Reporting colon cancer staging using a template

[Role of radiology for primary staging of colorectal cancer]

BACKGROUND

Imaging, specifically magnetic resonance imaging (MRI), has long been the cornerstone for staging rectal cancer. In contrast, computed tomography (CT) is the standard for colon cancer staging. Primary staging is essential for individualized risk stratification and therapy planning.

OBJECTIVES

To summarize current international guidelines on primary colorectal cancer staging, taking into account the advantages and disadvantages of different imaging methods.

MATERIALS AND METHODS

Based on extensive literature research, the current state of knowledge in the staging of colorectal cancer is summarized.

RESULTS

TNM staging includes local tumor extension as well as the presence of lymph node and distant metastases. For local tumor extension, MRI is very well suited for rectal cancer. In colon cancer, CT shows significant limitations regarding the sensitivity of differentiating individual stages. Lymph node metastases can pose a major challenge for both MRI and CT, which has led to the definition of several malignancy criteria. The detection of distant metastases remains primarily within the domain of CT, except for liver metastases.

CONCLUSIONS

Depending on tumor location, either MRI or CT is recommended for primary staging of colorectal cancer, and a combination of both modalities may also be appropriate. Accurate assessment of the primary tumor, lymph nodes, and organs using imaging is an essential component of the therapeutic approach to colorectal cancer.

Impact of diffusion-weighted imaging on agreement between radiologists and non-radiologist in musculoskeletal tumor imaging using magnetic resonance

Background

Diffusion-weighted imaging (DWI) is widely used in neuroradiology or abdominal imaging but not yet implemented in the diagnosis of musculoskeletal tumors.

Aim

This study aimed to evaluate how including diffusion imaging in the MRI protocol for patients with musculoskeletal tumors affects the agreement between radiologists and non-radiologist.

Methods

Thirty-nine patients with musculoskeletal tumors (Ewing sarcoma, osteosarcoma, and benign tumors) consulted at our institution were included. Three raters with different experience levels evaluated examinations blinded to all clinical data. The final diagnosis was determined by consensus. MRI examinations were split into 1) conventional sequences and 2) conventional sequences combined with DWI. We evaluated the presence or absence of diffusion restriction, solid nature, necrosis, deep localization, and diameter >4 cm as known radiological markers of malignancy. Agreement between raters was evaluated using Gwet's AC1 coefficients and interpreted according to Landis and Koch.

Results

The lowest agreement was for diffusion restriction in both groups of raters. Agreement among all raters ranged from 0.51 to 0.945, indicating moderate to almost perfect agreement, and 0.772-0.965 among only radiologists indicating substantial to almost perfect agreement.

Conclusion

The agreement in evaluating diffusion-weighted MRI sequences was lower than that for conventional MRI sequences, both among radiologists and non-radiologist and among radiologists alone. This indicates that assessing diffusion imaging is more challenging, and experience may impact the agreement.

Using structured templates or free text style in reporting CT staging on colon cancer: a national survey

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.

Use of a standardized reporting template: can we improve report quality in pancreatic and peri-ampullary malignancy?

BACKGROUND

Accurate pancreatic and periampullary cancer staging with resectability assessment is vital to optimize surgical management and improve patient outcomes. The aim of this study is to assess the usefulness of a standardized reporting template.

METHODS

Retrospective review of all surgically managed patients with pancreatic or periampullary malignancy between January 2018 and June 2019. Pre-operative CT imaging report was anonymised and audited against a modified NCCN reporting template. The same imaging studies were re-reported by two experienced GI radiologists using the same template.

RESULTS

Fifty-nine patients (37 male) with median age of 68 years (36-83) underwent surgery for suspected pancreatic/peri-ampullary malignancy. The median time between pre-operative CT scan and surgery was 56.5 days (14-225). The use of reporting template resulted in significant increase in number of reported key features (p < 0.005), interobserver agreed features (p < 0.005) and overall k-value assessed interobserver agreement (p < 0.005). Template reports correlated closely with key intraoperative findings whilst primary free text reports did not (k-value 0.85-0.96 versus 0.20-0.46, p < 0.05).

CONCLUSION

The use of a reporting template resulted in a more complete and accurate pancreatic/peri-ampullary tumour evaluation, improved inter-observer relatability and correlation with intraoperative findings.