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. 2022 Oct 20;13(1):171.
doi: 10.1186/s13244-022-01303-7.

Retrospective evaluation of national MRI reporting quality for lateral lymph nodes in rectal cancer patients and concordance with prospective re-evaluation following additional training

Tania C Sluckin  1   2   3 , Sanne-Marije J A Hazen  1   2   3 , Karin Horsthuis  3   4 , Regina G H Beets-Tan  5   6   7 , Corrie A M Marijnen  8   9 , Pieter J Tanis  10   11 , Miranda Kusters  12   13   14 ; Dutch Snapshot Research Group
Collaborators, Affiliations

Retrospective evaluation of national MRI reporting quality for lateral lymph nodes in rectal cancer patients and concordance with prospective re-evaluation following additional training

Tania C Sluckin et al. Insights Imaging. .

Abstract

Objectives: The presence and size of lateral lymph nodes (LLNs) are important factors influencing treatment decisions for rectal cancer. Awareness of the clinical relevance and describing LLNs in MRI reports is therefore essential. This study assessed whether LLNs were mentioned in primary MRI reports at a national level and investigated the concordance with standardised re-review.

Methods: This national, retrospective, cross-sectional cohort study included 1096 patients from 60 hospitals treated in 2016 for primary cT3-4 rectal cancer ≤ 8 cm from the anorectal junction. Abdominal radiologists re-reviewed all MR images following a 2-h training regarding LLNs.

Results: Re-review of MR images identified that 41.0% of enlarged (≥ 7 mm) LLNs were not mentioned in primary MRI reports. A contradictory anatomical location was stated for 73.2% of all LLNs and a different size (≥/< 7 mm) for 41.7%. In total, 49.4% of all cases did not mention LLNs in primary MRI reports. Reporting LLNs was associated with stage (cT3N0 44.3%, T3N+/T4 52.8%, p = 0.013), cN stage (N0 44.1%, N1 48.6%, N2 59.5%, p < 0.001), hospital type (non-teaching 34.6%, teaching 52.2%, academic 53.2% p = 0.006) and annual rectal cancer resection volumes (low 34.8%, medium 47.7%, high 57.3% p < 0.001). For LLNs present according to original MRI reports (n = 226), 64.2% also mentioned a short-axis size, 52.7% an anatomical location and 25.2% whether it was deemed suspicious.

Conclusions: Almost half of the primary MRI reports for rectal cancer patients treated in the Netherlands in 2016 did not mention LLNs. A significant portion of enlarged LLNs identified during re-review were also not mentioned originally, with considerable discrepancies for location and size. These results imply insufficient awareness and indicate the need for templates, education and training.

Keywords: Lateral lymph nodes; MR imaging; Rectal cancer.

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Conflict of interest statement

RBT is a member of the Insights into Imaging Advisory Editorial Board. She has not taken part in the review or selection process of this article. The remaining authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of patient inclusion
Fig. 2
Fig. 2
Flowchart of results according to MRI re-review
Fig. 3
Fig. 3
Stating the presence or absence of LLNs in primary MRI reports according to the type of hospital: academic, teaching or non-teaching
Fig. 4
Fig. 4
Stating the presence or absence of LLNs in primary MRI reports according to surgical volume of rectal resections per year. High volume: 60 rectal resections or more, medium volume: 30–59 resections, low volume: 0–29 resections (based on the number of resections according to part 1 of this Snapshot study for 2016)
Fig. 5
Fig. 5
Flowchart of results for enlarged LLNs according to MRI re-review
Fig. 6
Fig. 6
Flowchart of long-term oncological results
See this image and copyright information in PMC

References

    1. Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 2001;345(9):638–646. doi: 10.1056/NEJMoa010580. - DOI - PubMed
    1. Kodeda K, Johansson R, Zar N, Birgisson H, Dahlberg M, Skullman S, et al. Time trends, improvements and national auditing of rectal cancer management over an 18-year period. Colorectal Dis. 2015;17(9):O168–O179. doi: 10.1111/codi.13060. - DOI - PubMed
    1. Schaap DP, Ogura A, Nederend J, Maas M, Cnossen JS, Creemers GJ, et al. Prognostic implications of MRI-detected lateral nodal disease and extramural vascular invasion in rectal cancer. Br J Surg. 2018;105(13):1844–1852. doi: 10.1002/bjs.10949. - DOI - PubMed
    1. Peacock O, Chang GJ. The landmark series: management of lateral lymph nodes in locally advanced rectal cancer. Ann Surg Oncol. 2020;27(8):2723–2731. doi: 10.1245/s10434-020-08639-8. - DOI - PubMed
    1. Steup WH, Moriya Y, van de Velde CJ. Patterns of lymphatic spread in rectal cancer. A topographical analysis on lymph node metastases. Eur J Cancer. 2002;38(7):911–918. doi: 10.1016/S0959-8049(02)00046-1. - DOI - PubMed

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