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11:40-12:00 Mandating structured reports 11:40-12:00 Mandating structured reports

11:40-12:00 Mandating structured reports - PowerPoint Presentation

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11:40-12:00 Mandating structured reports - PPT Presentation

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

signal tumour items clock tumour signal clock items data spread cancer resection extramural core clinical stage nodes evidence circumferential

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Slide1

11:40-12:00 Mandating structured reports

Eric

Loveday Slide2
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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.Slide16
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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.Slide21
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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