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Rectal Ca

Guidelines

ESGAR 2016 1 Library

Was a consensus based system of 14 radiologists with non voting chairs.
Included Stu Taylor, Helen Fenlon and Steve Halligan.

Radiological

Nodes

Criteria for Malignant Node at staging. 1

Apply to nodes in mesorectum but can use outside.
Only use on <=3mm slice thicknesses.
'Panel acknowledges known inaccuracies of MR for nodal staging. Therefor this is a practical guide.

  1. Short axis diameter >= 9mm Huzzah!
  2. Short axis diameter 5-8mm AND >=2 morphologically suspicious characteristics.
  3. Short axis diameter <5mm AND 3 morphologically suspicious characteristics.
  4. All mucinous nodes (any size).
Morphologically suspicious criteria
  • Round shape
  • Irregular border
  • Heterogeneous signal

Criteria for Nodal assessment at RESTAGING 1

Use after long course and suitable interval. 1. All nodes < 5mm shoule be considered BENIGN. 2. Nodes >= 5mm no reliable criteria exist. As a practical guideline these nodes should be considered malignant.

"..differentiate between N0 and N+ status at primary staging (not reliable with 69% consensus)"

  1. Beets-Tan RGH, Lambregts DMJ, Maas M, Bipat S, Barbaro B, Curvo-Semedo L, Fenlon HM, Gollub MJ, Gourtsoyianni S, Halligan S, Hoeffel C, Kim SH, Laghi A, Maier A, Rafaelsen SR, Stoker J, Taylor SA, Torkzad MR, Blomqvist L. Magnetic resonance imaging for clinical management of rectal cancer: Updated recommendations from the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. Eur Radiol. 2018 Apr;28(4):1465-1475. doi: 10.1007/s00330-017-5026-2. Epub 2017 Oct 17. Erratum in: Eur Radiol. 2018 Jan 10;: PMID: 29043428; PMCID: PMC5834554. ↩↩↩