Training program for radiologists for improving the multidisciplinary approach for the treatment of rectal cancer

BACKGROUND: Diagnosis and treatment of patients with colorectal cancer is a multidisciplinary task. The transition to a new edition of clinical guidelines for the treatment of colorectal cancer in 2024, while maintaining the routine approach to MR staging of malignant neoplasms of this localization, reduces the level of continuity between medical specialists.

AIM: To improve the quality and completeness of MR diagnostics of malignant neoplasms of the rectum to ensure continuity and improve the multidisciplinary approach.

MATERIALS AND METHODS: A retrospective analysis of the completeness of compliance with the parameters of TNM 8 (2017) and the MRI subclassification T3 of rectal cancer was carried out on 137 MRI scans of the pelvic organs and protocols with conclusions to them. Based on the results of the analysis, educational training and a conclusion template for radiologists were developed and conducted, after which the MR images were re-evaluated. Before and after the training, the most fully evaluated MRI scans by radiologists were provided to medical experts to form a “second opinion”. The results obtained made it possible to calculate the absolute and relative number of consensuses (coinciding in all parameters of the conclusions) and to identify cases of rectal cancer restaging that require changes in treatment tactics.

RESULTS: Before the educational training, only 11% of MRI scans and their reports met the requirements of the modern protocol. After the training, 78% of the images were completed in compliance with all requirements. Particular difficulties and the majority of “discrepancies” in conclusions arose when determining the depth of tumor invasion into the mesorectal tissue; measuring the distance from the tumor and/or affected lymph node to the mesorectal fascia or edge of the levator ani muscle and identifying signs of extramural vascular invasion. It was not possible to achieve complete consensus in all cases on these parameters.

CONCLUSION: The analysis of MRI scans of the pelvic organs, the development and implementation of educational training to improve the interpretation of medical images, made it possible to significantly improve the staging of rectal cancer and ensure proper continuity in the implementation of a multidisciplinary approach.