Eric Loveday Clinical History CTC shows annular tumour of the mid rectum extending craniocaudally for approx 47cm for staging MRI please Requested By Annie Reilly CNS Bleep 40514 ID: 489674
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Slide1
11:40-12:00 Mandating structured reports
Eric
Loveday Slide2Slide3Slide4Slide5Slide6Slide7Slide8Slide9Slide10Slide11Slide12Slide13Slide14
Clinical History :
CTC shows annular tumour of the mid rectum extending
craniocaudally
for
approx
4.7cm. for staging MRI please
Requested By: Annie Reilly CNS
Bleep: 40514
DWI affected by large amount of metal work in leg. Unable to keep still due to cramp in legs, ordinarily doesn't lie on back much.
MRI Pelvis Rectum :
As per radiographer comment above the image quality, particularly on the critical small field of view images and the DWI is of very poor quality.
Primary Tumour: Annular
Height from anal verge: 96mm
Distal edge lies: 68 mm above the
puborectalis
sling
Extends
craniocaudally
over 50 mm
Lies below the peritoneal reflection
Invading edge of tumour from 12 o'clock to 4 o'clock.
Muscularis
Propria
: Extends through
Extramural spread 3-4mm
T stage: T3b
The tumour is of annular configuration with high signal elements within it indicating mucinous differentiation. The degree of extra mural spread is very difficult to ascertain accurately given the limitations described above but is favoured to represent a full-thickness extramural disease with less than 5 mm of measurable spread.
There is a bulging mucinous focus at approximately 1 o'clock but this does not appear to breach the outer layer of the
muscularis
propria
.
The tumour is well clear of the circumflex resection margin.
Lymph nodes: No overt pathological nodes.
Extramural venous invasion: No overt evidence.
Closest circumferential resection margin 3 o'clock.
Closest circumferential resection motion is from direct spread of tumour.
Minimum tumour distance to
mesorectal
fascia: 22 mm. CRM clear.
Peritoneal deposits: No evidence
Pelvic sidewall lymph nodes: None
Summary:
MRI overall stage: Mid rectal tumour. T3b N0
Mx
. CRM clear. EMVI negative. Mucinous differentiation.
No adverse features - eligible for primary surgery.
Comment: Poor quality study with low diagnostic confidence for accurate T staging and EMVI status but no indication for preoperative
downstaging
. Slide15
Clinical History :
post long course for rectal cancer. MRI to assess response to treatment.
Requested By: Annie Reilly CNS
Bleep: 40514
MRI Pelvis Rectum : (Structured report)
>75% fibrosis, minimal tumour signal tumour intensity, TRG2
Height from anal verge: 66 mm
Treated tumour distal edge lies: 38 mm above the
puborectalis
sling
Extends
craniocaudally
over 50 mm
Lies below the peritoneal reflection
Invading edge of tumour from 7 o'clock to 12 o'clock.
Tumour signal extends through the
muscularis
propria
Fibrotic signal extends through the
muscularis
propria
Extramural spread 7mm for tumour signal 8mm for fibrotic
stroma
.
yMR
T stage:T3c
Low rectal tumour:
-Into
intersphincteric
plane:
Intersphincteric
plane/
mesorectal
plane is unsafe, extra
levator
APE.
Lymph nodes: Non-
Extramural venous invasion: No evidence
Closest circumferential resection margin 11 o'clock.
Closest circumferential resection margin is from direct spread of tumour
Minimum tumour distance to
mesorectal
fascia: 0 mm. CRM is involved.
Peritoneal deposits: No evidence
Pelvic sidewall lymph nodes: None
Summary:
yMRI
overall stage: ymrT3c ymrN0
ymrMx
. TRG 2
CRM is involved. EMVI negative
Comment: Unfortunately the scan is being performed on a different scanner to the original. Good quality study notwithstanding.
Much of the tumour signal is replaced by fibrosis. There are
mucin
lakes in the submucosa layer which have increased in size in the interval.
There is intermediate signal material anteriorly in contact with the posterior aspect of the medial right seminal vesicle (image 21 series 5.) Treated tumour is in contact with the lateral circumferential resection margin and in the
intersphincteric
plane (image 14 series 6). No definite vascular involvement on these scans.Slide16Slide17Slide18Slide19Slide20
Each dataset contains
core data items
that are mandated for inclusion in the Cancer
Outcomes and
Services Dataset (COSD – previously the National Cancer Dataset) in England. Core
data items
are items that are supported by robust published evidence and
are
required for
cancer staging
, optimal patient management and prognosis. Core data
items meet
the requirements
of professional
standards (as defined by the Information Standards Board for Health and Social
Care [ISB
]) and it is recommended that at least 90% of reports on cancer
resections should
record a
full set
of core data items. Other,
non-core, data items
are described. These may be included
to provide
a comprehensive report or to meet local clinical or research requirements. All data
items should
be clearly defined to allow the
unambiguous
recording of data.Slide21Slide22Slide23
The cancer datasets published by The Royal College of Pathologists (
RCPath
) are a
combination of
textual
guidance
guidance
, educational information and reporting
proformas
. The datasets
enable pathologists
to grade and stage cancers in an
accurate, consistent
manner in
compliance
with international
standards and provide
prognostic information
, thereby allowing clinicians to provide
a
high
standard
of care for patients and appropriate management for specific clinical circumstances
. It
may rarely be necessary or even desirable to depart from the guidelines in the interests
of specific
patients and special circumstances. The clinical risk of departing from the
guidelines should
be assessed by the relevant multidisciplinary team (MDT); just as adherence to
the guidelines
may not constitute defence against a claim of negligence, so a decision to deviate
from them
should not necessarily be deemed negligent.Slide24
Potential benefits of structured reporting
Consistency
Quality
Compliance
Comparability
Supports research
Improved outcomes
Use of existing tools