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Leithner D, Sala E, Neri E, Schlemmer HP, D'Anastasi M, Weber M, Avesani G, Caglic I, Caruso D, Gabelloni M, Goh V, Granata V, Kunz WG, Nougaret S, Russo L, Woitek R, Mayerhoefer ME. Perceptions of radiologists on structured reporting for cancer imaging-a survey by the European Society of Oncologic Imaging (ESOI). Eur Radiol 2024; 34:5120-5130. [PMID: 38206405 PMCID: PMC11254975 DOI: 10.1007/s00330-023-10397-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/20/2023] [Accepted: 09/07/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVES To assess radiologists' current use of, and opinions on, structured reporting (SR) in oncologic imaging, and to provide recommendations for a structured report template. MATERIALS AND METHODS An online survey with 28 questions was sent to European Society of Oncologic Imaging (ESOI) members. The questionnaire had four main parts: (1) participant information, e.g., country, workplace, experience, and current SR use; (2) SR design, e.g., numbers of sections and fields, and template use; (3) clinical impact of SR, e.g., on report quality and length, workload, and communication with clinicians; and (4) preferences for an oncology-focused structured CT report. Data analysis comprised descriptive statistics, chi-square tests, and Spearman correlation coefficients. RESULTS A total of 200 radiologists from 51 countries completed the survey: 57.0% currently utilized SR (57%), with a lower proportion within than outside of Europe (51.0 vs. 72.7%; p = 0.006). Among SR users, the majority observed markedly increased report quality (62.3%) and easier comparison to previous exams (53.5%), a slightly lower error rate (50.9%), and fewer calls/emails by clinicians (78.9%) due to SR. The perceived impact of SR on communication with clinicians (i.e., frequency of calls/emails) differed with radiologists' experience (p < 0.001), and experience also showed low but significant correlations with communication with clinicians (r = - 0.27, p = 0.003), report quality (r = 0.19, p = 0.043), and error rate (r = - 0.22, p = 0.016). Template use also affected the perceived impact of SR on report quality (p = 0.036). CONCLUSION Radiologists regard SR in oncologic imaging favorably, with perceived positive effects on report quality, error rate, comparison of serial exams, and communication with clinicians. CLINICAL RELEVANCE STATEMENT Radiologists believe that structured reporting in oncologic imaging improves report quality, decreases the error rate, and enables better communication with clinicians. Implementation of structured reporting in Europe is currently below the international level and needs society endorsement. KEY POINTS • The majority of oncologic imaging specialists (57% overall; 51% in Europe) use structured reporting in clinical practice. • The vast majority of oncologic imaging specialists use templates (92.1%), which are typically cancer-specific (76.2%). • Structured reporting is perceived to markedly improve report quality, communication with clinicians, and comparison to prior scans.
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Affiliation(s)
- Doris Leithner
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA
| | - Evis Sala
- Department of Radiology, Universita Cattolica del Sacro Cuore, Rome, Italy
- Advanced Radiology Center, Fondazione Universitario Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Emanuele Neri
- Diagnostic and Interventional Radiology, Department of Translational Research, University of Pisa, Pisa, Italy
| | | | - Melvin D'Anastasi
- Medical Imaging Department, Mater Dei Hospital, University of Malta, Msida, Malta
| | - Michael Weber
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Giacomo Avesani
- Department of Radiology, Radiation Oncology and Hematology, Fondazione Policlinico Universitario, A. Gemelli IRCCS, Rome, Italy
| | - Iztok Caglic
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Damiano Caruso
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Michela Gabelloni
- Nuclear Medicine Unit, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Vicky Goh
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Department of Radiology, Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS, Naples, Italy
| | - Wolfgang G Kunz
- Department of Radiology, University Hospital LMU Munich, Munich, Germany
| | | | - Luca Russo
- Department of Radiology, Radiation Oncology and Hematology, Fondazione Policlinico Universitario, A. Gemelli IRCCS, Rome, Italy
| | - Ramona Woitek
- Research Centre for Medical Image Analysis and Artificial Intelligence, Danube Private University, Krems, Austria
| | - Marius E Mayerhoefer
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA.
