Standardised reports with a template format are superior to free text reports: the case for rectal cancer reporting in clinical practice

P. J. Brown,E. Morris,D. Tolan,J. Taylor,N. P. West,P. Quirke,D. M. J. Lambregts,H. Rossington

doi:10.1007/s00330-019-06028-8

Abstract

PurposeRectal cancer staging with magnetic resonance imaging (MRI) allows accurate assessment and preoperative staging of rectal cancers. Therefore, complete MRI reports are vital to treatment planning. Significant variability may exist in their content and completeness. Template-style reporting can improve reporting standards, but its use is not widespread. Given the implications for treatment, we have evaluated current clinical practice amongst specialist gastrointestinal (GI) radiologists to measure the quality of rectal cancer staging MRI reports.Materials and methodsSixteen United Kingdom (UK) colorectal cancer multi-disciplinary teams (CRC-MDTs) serving a population over 5 million were invited to submit up to 10 consecutive rectal cancer primary staging MRI reports from January 2016 for each radiologist participating in the CRC-MDT. Reports were compared to a reference standard based on recognised staging and prognostic factors influencing case managementResultsFour hundred ten primary staging reports were submitted from 41 of 42 (97.6%) eligible radiologists. Three hundred sixty reports met the inclusion criteria, of these, 81 (22.5%) used a template. Template report usage significantly increased recording of key data points versus non-template reports for extra-mural venous invasion (EMVI) status (98.8% v 51.6%, p < 0.01) and circumferential resection margin (CRM) status (96.3% v 65.9%, p < 0.01). Local tumour stage (97.5% v 93.5%, NS) and nodal status (98.8% v 96.1%, NS) were reported and with similar frequency.ConclusionRectal cancer primary staging reports do not meet published standards. Template-style reports have significant increases in the inclusion of key tumour descriptors. This study provides further support for their use to improve reporting standards and outcomes in rectal cancer.Key Points• MRI primary staging of rectal cancer requires detailed tumour descriptions as these alter the neoadjuvant and surgical treatments.• Currently, rectal cancer MRI reports in clinical practice do not provide sufficient detail on these tumour descriptors.• The use of template-style reports for primary staging of rectal cancer significantly improves report quality compared to free-text reports.

Highlights

Magnetic resonance imaging (MRI) is the most accurate method of rectal cancer pre-operative staging and re-assessment [1,2,3,4]
Tumour features identified on the rectal cancer baseline staging MRI (‘primary staging’) determine the subsequent clinical management including whether neo-adjuvant radiotherapy or chemoradiotherapy (CRT) is given prior to surgical resection [1, 5]
Across our population of approximately 1000 new rectal cancer diagnoses per year, we retrospectively evaluated the current standard of primary staging rectal cancer MRI reports in clinical practice [19]

Summary

Introduction

Magnetic resonance imaging (MRI) is the most accurate method of rectal cancer pre-operative staging and re-assessment [1,2,3,4]. Tumour features identified on the rectal cancer baseline staging MRI (‘primary staging’) determine the subsequent clinical management including whether neo-adjuvant radiotherapy or chemoradiotherapy (CRT) is given prior to surgical resection [1, 5]. Follow-up rectal cancer assessment MRI (‘restaging’) helps to determine the operative technique or alternative treatment approaches including the ‘watch and wait’ approach. Imaging reports describe the tumour features to clinical teams influencing clinical decisions. This emphasises the importance of accurate and reproducible primary staging and restaging MRI reports

Methods

Results

Discussion

Conclusion