Significant improvement after training in the assessment of lateral compartments and short-axis measurements of lateral lymph nodes in rectal cancer

Tania C. Sluckin, Sanne Marije J.A. Hazen, on behalf of the Dutch Lateral Node Imaging group, Karin Horsthuis, Doenja M.J. Lambregts, Regina G.H. Beets-Tan, Pieter J. Tanis, Miranda Kusters*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

12 Citations (Scopus)
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Objectives: In patients with rectal cancer, the size and location of lateral lymph nodes (LLNs) are correlated to increased lateral local recurrence rates. Sufficient knowledge and accuracy when measuring these features are therefore essential. The objective of this study was to evaluate the variation in measurements and anatomical classifications of LLNs before and after training. Methods: Fifty-three Dutch radiologists examined three rectal MRI scans and completed a questionnaire. Presence, location, size, and suspiciousness of LLNs were reported. This assessment was repeated after a 2-hour online training by the same radiologists with the same three cases plus three additional cases. Three expert radiologists independently evaluated these 6 cases and served as the standard of reference. Results: Correct identification of the anatomical location improved in case 1 (62 to 77% (p =.077)) and in case 2 (46 to 72% (p =.007)) but decreased in case 3 (92 to 74%, p =.453). Compared to the first three cases, cases 4, 5, and 6 all had a higher initial consensus of 73%, 79%, and 85%, respectively. The mean absolute deviation of the short-axis measurements in cases 1–3 were closer—though not significantly—to the expert reference value after training with reduced ranges and standard deviations. Subjective determination of malignancy had a high consensus rate between participants and experts. Conclusion: Though finding a high consensus rate for determining malignancy of LLNs, variation in short-axis measurements and anatomical location classifications were present and improved after training. Adequate training would support the challenges involved in evaluating LLNs appropriately. Key Points: • Variation was present in the assessment of the anatomical location and short-axis size of lateral lymph nodes. • In certain cases, the accuracy of short-axis measurements and anatomical location, when compared to an expert reference value, improved after a training session. • Consensus before and after training on whether an LLN was subjectively considered to be suspicious for malignancy was high.

Original languageEnglish
Pages (from-to)483-492
Number of pages10
JournalEuropean Radiology
Issue number1
Early online date8 Jul 2022
Publication statusPublished - Jan 2023

Bibliographical note

Funding Information:
This study has received funding from the Dutch Cancer fund (KWF): reference no. 12768.

Publisher Copyright:
© 2022, The Author(s).


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