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.
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Robinson E, Balasubramaniam R, Hameed M, Clarke C, Taylor SA, Tolan D, Foley KG. Survey of rectal cancer MRI technique and reporting tumour descriptors in the UK: a multi-centre British Society of Gastrointestinal and Abdominal Radiology (BSGAR) audit. Clin Radiol 2024; 79:117-123. [PMID: 37989667 DOI: 10.1016/j.crad.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/17/2023] [Accepted: 10/21/2023] [Indexed: 11/23/2023]
Abstract
AIM To evaluate variation in magnetic resonance imaging (MRI) technique and reporting of rectal cancer staging examinations across the UK. MATERIALS AND METHODS A retrospective, multi-centre audit was undertaken of imaging protocols and information documented within consecutive MRI rectal cancer reports between March 2020 and August 2021, which were compared against American and European guidelines. Inclusion criteria included histologically proven rectal adenocarcinoma and baseline staging MRI rectum only. RESULTS Fully anonymised data from 924 MRI reports by 78 radiologists at 24 centres were evaluated. Thirty-two per cent of radiologists used template reporting, but these reports offered superior documentation of 13 out of 18 key tumour features compared to free-text reports including T-stage, relation to peritoneal reflection and mesorectal fascia (MRF), nodal status, and presence of extramural venous invasion (EMVI; p<0.027 in each). There was no significant differences in the remaining five features. Across all tumour locations, the tumour relationship to the MRF, the presence of EMVI, and the presence of tumour deposits were reported in 79.5%, 85.6%, and 44% of cases, respectively, and tumour, nodal, and distant metastatic stage documented in 94.4%, 97.7%, and 78.3%. In low rectal tumours, the relationship to the anal sphincter complex was reported in only 54.6%. CONCLUSION Considerable variation exists in rectal cancer MRI acquisition and reporting in this sample of UK centres. Inclusion of key radiological features in reports must be improved for risk stratification and treatment decisions. Template reporting is superior to free-text reporting. Routine adoption of standardised radiology practices should now be considered to improve standards to facilitate personalised precision treatment for patients to improve outcomes.
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Affiliation(s)
- E Robinson
- North Bristol NHS Trust, Southmead Road, Westbury-on-Trym Bristol, BS10 5NB, UK.
| | - R Balasubramaniam
- Royal Stoke University Hospital, Newcastle Road, Stoke-on-Trent, Staffordshire, ST4 6QG, UK
| | - M Hameed
- University College Hospital, 235 Euston Road, London, NW1 2BU, UK; University College London, Centre for Medical Imaging, 2nd Floor Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK
| | - C Clarke
- Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, Nottinghamshire, NG7 2UH, UK
| | - S A Taylor
- University College London, Centre for Medical Imaging, 2nd Floor Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK
| | - D Tolan
- Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK.
