The awareness of radiologists for the presence of lateral lymph nodes in patients with locally advanced rectal cancer: a single-centre, retrospective cohort study

Abstract

Objectives Enlarged lateral lymph nodes (LLNs) are associated with increased (lateral) local recurrence rates. Size and anatomical location should therefore always be reported by radiologists and discussed during multidisciplinary meetings. The objective was to investigate how often LLNs are mentioned in MRI reports in a tertiary referral centre. Methods A single - centre, retrospective study of 202 patients treated for primary rectal cancer between 2012 and 2020, with at least a T2 tumour located within 12cm of the anorectal junction. The radiology reports were written by 30–40 consultant radiologists. MRI scans were independently re-assessed by an expert radiologist. The primary outcome was how often the presence or absence of LLNs was mentioned in the initial report. Results Primary MRI reports explicitly mentioned the presence or absence of LLNs in 89 (44%) cases. Of the 43 reports with present LLNs, only one (1%) reported on all features such as size, location or malignant features. Expert review revealed 17 LLNs which were ≥ 7 mm (short-axis); two of these were not mentioned in the original reports. In 14/43 (33%) cases, LLNs were discussed during the primary multidisciplinary meeting, while 17/43 (40%) restaging MRI reports failed to report on the previously visible LLN. Reporting LLNs increased significantly with higher N-stage (p = .010) and over time (p = .042). Conclusions Though improving with time, there is still limited consistency in reporting LLNs. Only 44% of primary MRI reports mentioned LLNs and relevant features of those LLNs were seldomly reported. Given the importance of this information for subsequent treatment; increased awareness, proper training and the use of templates are needed. Key Points • Comprehensive reporting of lateral lymph nodes in primary MRI reports was limited to less than 50%. • Lateral lymph nodes are not always discussed during primary multidisciplinary meetings or mentioned in restaging reports. • Improvements in the awareness and knowledge of lateral lymph nodes are needed to ensure adequate multidisciplinary treatment decisions.

Prognostic Implications of Lateral Lymph Nodes in Rectal Cancer: A Population-Based Cross-sectional Study With Standardized Radiological Evaluation After Dedicated Training

“…Our research group is examining the irradiation doses received by patients with LLNs ≥5 mm and the outcomes after LLN surgery (not LLND; separate articles). 10 , 22 We hypothesize that the majority of LLNs received an adequate dose, meaning that surgical treatment might be imperative to improve oncological outcomes for this population in the future.…”

Management of internal iliac and obturator lymph nodes in mid-low rectal cancer

“…Furthermore, even when lateral lymph node enlargement is reported, incomplete or contradictory descriptions of lymph node features occur. These findings underscore the need for enhanced awareness, improved reporting templates, and targeted education and training regarding LLN [ 21 – 23 ].…”

A Deep Learning Framework with Explainability for the Prediction of Lateral Locoregional Recurrences in Rectal Cancer Patients with Suspicious Lateral Lymph Nodes

“…This multicentre retrospective cohort study included patients from three expert hospitals in the Netherlands: Amsterdam UMC, location VUmc (AUMC), the Netherlands Cancer Institute (NKI), and Catharina Hospital (CH). Patients from the NKI and CH were selected from the retrospective Lateral Node Consortium study [7], and patients from AUMC were included from a retrospective study of LARC patients [17]. Both studies only included patients with primary rectal carcinoma, of at least cT2 stage, diagnosed between July 2008 and November 2020.…”