Objectives: 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 standardized 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 ≤8cm from the anorectal junction. Abdominal radiologists re-reviewed all MR-images after following a 2-hour training regarding LLNs.
Results: Re-review of MR-images identified 41.0% of enlarged (≥7mm) LLNs were not mentioned in primary MRI-reports and a contradictory anatomical location was stated for 73.2% of all LLNs and a different size (≥/<7mm) for 41.7%. In total, 49.4% of cases did not mention LLNs in...
Show moreObjectives: 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 standardized 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 ≤8cm from the anorectal junction. Abdominal radiologists re-reviewed all MR-images after following a 2-hour training regarding LLNs.
Results: Re-review of MR-images identified 41.0% of enlarged (≥7mm) LLNs were not mentioned in primary MRI-reports and a contradictory anatomical location was stated for 73.2% of all LLNs and a different size (≥/<7mm) for 41.7%. In total, 49.4% of cases did not mention LLNs in primary MRI-reports. Reporting LLNs was associated with stage (cT3N0 44.3%, T3N+/T4 52.8%, p=.013), cN-stage (N0 44.1%, N1 48.6%, N2 59.5%, p<.001), hospital type (non-teaching 34.6%, teaching 52.2%, academic 53.2% p=.006) and annual rectal cancer resection volumes (low 34.8%, medium 47.7%, high 57.3% p<.001). For LLNs identified during re-review (n=226), 64.2% original reports mentioned short-axis size, 52.7% location and 25.2% suspiciousness.
Conclusions: Almost half of 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.
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