| | - K G Foley
- Royal Glamorgan Hospital, Ynysmaerdy, Llantrisant, UK; Velindre Cancer Centre, Velindre Road, Whitchurch, Cardiff, CF14 2TL, UK
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Hazen SJA, Sluckin TC, Horsthuis K, Lambregts DMJ, Beets-Tan RGH, Tanis PJ, Kusters M. An updated evaluation of the implementation of the sigmoid take-off landmark 1 year after the official introduction in the Netherlands. Tech Coloproctol 2023; 27:1243-1250. [PMID: 37184772 PMCID: PMC10638143 DOI: 10.1007/s10151-023-02803-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/10/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE The definition of rectal cancer based on the sigmoid take-off (STO) was incorporated into the Dutch guideline in 2019, and became mandatory in the national audit from December 2020. This study aimed to evaluate the use of the STO in clinical practice and the added value of online training, stratified for the period before (group A, historical cohort) and after (group B, current cohort) incorporation into the national audit. METHODS Participants, including radiologists, surgeons, surgical and radiological residents, interns, PhD students, and physician assistants, were asked to complete an online training program, consisting of questionnaires, 20 MRI cases, and a training document. Outcomes were agreement with the expert reference, inter-rater variability, and accuracy before and after the training. RESULTS Group A consisted of 86 participants and group B consisted of 114 participants. Familiarity with the STO was higher in group B (76% vs 88%, p = 0.027). Its use in multidisciplinary meetings was not significantly higher (50% vs 67%, p = 0.237). Agreement with the expert reference was similar for both groups before (79% vs 80%, p = 0.423) and after the training (87% vs 87%, p = 0.848). Training resulted in significant improvement for both groups in classifying tumors located around the STO (group A, 69-79%; group B, 67-79%, p < 0.001). CONCLUSIONS The results of this study show that after the inclusion of the STO in the mandatory Dutch national audit, the STO was consequently used in only 67% of the represented hospitals. Online training has the potential to improve implementation and unambiguous assessment.
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Affiliation(s)
- S J A Hazen
- Department of Surgery, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, P.O. Box 7057, 1007 MB, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - T C Sluckin
- Department of Surgery, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, P.O. Box 7057, 1007 MB, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - K Horsthuis
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
- Radiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - D M J Lambregts
- Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - R G H Beets-Tan
- Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School of Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - P J Tanis
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
- Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Erasmus Medical Center, Surgical Oncology and Gastrointestinal Surgery, Rotterdam, The Netherlands
| | - M Kusters
- Department of Surgery, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, P.O. Box 7057, 1007 MB, Amsterdam, the Netherlands.
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands.
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Mayaud A, Grange R, Leroy B, Phelip JM, Sotton S, Boutet C, Magné N. MRI in rectal cancer: An institutional real life analysis of technical parameters. Bull Cancer 2023; 110:1244-1250. [PMID: 37858424 DOI: 10.1016/j.bulcan.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 07/19/2023] [Accepted: 08/13/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION MRI plays a key role in the preoperative staging of rectal cancers and choice of neoadjuvant radiochemotherapy. Yet, the acquisition and interpretation of rectum magnetic resonance imaging (MRI) turn out to be unequal, impacting patients'care. The present study aims at evaluating the quality of the acquisition of technical parameters of the rectal MRI performed by comparing them according to the various guidelines. METHODS The medical MRI reports of all consecutive patients with locally advanced rectal cancer treated in a curative intent, by preoperative RCT and completion surgery were retrospectively reviewed over two periods (January 2010-December 2014 and January 2018 and December 2020) according to international 2012 and 2016 ESGAR and 2017 SAR MRI recommendation reports. RESULTS During the first period (69 MRI performed), 58% of these MRI abided by the recommendations and 75% of essential criteria could be found in 25.5% of MRI reportings. During the second period (73 MRI performed), the protocol used by 6.8% of MR images abided by the 2016 Society of Gastrointestinal and Abdominal Radiology (ESGAR) recommendations and 39.7% abided by the Society of Abdominal Radiology (SAR) recommendations. 75% of essential criteria could be found in 52.3% of MRI reportings and 90% of essential criteria could be found in 6.2% of MRI reportings. DISCUSSION In an era of increasing individualized patient care and conservative treatment focused on tumour response and prognostic factors, the present study showed that compliance to MRI protocols and reporting guidelines needs improving to upgrade patient care.
