage completed Lymph nodes: N staging given 38/39 97.4% EMVI 38/39 97.4% CRM involvement: Minimum tumour distance to mesorectal fascia given in mm 24/29 82.8% Peritoneal deposits 37/39 94.9% Pelvic side wall lymph node: Present 36/39 92.3% Pelvic side wall lymph node: Location given 36/39 92.3% Conclusion: overall TNM staging 38/39 97.4% Ø Achieved 100% completion in 7/17 of the headings and >90% in 6/17 Discussion Ø For lower rectal tumours – the importance of describing the involvement of the sphincter complex Figure 1: When the intersphincteric plane is tumor-free, the external sphincter can be spared with an intersphincteric abdomino- perineal resection. APE - abdomino-perineal excision ELAPE - extra-levator abdominal perineal resection Ø The prognostic value of the circumferential resection margin CRM has been called into question in some recent studies. However, remains to be a important prognostic factor Conclusion and recommendation: References: 1) Wong RKS, Berry S, Spithoff K, et al. Preoperative or postoperative therapy for stage II or III rectal cancer: an updated practice guideline. Clin Oncol (R Coll Radiol) 2010; 22:265–271. 2) Beets-Tan RGH, Lambregts DMJ, Maas M, et al. Magnetic resonance imaging for the clinical management of rectal cancer patients: recommendations from the 2012 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. Eur Radiol 2013; 23:2522–2531.
Transcript of Use of structured reporting in MRI for rectal cancer · The template acts as an aide-memoire for...
Structured reporting results in comprehensive, consistent reports and gives opportunities for quality assurance and research.
Our MRI reporting pro forma has been widely adopted within our department, resulting inclusion of the majority of significant findings. Departmental education will be undertaken with respect to the importance of completion of the minimum data for low rectal tumours.
If the pro forma is not used, it can still act as an aide-memoire for the radiologist, prompting inclusion of the relevant imaging features to ensure that all the necessary information is imparted to the referring service in a clear and concise format.
Improved report clarity and consistency. The template acts as an aide-memoire for inclusion of the relevant imaging features and ensures that all the necessary information is imparted to the
referring service in a clear and concise format.
Higher Radiological and end use satisfaction. More efficient workflow.
Use of structured reporting in MRI for rectal cancer Dr Dekan Albasha1 and Dr Catriona Farrell2
1Radiology registrar, Mersey school of radiology and 2Consultant radiologist, The royal liverpool and broadgreen university hospitals
Ø Rectal cancer staging MRI plays an essential role in the primary preoperative staging of rectal cancer. The technique has been shown to be accurate in tumor staging and is able to identify imaging features that place the patient at increased risk for local recurrence [1].
Ø The MRI staging helps determine the care plan for the patient. Ø MR provides useful information that determines the surgical approach. Ø Standardized reporting of MRI for rectal cancer staging has been advocated, including in
consensus recommendations published by the European Society of Gastrointestinal and Abdominal Radiology [2].
Background
Advantages of structured reporting
Structured reports achieved significantly higher satisfaction rates with report content and clarity, and included significantly more of the 13 predefined key features compared with FT reports (SRs: mean ± SD, 12.2 ± 4.6 [range, 9–13] versus FT reports: mean ± SD, 9.2 ± 10.8 [range, 5–13]) (P < 0.001). Definite further clinical decision making (surgery vs neoadjuvant radiochemotherapy) was possible in 96% of SRs and only in 60% of FT reports (P < 0.001). In case of surgery, the reported information was considered to be sufficient for surgical planning in 94% of SRs versus only 38% in FT reports (P < 0.001). Structured report received a significantly higher overall report quality rated on a Likert scale from 1 to 6 (1, insufficient; 6, excellent) with a mean of 5.8 ± 0.42 (range, 5–6) in comparison to FT reports with 3.6 ± 1.19 (range, 1–5) (P < 0.001).
• To audit our compliance with the structured reporting of MR rectum for the primary diagnosis of rectal cancer.
Our aim:
Methodology Time period: Ø Database of patients (from CRIS) who underwent MR rectum from 26/05/16 to 21/04/17. Total of 98 patients. Inclusion criteria: Ø MR indication for the primary diagnosis/initial staging for rectal cancer. Total number of scans suitable for study: 39 (n)
• Height from the anal verge. • Height above or below puborectalis. • Length of tumour. • Circumferential tumour location e.g. 3 o’clock to 7 o’clock or circumferential. • Tumour relationship to peritoneal reflection. • T stage given
• If T3, is the sub-stage given i.e. T3a, T3b, T3c or T3d. • b) Depth of extramural spread in mm. • c) For T4b tumours, which structures are involved.
• For low rectal tumours, is the following info available: Involvement of sphincter
complex • a) Full/partial thickness internal sphincter • b) Interphincteric plane • c) External sphincter • d) Beyond external sphincter to ischiorectal fat.
• Lymph nodes: N staging given • EMVI: EMVI present (small/medium/large vessel involvement) • CRM involved or not (same as TME plane).
• a) Minumum tumour distance to mesorectal fascia (in mm). • Peritoneal deposits (evidence or no evidence) • Pelvic side wall lymph nodes: present or not.
• a) If present, then location mentioned.
• Conclusion: Overall TNM stage given.
The following criteria within the report were assessed:
Results Numbers completed / numbers applicable to
Percentage completed
Height from anal verge 39/39 100% Height above or below puborectalis 39/39 100% Length of tumour 39/39 100% Circumferential tumour location ie ‘3 o’clock to 7 o’clock or circumferential’
39/39 100%
Tumour relationship to peritoneal reflection 39/39 100% T stage 39/39 100% If T3, is the substage given ie T3a T3b T3c T3d 21/24 87.5% Depth of extramural spread in mm 26/31 83.9% For T4b tumours, which structures are involved 6/6 100% For lower rectal tumours: Involvement of the sphincter complex
7/18 38.9%
Numbers completed / numbers applicable to
Percentage completed
Lymph nodes: N staging given 38/39 97.4% EMVI 38/39 97.4% CRM involvement: Minimum tumour distance to mesorectal fascia given in mm
24/29 82.8%
Peritoneal deposits 37/39 94.9% Pelvic side wall lymph node: Present 36/39 92.3% Pelvic side wall lymph node: Location given 36/39 92.3%
Conclusion: overall TNM staging 38/39 97.4%
Ø Achieved 100% completion in 7/17 of the headings and >90% in 6/17 Discussion Ø For lower rectal tumours – the importance of describing the involvement of the sphincter complex
Figure 1: When the intersphincteric plane is tumor-free, the external sphincter can be spared with an intersphincteric abdomino-perineal resection. APE - abdomino-perineal excision ELAPE - extra-levator abdominal perineal resection
Ø The prognostic value of the circumferential resection margin CRM has been called into question in some recent studies. However, remains to be a important prognostic factor
Conclusion and recommendation:
References: 1) Wong RKS, Berry S, Spithoff K, et al. Preoperative or postoperative therapy for stage II or III rectal cancer: an updated practice guideline. Clin Oncol (R Coll Radiol) 2010; 22:265–271. 2) Beets-Tan RGH, Lambregts DMJ, Maas M, et al. Magnetic resonance imaging for the clinical management of rectal cancer patients: recommendations from the 2012 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. Eur Radiol 2013; 23:2522–2531.
