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 preoperative 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.
The ureteric “rendezvous” procedure is an interventional procedure involving both uro-radiological and cystoscopic techniques to manage complex ureteric stenoses or fistulae. We present a case in which this procedure was utilised, with an unusual intra-procedural finding. Macroscopic visualisation of lipids within the urinary tract is an unusual finding at CT, and rarely seen at cystoscopy. The aetiology of lipiduria is varied; it may indicate the presence of unrecognised pathology, occur as a sequelae of trauma, or arise secondary to intervention. Understanding the patient's history is vital to determining the likely aetiology and significance of such a finding.
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