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Affiliation(s)
- Alexandre Mayaud
- Saint-Étienne Teaching Hospital (CHU), Radiology Department, Saint-Étienne, France
| | - Rémi Grange
- Saint-Étienne Teaching Hospital (CHU), Radiology Department, Saint-Étienne, France
| | - Bertrand Leroy
- Saint-Étienne Teaching Hospital (CHU), Digestive Surgery Department, Saint-Étienne, France
| | - Jean-Marc Phelip
- Saint-Étienne Teaching Hospital (CHU), Gastroenterology Department, Saint-Étienne, France
| | - Sandrine Sotton
- Lucien Neuwirth Cancer Centre (ICLN), Teaching and Research Department, Saint-Priest-en Jarez, France
| | - Claire Boutet
- Saint-Étienne Teaching Hospital (CHU), Radiology Department, Saint-Étienne, France
| | - Nicolas Magné
- Bergonié Institut, Radiotherapy Department, Bordeaux, France.
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5
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Andersen RD, Vils Pedersen MR, Hesseldal L, Rafaelsen SR. Using structured templates or free text style in reporting CT staging on colon cancer: a national survey. Acta Radiol 2022; 64:1765-1769. [PMID: 36575645 DOI: 10.1177/02841851221142226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Computed tomography (CT) is a widely used method for the staging of colon cancer. Accurate reports could lead to a better preoperative evaluation and planning of the treatment of colon cancer. PURPOSE To evaluate the use of CT free-text reports and structured report templates when it comes to staging CT imaging of colon cancer. MATERIAL AND METHODS A multiple choice questionnaire survey was conducted over four weeks. Online questionnaire software was used, and a link was shared to medical doctors with help from the Danish Colorectal Cancer Group (DCCG) and from a social media radiologist group. RESULTS Clinicians preferred the template style (95%), whereas the level of support was lower among the radiologists (76%). All female responders preferred the template style, in contrast to only 84% of the male responders. Furthermore, the survey showed a slightly deficient level of the national CT reporting quality; only 7/13 questions and sub-questions, concerning CT report quality, achieved an approval rate >85%. The colorectal cancer multidisciplinary team consultants who always or usually work with template style reporting of CT scans of colon cancer tend to be more satisfied with the quality and content of the reports, compared to those who rarely use or read template reports. CONCLUSION The following indicators were insufficiently reported: tumor invasion growth; number of hepatic metastases; segment location of hepatic metastasis; and retroperitoneal lymph node involvement. In the template reports group, nearly all participants found relevant information easily accessible.
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Affiliation(s)
- Rasmus Dam Andersen
- Department of Radiology, Vejle Hospital, Clinical Cancer Centre, University Hospital of Southern Denmark, Vejle, Denmark
| | - Malene Roland Vils Pedersen
- Department of Radiology, Vejle Hospital, Clinical Cancer Centre, University Hospital of Southern Denmark, Vejle, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Danish Colorectal Cancer Center South, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Laura Hesseldal
- Research Unit for General Practice, Department of Public Health; University of Southern Denmark, Vejle, Denmark
| | - Søren Rafael Rafaelsen
- Department of Radiology, Vejle Hospital, Clinical Cancer Centre, University Hospital of Southern Denmark, Vejle, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Danish Colorectal Cancer Center South, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
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6
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Zhu K, Chen Z, Cui L, Zhao J, Liu Y, Cao J. The Preoperative Diagnostic Performance of Multi-Parametric Quantitative Assessment in Rectal Carcinoma: A Preliminary Study Using Synthetic Magnetic Resonance Imaging. Front Oncol 2022; 12:682003. [PMID: 35707367 PMCID: PMC9190242 DOI: 10.3389/fonc.2022.682003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/19/2022] [Indexed: 12/24/2022] Open
Abstract
