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

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: 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.

Clinical History : post long course for rectal cancer. MRI to assess response to treatment. Requested By: Annie Reilly CNS Bleep: 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.

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.

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.

Potential benefits of structured reporting Consistency Quality Compliance Comparability Supports research Improved outcomes Use of existing tools