Zahra Kassam1,2, Rebecca Lang3, Supreeta Arya4, David D B Bates5, Kevin J Chang6, Tyler J Fraum7, Kenneth A Friedman8, Jennifer S Golia Pernicka5, Marc J Gollub5, Mukesh Harisinghani9, Gaurav Khatri10, Elena Korngold11, Chandana Lall12, Sonia Lee13, Michael Magnetta14, Courtney Moreno15, Stephanie Nougaret16, Viktoriya Paroder5, Raj M Paspulati17, Iva Petkovska5, Perry J Pickhardt18, Hiram Shaish19, Shannon Sheedy20, Martin R Weiser5, Lisa Xuan3, David H Kim18. 1. Western University, London, ON, Canada. Zahra.kassam@sjhc.london.on.ca. 2. Department of Medical Imaging, St. Joseph's Hospital, Schulich School of Medicine Western University, 268 Grosvenor Street, London, ON, N6A 4V2, Canada. Zahra.kassam@sjhc.london.on.ca. 3. Western University, London, ON, Canada. 4. Tata Memorial Centre, Mumbai, India. 5. Memorial Sloan Kettering Cancer Center, New York, NY, USA. 6. Boston University, Boston, MA, USA. 7. Mallinckrodt Institute of Radiology, St. Louis, MO, USA. 8. Cleveland Medical Center, Cleveland, OH, USA. 9. Massachusetts General Hospital, Boston, MA, USA. 10. University of Texas Southwestern, Dallas, TX, USA. 11. Oregon Health & Science University, Portland, OR, USA. 12. University of Florida-Jacksonville, Jacksonville, FL, USA. 13. University of California-Irvine, Irvine, CA, USA. 14. Northwestern University, Evanston, IL, USA. 15. Emory University School of Medicine, Atlanta, GA, USA. 16. Montpellier Cancer Institute, Montpellier University, Montpellier, France. 17. Case Western Reserve University, Cleveland, OH, USA. 18. University of Wisconsin, Madison, WI, USA. 19. Columbia University, New York, NY, USA. 20. Mayo Clinic Rochester, Rochester, MN, USA.
Abstract
OBJECTIVE: To review existing structured MRI reports for primary staging of rectal cancer and create a new, freely available structured report based on multidisciplinary expert opinion and literature review. METHODS: Twenty abdominal imaging experts from the Society of Abdominal Radiology (SAR)'s Disease Focused Panel (DFP) on Rectal and Anal Cancer completed a questionnaire and participated in a subsequent consensus meeting based on the RAND-UCLA Appropriateness Method. Twenty-two items were classified via a group survey as "appropriate" or "inappropriate" (defined by ≥ 70% consensus), or "needs group discussion" (defined by < 70% consensus). Certain items were also discussed with multidisciplinary team members from colorectal surgery, oncology and pathology. RESULTS: After completion of the questionnaire, 16 (72%) items required further discussion (< 70% consensus). Following group discussion, consensus was achieved for 21 (95%) of the items. Based on the consensus meeting, a revised structured report was developed. The most significant modifications included (1) Exclusion of the T2/early T3 category; (2) Replacement of the term "circumferential resection margin (CRM)" with "mesorectal fascia (MRF)"; (3) A revised definition of "mucinous content"; (4) Creation of two distinct categories for suspicious lymph nodes (LNs) and tumor deposits; and (5) Classification of suspicious extra-mesorectal LNs by anatomic location. CONCLUSION: The SAR DFP on Rectal and Anal Cancer recommends using this newly updated reporting template for primary MRI staging of rectal cancer.
OBJECTIVE: To review existing structured MRI reports for primary staging of rectal cancer and create a new, freely available structured report based on multidisciplinary expert opinion and literature review. METHODS: Twenty abdominal imaging experts from the Society of Abdominal Radiology (SAR)'s Disease Focused Panel (DFP) on Rectal and Anal Cancer completed a questionnaire and participated in a subsequent consensus meeting based on the RAND-UCLA Appropriateness Method. Twenty-two items were classified via a group survey as "appropriate" or "inappropriate" (defined by ≥ 70% consensus), or "needs group discussion" (defined by < 70% consensus). Certain items were also discussed with multidisciplinary team members from colorectal surgery, oncology and pathology. RESULTS: After completion of the questionnaire, 16 (72%) items required further discussion (< 70% consensus). Following group discussion, consensus was achieved for 21 (95%) of the items. Based on the consensus meeting, a revised structured report was developed. The most significant modifications included (1) Exclusion of the T2/early T3 category; (2) Replacement of the term "circumferential resection margin (CRM)" with "mesorectal fascia (MRF)"; (3) A revised definition of "mucinous content"; (4) Creation of two distinct categories for suspicious lymph nodes (LNs) and tumor deposits; and (5) Classification of suspicious extra-mesorectal LNs by anatomic location. CONCLUSION: The SAR DFP on Rectal and Anal Cancer recommends using this newly updated reporting template for primary MRI staging of rectal cancer.