Objective Synthetic MRI (SyMRI) can reconstruct different contrast-weighted images(T1, T2, PD) and has shorter scan time, easier post-processing and better reproducibility. Some studies have shown splendid correlation with conventional mapping techniques and no degradation in the quality of syMRI images compared with conventional MRI. It is crucial to select an individualized treatment plan based on the preoperative images of rectal carcinoma (RC). We tried to explore the feasibility of syMRI on T, N stage and extramural vascular invasion (EMVI) of rectal cancer. Materials and Methods A total of 100 patients (37 females and 63 males) diagnosed with rectal carcinoma were enrolled. All the patients underwent preoperative pelvic MR examinations including conventional MR sequence and synthetic MRI. Two radiologists evaluated the MRI findings of each rectal carcinoma and EMVI score in consensus. The values for T1, T2 relaxation times and PD value were measured in tumor(ROI-1) and pararectal fat space(ROI-2) and analyzed independently. A receiver operating characteristic (ROC) analysis was performed. Correlations between the T1, T2 and PD values and EMVI score were also evaluated. Results Compared with the normal rectal wall, the values of T1 and T2 relaxation times of the tumor were significantly higher (P <0.001). There was no statistically significant difference in the PD value (P >0.05). As for ROI, the ROI of pararectal fat space(ROI-2) had better significance than rectal cancer lesion (ROI-1). T2 value of ROI-1 and T1 value of ROI-2 were higher in the pEMVI positive group than in the negative group (P=0.002 and 0.001) and T1 value of ROI-2 had better performance with an AUC of 0.787, (95% CI:0.693- 0.882). T1 value, T2 value and PD value from ROI-2 were effective for both T and N stage of rectal cancer. High-grade pathological stage had showed higher T1 value (PT stage=0.013,PN stage=0.035), lower T2 value (PT stage=0.025,PN stage=0.034) and lower PD value (PT stage=0.017). We also enrolled the characteristics with P < 0.05 in the combined model which had better diagnostic efficacy. A significant positive correlation was found between the T1 value of pararectal fat space(ROI-2) and EMVI score (r value = 0.519, P<0.001). The T2 value(r=0.213,P=0.049) and PD value(r=0.354,P=0.001) from ROI-1 was correlated with EMVI score. Correlation analysis did not show any significant associations between T2 value of tumor, T2, PD values of pararectal fat space and EMVI scores. Conclusion Synthetic MRI can provide multi-parameter quantitative image maps with a easier measurement and slightly shorter acquisition time compared with conventional MRI. The measurement of multi-parametric quantitative values contributes to diagnosing the tumor and evaluating T stage, N stage and EMVI. It has the potential to be used as a preoperative diagnostic and grading technique in rectal carcinoma.
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Affiliation(s)
- Kexin Zhu
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Zhicheng Chen
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Lingling Cui
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jinli Zhao
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yi Liu
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jibin Cao
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
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Rouleau Fournier F, Motamedi MAK, Brown CJ, Phang T, Raval MJ, Hague CJ, Karimuddin AA. Oncologic Outcomes Associated With MRI-detected Extramural Venous Invasion (mrEMVI) in Rectal Cancer: A Systematic Review and Meta-analysis. Ann Surg 2022; 275:303-314. [PMID: 33491979 DOI: 10.1097/sla.0000000000004636] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The role of MRI-detected EMVI (mrEMVI) as a reliable prognostic factor in rectal cancer has been emphasized in recent years but this finding remains underreported by many institutions. OBJECTIVE This review aimed to demonstrate the importance of pre- and post-treatment MRI-detected EMVI as independent prognostic factors of adverse oncologic outcomes in patients undergoing neoadjuvant therapy followed by total mesorectal excision. METHODS This review was designed using the PRISMA guidelines. The following electronic databases were searched from January 2002 to January 2020: CENTRAL, Ovid MEDLINE, PubMed, and Ovid Embase. Main outcomes included DFS and overall survival (OS). Other outcomes of interest comprised positive resection margin and synchronous metastases. RESULTS Seventeen studies involving a total of 3821 patients were included for data synthesis. For preneoadjuvant treatment mrEMVI, pooled hazard ratio (HR) estimate for DFS was 2.30 (95% confidence intervals (CI) 1.54-3.44) for higher recurrence in mrEMVI-positive patients. mrEMVI-positive patients were found to have a lower OS with a pooled HR of 1.68 (95%CI 1.27-2.22). Pooled risk ratio for synchronous metastasis was 4.11 (95%CI 2.80-6.02) for mrEMVI-positivity. For postneoadjuvant treatment EMVI (ymrEMVI), positive status showed a lower DFS with a pooled HR of 2.04 (95%CI 1.55-2.69). Risk ratio of having a positive resection margin status was 2.95 (95%CI 1.75-4.98) for ymrEMVI-positive patients. CONCLUSIONS This review showed that oncologic outcomes are significantly worse for both pre- and post-neoadjuvant treatment mrEMVI-positive patients. MRI-detected EMVI should be consistently reported in rectal cancer staging and may provide guidance for the targeted use of additional systemic therapy.
