Development of a synoptic MRI report for primary rectal cancer

Abstract

BackgroundAlthough magnetic resonance imaging (MRI) is an important imaging modality for pre-operative staging and surgical planning of rectal cancer, to date there has been little investigation on the completeness and overall quality of MRI reports. This is important because optimal patient care depends on the quality of the MRI report and clear communication of these reports to treating physicians. Previous work has shown that the use of synoptic pathology reports improves the quality of pathology reports and communication between physicians.MethodsThe aims of this project are to develop a synoptic MRI report for rectal cancer and determine the enablers and barriers toward the implementation of a synoptic MRI report for rectal cancer in the clinical setting. A three-step Delphi process with an expert panel will extract the key criteria for the MRI report to guide pre-operative chemoradiation and surgical planning following a review of the literature, and a synoptic template will be developed. Furthermore, standardized qualitative research methods will be used to conduct interviews with radiologists to determine the enablers and barriers to the implementation and sustainability of the synoptic MRI report in the clinic setting.ConclusionSynoptic MRI reports for rectal cancer are currently not used in North America and may improve the overall quality of MRI report and communication between physicians. This may, in turn, lead to improved patient care and outcomes for rectal cancer patients.

A structured approach to reporting rectal cancer with magnetic resonance imaging

“…Signal intensity, border contour, and shape are more important features than size alone. The suggested short axis size thresholds of 0.8 and 1 cm for mesorectal and extramesorectal nodes, respectively, has good specificity (>95%) but poor sensitivity [18,19]. Involved lymph nodes are most often found at the level of the tumor.…”

“…T3 tumors invade through the external sphincter and into surrounding soft tissue with no organ involvement. T4 tumors invade through the external sphincter with possible involvement of the adjacent organs such as the prostate or vagina [18].…”

“…A synoptic MRI report was developed based on a metaanalysis of the literature by analyzing the sensitivity and specificity of rectal MRI for the parameters including CRM, T-category, and lymph node metastases [18][19][20]. A condensed version of the essential elements of the synoptic MRI report is provided in Table 2, designed to answer key questions from the surgical oncologist summarized in Table 3 adapted from [14].…”

The Oncologist’s Guide to Synoptic Reporting: A Primer

“…While the historic origin and widest application of synoptic reporting are in oncologic pathology, its concepts are spreading to non-neoplastic pathology [22,23] as well as oncologic specialities other than pathology. Main areas of application of synoptic reporting include radiology [24][25][26][27][28] and operative reports in surgery [29][30][31][32][33][34]. While the overall number of studies addressing the effects of synoptic reporting is considerably lower than in pathology, they tend to show similar outcomes; completeness of reports increases with the use of synoptic reporting, while at the same time the amount of non-essential information is reduced [35][36][37].…”

Clinical Feasibility Assessment of T3 Sub-Stage in Rectal Cancer Using MRI

“…High, mid, and low rectal cancer was categorized according to the location of the tumor (0 -6 cm, lower rectum; 7 -11 cm, middle rectum; and 12 -15 cm, upper rectum) (12). Invasion of the surrounding soft tissue through the external sphincter, but with no other organ invasion were also included in this study and considered as lower T3 rectal tumor (13). After exclusion, we had complete data available for analysis of 188 patients with clinical T3 rectal cancer.…”