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European Radiology
Published in: European Radiology 10/2022

Open Access 18-05-2022 | Magnetic Resonance Imaging | Gastrointestinal

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

Authors: T. C. Sluckin, Y. F. L. Rooker, S. Q. Kol, S. J. A. Hazen, J. B. Tuynman, J. Stoker, P. J. Tanis, K. Horsthuis, M. Kusters

Published in: European Radiology | Issue 10/2022

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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.
Appendix
Available only for authorised users
Literature
1.
Beets-Tan RG, Beets GL (2004) Rectal cancer: review with emphasis on MR imaging. Radiology. 232(2):335–346CrossRef
2.
Beets-Tan RG, Lambregts DM, Maas M et al (2013) Magnetic resonance imaging for the clinical management of rectal cancer patients: recommendations from the 2012 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. Eur Radiol 23(9):2522–2531CrossRef
3.
Beets-Tan RGH, Lambregts DMJ, Maas M et al (2018) Magnetic resonance imaging for clinical management of rectal cancer: updated recommendations from the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. Eur Radiol 28(4):1465–1475CrossRef
4.
Gollub MJ, Arya S, Beets-Tan RG et al (2018) Use of magnetic resonance imaging in rectal cancer patients: Society of Abdominal Radiology (SAR) rectal cancer disease-focused panel (DFP) recommendations 2017. Abdom Radiol (NY) 43(11):2893–2902CrossRef
5.
Horvat N, Carlos Tavares Rocha C, Clemente Oliveira B, Petkovska I, Gollub MJ (2019) MRI of rectal cancer: tumor staging, imaging techniques, and management. Radiographics. 39(2):367–387CrossRef
6.
7.
Swedish Rectal Cancer Trial, Cedermark B, Dahlberg M et al (1997) Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med 336(14):980–987
8.
Kapiteijn E, Marijnen CA, Nagtegaal ID et al (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345(9):638–646CrossRef
9.
10.
Steup WH, Moriya Y, van de Velde CJ (2002) Patterns of lymphatic spread in rectal cancer. A topographical analysis on lymph node metastases. Eur J Cancer 38(7):911–918CrossRef
11.
Kim JH, Beets GL, Kim MJ, Kessels AG, Beets-Tan RG (2004) High-resolution MR imaging for nodal staging in rectal cancer: are there any criteria in addition to the size? Eur J Radiol 52(1):78–83CrossRef
12.
Brown G, Richards CJ, Bourne MW et al (2003) Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison. Radiology. 227(2):371–377CrossRef
13.
Ogura A, Konishi T, Cunningham C et al (2019) Neoadjuvant (Chemo)radiotherapy with total mesorectal excision only is not sufficient to prevent lateral local recurrence in enlarged nodes: results of the multicenter lateral node study of patients with Low cT3/4 rectal cancer. J Clin Oncol 37(1):33–43CrossRef
14.
Georgiou P, Tan E, Gouvas N et al (2009) Extended lymphadenectomy versus conventional surgery for rectal cancer: a meta-analysis. Lancet Oncol 10(11):1053–1062CrossRef
15.
Peacock O, Chang GJ (2020) The landmark series: management of lateral lymph nodes in locally advanced rectal cancer. Ann Surg Oncol 27(8):2723–2731CrossRef
16.
Kim MJ, Kim TH, Kim DY et al (2015) Can chemoradiation allow for omission of lateral pelvic node dissection for locally advanced rectal cancer? J Surg Oncol 111(4):459–464CrossRef
17.
Kim TG, Park W, Choi DH et al (2014) Factors associated with lateral pelvic recurrence after curative resection following neoadjuvant chemoradiotherapy in rectal cancer patients. Int J Colorectal Dis 29(2):193–200CrossRef
18.
Akiyoshi T, Ueno M, Matsueda K et al (2014) Selective lateral pelvic lymph node dissection in patients with advanced low rectal cancer treated with preoperative chemoradiotherapy based on pretreatment imaging. Ann Surg Oncol 21(1):189–196CrossRef
19.
