Retrospective evaluation of national MRI reporting quality for lateral lymph nodes in rectal cancer patients and concordance with prospective re-evaluation following additional training
Authors: Sluckin Tania C. , Hazen Sanne-Marije J. A. , Horsthuis Karin , Beets-Tan Regina G. H. , Marijnen Corrie A. M. , Tanis Pieter J. , Kusters Miranda ,   The Dutch Snapshot Research Group, Aalbers Arend G. J. , van Aalten Susanna M. , Amelung Femke J. , Ankersmit Marjolein , Antonisse Imogeen E. , Ashruf Jesse F. , Aukema Tjeerd S. , Avenarius Henk , Bahadoer Renu R. , Bakers Frans C. H. , Bakker Ilsalien S. , Bangert Fleur , Barendse Renée M. , Beekhuis Heleen M. D. , Beets Geerard L. , Bemelman Willem A. , Berbée Maaike , de Bie Shira H. , Bisschops Robert H. C. , Blok Robin D. , van Bockel Liselotte W. , Boer Anniek H. , Boer Frank C. den , Boerma Evert-Jan G. , Boogerd Leonora S. F. , Borstlap Jaap , Borstlap Wernard A. A. , Bouwman Johanna E. , Braak Sicco J. , Braat Manon N. G. J. A. , Bradshaw Jennifer , Brandsma Amarins T. A. , van Breest Smallenburg Vivian , van den Broek Wim T. , van der Burg Sjirk W. , Burger Jacobus W. A. , Burghgraef Thijs A. , Cate David W. G. ten , Ceha Heleen M. , Cnossen Jeltsje S. , van den Braak Robert R. J. Coebergh , Consten Esther C. J. , Corver Maaike , Crolla Rogier M. P. H. , Curutchet Sam , Daniëls-Gooszen Alette W. , Davids Paul H. P. , Dekker Emmelie N. , Dekker Jan Willem T. , Demirkiran Ahmet , Derksen Tyche , Diederik Arjen L. , Dinaux Anne M. , Dogan Kemal , van Dop Ilse M. , Greve Kitty E. Droogh-de , Duijsens Hanneke M. H. , Dunker Michalda S. , Duyck Johan , van Duyn Eino B. , van Egdom Laurentine S. E. , Eijlers Bram , El-Massoudi Youssef , van Elderen Saskia , Emmen Anouk M. L. H. , Engelbrecht Marc , van Erp Anne C. , van Essen Jeroen A. , Fabry Hans F. J. , Fassaert Thomas , Feitsma Eline A. , Feshtali Shirin S. , Frietman Bas , Furnée Edgar J. B. , van Geel Anne M. , Geijsen Elisabeth D. , van Geloven Nanette , Gerhards Michael F. , Gielkens Hugo , van Gils Renza A. H. , Goense Lucas , Govaert Marc J. P. M. , van Grevenstein Wilhelmina M. U. , de Groof E. Joline , de Groot Irene , de Haas Robbert J. , Hakkenbrak Nadia A. G. , Hartogh Mariska D.den , Heesink Vera , Heikens Joost T. , Hendriksen Ellen M. , van den Hoek Sjoerd , van der Hoeven Erik J. R. J. , Hoff Christiaan , Hogewoning Anna , Hogewoning Cornelis R. C. , Hoogendoorn Stefan , van Hoorn Francois , van der Hul René L. , van Hulst Rieke , Imani Farshad , Inberg Bas , Intven Martijn P. W. , Janssen Pedro , de Jong Chris E. J. , Jonkers Jacoline , Jou-Valencia Daniela , Keizers Bas , Ketelaers Stijn H. J. , Knöps Eva , van Koeverden Sebastiaan , Kok Sylvia , Kolderman Stephanie E. M. , de Korte Fleur I. , Kortekaas Robert T. J. , Korving Julie C. , Koster Ingrid M. , Krdzalic Jasenko , Krielen Pepijn , Kroese Leonard F. , Krul Eveline J. T. , Lahuis Derk H. H. , Lamme Bas , van Landeghem An A. G. , Leijtens Jeroen W. A. , Leseman-Hoogenboom Mathilde M. , de Lijster Manou S. , Marsman Martijn S. , Martens Milou. H. , Masselink Ilse , van der Meij Wout , Meijnen Philip , Melenhorst Jarno , de Mey Dietrich J. L. , Moelker-Galuzina Julia , Morsink Linda , Mulder Erik J. , Muller Karin , Musters Gijsbert D. , Nederend Joost , Neijenhuis Peter A. , de Nes Lindsey C. F. , Nielen Mandy , van den Nieuwboer Jan B. J. , Nieuwenhuis Jonanne F. , Nonner Joost , Noordman Bo J. , Nordkamp Stefi , Olthof Pim B. , Oosterling Steven J. , Ootes Daan , Oppedijk Vera , Ott Pieter , Paulusma Ida , Peeters Koen C. M. J. , Pereboom Ilona T. A. , Peringa Jan , Pironet Zoë , Plate Joost D. J. , Polat Fatih , Poodt Ingrid G. M. , Posma Lisanne A. E. , Prette Jeroen F. , Pultrum Bareld B. , Qaderi Seyed M. , van Rees Jan M. , Renger Rutger-Jan , Rombouts Anouk J. M. , Roosen Lodewijk J. , Brinke Ellen A. Roskott-ten , Rothbarth Joost , Rouw Dennis B. , Rozema Tom , Rütten Heidi , Rutten Harm J. T. , van der Sande Marit E. , Schaafsma Boudewijn E. , Schasfoort Renske A. , Scheurkogel Merel M. , van der Velden Arjan P. Schouten , Schreurs Wilhelmina H. , Schuivens Puck M. E. , Sietses Colin , Simons Petra C. G. , Slob Marjan J. , Slooter Gerrit D. , van der Sluis Martsje , Smalbroek Bo P. , Smits Anke B. , Spillenaar-Bilgen Ernst J. , Spruit Patty H. , Stam Tanja C. , Stoker Jaap , Talsma Aaldert K. , Temmink Sofieke J. D. , The G. Y. Mireille , Tielbeek Jeroen A. W. , van Tilborg Aukje A. J. M. , van Tilborg Fiek , van Trier Dorothée , Tuynman Jurriaan B. , van der Valk Maxime J. M. , Vanhooymissen Inge J. S. , Vasbinder G. Boudewijn C. , Veeken Cornelis J. , Velema Laura A. , van de Ven Anthony W. H. , Verdaasdonk Emiel G. G. , Verduin Wouter M. , Verhagen Tim , Verheijen Paul M. , Vermaas Maarten , Verrijssen An-Sofie E. , Verschuur Anna V. D. , Schaik Harmke Verwoerd-van , Vliegen Roy F. A. , Voets Sophie , Vogelaar F. Jeroen , Vogelij Clementine L. A. , Vos-Westerman Johanna , de Vries Marianne , Vroemen Joy C. , van Vugt Bas S. T. , Wegdam Johannes A. , van Wely Bob J. , Westerterp Marinke , van Westerveld Paul P. , van Westreenen Henderik L. , Wijma Allard G. , de Wilt Johannes H. W. , de Wit Bart W. K. , Wit Fennie , Woensdregt Karlijn , van Woerden Victor , van der Wolf Floor S. W. , van der Wolk Sander , Wybenga Johannes M. , van der Zaag Edwin S. , Zamaray Bobby , Zandvoort Herman J. A. , van der Zee Dennis , Zeilstra Annette , Zheng Kang J. , Zimmerman David D. E. , Zorgdrager Marcel 
Published: October 2022