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Affiliation(s)
- François Rouleau Fournier
- Department of Surgery, St-Paul's Hospital, University of British Columbia, 1081 Burrard Street, Third Floor, Burrard Building, Vancouver, BC V6Z 1Y6, Canada
| | - Mohammad Ali K Motamedi
- Department of Surgery, St-Paul's Hospital, University of British Columbia, 1081 Burrard Street, Third Floor, Burrard Building, Vancouver, BC V6Z 1Y6, Canada
| | - Carl J Brown
- Department of Surgery, St-Paul's Hospital, University of British Columbia, 1081 Burrard Street, Third Floor, Burrard Building, Vancouver, BC V6Z 1Y6, Canada
| | - Terry Phang
- Department of Surgery, St-Paul's Hospital, University of British Columbia, 1081 Burrard Street, Third Floor, Burrard Building, Vancouver, BC V6Z 1Y6, Canada
| | - Manoj J Raval
- Department of Surgery, St-Paul's Hospital, University of British Columbia, 1081 Burrard Street, Third Floor, Burrard Building, Vancouver, BC V6Z 1Y6, Canada
| | - Cameron J Hague
- Department of Radiology, St-Paul's Hospital, University of British Columbia, 1081 Burrard Street, Third Floor, Burrard Building, Vancouver, BC V6Z 1Y6, Canada
| | - Ahmer A Karimuddin
- Department of Surgery, St-Paul's Hospital, University of British Columbia, 1081 Burrard Street, Third Floor, Burrard Building, Vancouver, BC V6Z 1Y6, Canada
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8
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Alvfeldt G, Aspelin P, Blomqvist L, Sellberg N. Radiology reporting in rectal cancer using MRI: adherence to national template for structured reporting. Acta Radiol 2021; 63:1603-1612. [PMID: 34866405 DOI: 10.1177/02841851211057276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In 2014, a national workshop program was initiated and a reporting template and manual for rectal cancer primary staging using magnetic resonance imaging (MRI) was introduced and made available by the national Swedish Colorectal Cancer Registry. PURPOSE To evaluate the effect of the national template program by identify if there was a gap between the content in Swedish MRI reports from 2016 and the national reporting template from 2014. The aim was to explore and compare differences in content in reporting practice in different hospitals in relation to the national reporting template, with focus on: (i) identifying any implementational differences in reporting styles; and (ii) evaluating if reporting completeness vary based on such implementational differences. MATERIAL AND METHODS A total of 250 MRI reports from 10 hospitals in four healthcare regions in Sweden were collected. Reports were analyzed using qualitative content analysis with a deductive thematic coding scheme based on the national reporting template. RESULTS Three different implemented reporting styles were identified with variations of content coverage in relation to the template: (i) standardized and structured protocol (reporting style A); (ii) standardized semi-structured free-text (reporting style B); and (iii) regular free-text (reporting style C). The relative completeness of reporting practice of rectal cancer staging in relation to the national reporting template were 92.9% for reporting style A, 77.5% for reporting style B, and 63.9% for reporting style C. CONCLUSION The implementation of template-based reporting according to reporting style A is a key factor to conform to evidence-based practice for rectal cancer reporting using MRI.