Williamson JS, Quyn AJ, Sagar PM (2020) Rectal cancer lateral pelvic sidewall lymph nodes: a review of controversies and management. Br J Surg 107(12):1562–1569CrossRef
20.
21.
Christou N, Meyer J, Toso C, Ris F, Buchs NC (2019) Lateral lymph node dissection for low rectal cancer: is it necessary? World J Gastroenterol 25(31):4294–4299CrossRef
22.
Ito M, Kobayashi A, Fujita S et al (2018) Urinary dysfunction after rectal cancer surgery: results from a randomized trial comparing mesorectal excision with and without lateral lymph node dissection for clinical stage II or III lower rectal cancer (Japan Clinical Oncology Group Study, JCOG0212). Eur J Surg Oncol 44(4):463–468
23.
Saito S, Fujita S, Mizusawa J et al (2016) Male sexual dysfunction after rectal cancer surgery: results of a randomized trial comparing mesorectal excision with and without lateral lymph node dissection for patients with lower rectal cancer: Japan Clinical Oncology Group Study JCOG0212. Eur J Surg Oncol 42(12):1851–1858
24.
Fujita S, Mizusawa J, Kanemitsu Y et al (2017) Mesorectal excision with or without lateral lymph node dissection for clinical stage II/III lower rectal cancer (JCOG0212): a multicenter, randomized controlled, noninferiority trial. Ann Surg 266(2):201–207
25.
Kim YI, Jang JK, Park IJ et al (2020) Lateral lymph node and its association with distant recurrence in rectal cancer: a clue of systemic disease. Surg Oncol 35:174–181CrossRef
26.
Sluckin TC, Hazen SJA, Kusters M (2021) From “East vs West” towards international multidisciplinary collaboration: an appraisal of lateral lymph nodes in rectal cancer. Ann Gastroenterol Surg 5(6):731–737CrossRef
27.
28.
Kim TH, Jeong SY, Choi DH et al (2008) Lateral lymph node metastasis is a major cause of locoregional recurrence in rectal cancer treated with preoperative chemoradiotherapy and curative resection. Ann Surg Oncol 15(3):729–737CrossRef
29.
Brown PJ, Rossington H, Taylor J et al (2019) Standardised reports with a template format are superior to free text reports: the case for rectal cancer reporting in clinical practice. Eur Radiol 29(9):5121–5128CrossRef
30.
Sahni VA, Silveira PC, Sainani NI, Khorasani R (2015) Impact of a structured report template on the quality of MRI reports for rectal cancer staging. AJR Am J Roentgenol 205(3):584–588CrossRef
31.
Tersteeg JJC, Gobardhan PD, Crolla R et al (2018) Improving the quality of MRI reports of preoperative patients with rectal cancer: effect of national guidelines and structured reporting. AJR Am J Roentgenol 210(6):1240–1244CrossRef
32.
Nörenberg D, Sommer WH, Thasler W et al (2017) Structured reporting of rectal magnetic resonance imaging in suspected primary rectal cancer: potential benefits for surgical planning and interdisciplinary communication. Invest Radiol 52(4):232–239CrossRef
33.
Waite S, Scott JM, Drexler I et al (2018) Communication errors in radiology - pitfalls and how to avoid them. Clin Imaging 51:266–272CrossRef
34.
35.
Minn MJ, Zandieh AR, Filice RW (2015) Improving Radiology Report Quality by Rapidly Notifying Radiologist of Report Errors. J Digit Imaging 28(4):492–498CrossRef
36.
Thrall JH, Li X, Li Q et al (2018) Artificial intelligence and machine learning in radiology: opportunities, challenges, pitfalls, and criteria for success. J Am Coll Radiology 15(3 Pt B):504–508CrossRef
Metadata
Title
The awareness of radiologists for the presence of lateral lymph nodes in patients with locally advanced rectal cancer: a single-centre, retrospective cohort study
Authors
T. C. Sluckin
Y. F. L. Rooker
S. Q. Kol
S. J. A. Hazen
J. B. Tuynman
J. Stoker
P. J. Tanis
K. Horsthuis
M. Kusters
Publication date
18-05-2022
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 10/2022
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-022-08840-1

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