Abstract
Objectives
The presence and size of lateral lymph nodes (LLNs) are important factors influencing treatment decisions for rectal cancer. Awareness of the clinical relevance and describing LLNs in MRI reports is therefore essential. This study assessed whether LLNs were mentioned in primary MRI reports at a national level and investigated the concordance with standardised re-review.

Methods
This national, retrospective, cross-sectional cohort study included 1096 patients from 60 hospitals treated in 2016 for primary cT3-4 rectal cancer ≤ 8 cm from the anorectal junction. Abdominal radiologists re-reviewed all MR images following a 2-h training regarding LLNs.

Results
Re-review of MR images identified that 41.0% of enlarged (≥ 7 mm) LLNs were not mentioned in primary MRI reports. A contradictory anatomical location was stated for 73.2% of all LLNs and a different size (≥/< 7 mm) for 41.7%. In total, 49.4% of all cases did not mention LLNs in primary MRI reports. Reporting LLNs was associated with stage (cT3N0 44.3%, T3N+/T4 52.8%, p = 0.013), cN stage (N0 44.1%, N1 48.6%, N2 59.5%, p < 0.001), hospital type (non-teaching 34.6%, teaching 52.2%, academic 53.2% p = 0.006) and annual rectal cancer resection volumes (low 34.8%, medium 47.7%, high 57.3% p < 0.001). For LLNs present according to original MRI reports (n = 226), 64.2% also mentioned a short-axis size, 52.7% an anatomical location and 25.2% whether it was deemed suspicious.

Conclusions
Almost half of the primary MRI reports for rectal cancer patients treated in the Netherlands in 2016 did not mention LLNs. A significant portion of enlarged LLNs identified during re-review were also not mentioned originally, with considerable discrepancies for location and size. These results imply insufficient awareness and indicate the need for templates, education and training.