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Affiliation(s)
- Gustav Alvfeldt
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Peter Aspelin
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Lennart Blomqvist
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. Department of Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Nina Sellberg
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
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9
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Zhao AH, Matalon SA, Shinagare AB, Lee LK, Boland GW, Khorasani R. Improving the completeness of structured MRI reports for rectal cancer staging. Abdom Radiol (NY) 2021; 46:885-893. [PMID: 32949276 DOI: 10.1007/s00261-020-02754-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 08/25/2020] [Accepted: 09/03/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE Assess the impact of a multifaceted intervention to improve the completeness of structured MRI reports for patients undergoing initial staging for rectal cancer. METHODS This Institutional Review Board-approved retrospective study was performed at a large academic hospital. MRI reports for initial staging of rectal cancer in 2017 and 2019 were analyzed pre- and post-implementation of multiple quality improvement interventions in 2018, including harmonizing MRI protocols across the institution, educational conferences and modules, and requiring second opinion consultation for all MRI rectal cancer examinations. The primary outcome measure was the completeness of rectal cancer staging MRI reports, classified as optimal, satisfactory, or unsatisfactory based on the inclusion of 15 quality measures pre-defined by a consensus of abdominal and cancer imaging subspecialists, colorectal surgeons, and radiation oncologists at our institution, based on published recommendations. Fisher's exact test was used to evaluate changes in report quality and documentation of each quality measure. RESULTS The study included 138 MRI reports, of which 72 (52%) were completed in 2017 pre-intervention. Post intervention, the proportion of optimal reports increased significantly from 52.8% (38/72) to 71.2% (47/66) (p = 0.035). Documentation of 1 quality measure (N stage) increased post intervention from 91.7% (66/72) to 100% (66/66) (p = 0.029). Documentation of 7 quality measures was 100% post intervention, with a documentation rate of > 95% for all quality measures except radial location of tumor. CONCLUSION A combination of educational and system-wide interventions was associated with an improvement in the completeness of structured MRI reports for rectal cancer staging.
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Affiliation(s)
- Anna H Zhao
- Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
| | - Shanna A Matalon
- Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Atul B Shinagare
- Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Leslie K Lee
- Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Giles W Boland
- Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Ramin Khorasani
- Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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Alvfeldt G, Aspelin P, Blomqvist L, Sellberg N. Rectal cancer staging using MRI: adherence in reporting to evidence-based practice. Acta Radiol 2020; 61:1463-1472. [PMID: 32106682 PMCID: PMC7653401 DOI: 10.1177/0284185120906663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Magnetic resonance imaging (MRI) is the first-line imaging modality for local
staging of rectal cancer. The radiology report should deliver all relevant
available imaging information to guide treatment. Purpose To explore and describe if there was a gap between the contents in MRI
reports for primary staging of rectal cancer in Sweden in 2010 compared to
evidence-based practice. Material and Methods A total of 243 primary MRI staging reports from 2010, collected from 10
hospitals in four healthcare regions in Sweden, were analyzed using content
analysis with a deductive thematic coding scheme based on evidence-based
practice. Focus was on: (i) most frequently reported findings; (ii)
correlation to key prognostic findings; and (iii) identifying if any
findings being reported were beyond the information defined in
evidence-based practice. Results Most frequently reported findings were spread through the bowel wall or not,
local lymph node description, tumor length, and distance of tumor from anal
verge. These items accounted for 35% of the reporting content. Of all
reported content, 86% correlated with the evidence-based practice. However,
these included more information than was generally found in the reports.
When adjusting for omitted information, 48% of the reported content were
accounted for. Of the reported content, 20% correlated to key pathological
prognostic findings. Six types of findings were reported beyond the
evidence-based practice, representing 14% of the total reporting
content. Conclusion There was a gap between everyday practice and evidence-based practice in
2010. This indicates a need for national harmonization and implementation of
standardized structured reporting templates.
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Affiliation(s)
- Gustav Alvfeldt
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Peter Aspelin
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Lennart Blomqvist
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Nina Sellberg
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
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