Radiology Structured Reporting for Pancreatic

Carcinoma

Isaac R. Francis, M.B; B.S University of Michigan Hospitals Ann Arbor, Michigan

SAMPLE UNSTRUCTURED REPORTS

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Structured Reports Attributes of a “Good” Radiology Report

• Clarity • Correctness • Confidence • Concision • Completeness • Consistency • Communication • Consultation • Timeliness • Standardization

* Reiner BI J Digit Imaging 2009

RSNA Radiology Reporting Templates Structured Reporting

RSNA Structured Report Initiative (M Heilburn, Univ. of Utah, Salt Lake City, UT)

• PRIMARY TUMOR: • - Size, location, attenuation, size of pancreatic duct • MESENTERIC ARTERIES - Arterial anatomy: Arterial tumor abutment or encasement:

Proximal celiac artery, SMA, and hepatic artery • MESENTERIC VEINS • - Venous tumor abutment or encasement: less than or equal

to 180 degrees or greater than 180 degrees - SMV, SV and Portal venous system • LOCOREGIONAL SPREAD - Lymph nodes, peritoneum, omentum, ascites • DISTANT SPREAD: - Focal liver lesion, lung, etc. * Tolat P et al. Medical College of Wisconsin

Template for Pancreatic Carcinoma Reporting

Pancreatic Cancer Template Work Group

M Al-Hawary, S Chari, EK Fishman, D Hough, DS Lu, M Macari, AJ Megibow, N Merchant, F Miller, R Minter, K Mortele, D Simeone, D Sahani, EA Tamm Beth Israel Deaconess, Johns Hopkins,

Massachusetts General Hospital, Northwestern University, New York University, MD Anderson, Mayo Clinic, University of Southern California, University of Michigan, Vanderbilt University

Radiology Reporting Templates

Structured Reporting American Pancreatic Association

• PRIMARY TUMOR: • - Size, location, attenuation, presence of atrophy, MPD, and CBD

diln. • MESENTERIC ARTERIES - Arterial anatomy: Proximal celiac artery, SMA, and hepatic artery - Tumor abutment (less than or equal to 180 degrees or

encasement (greater than 180 degrees) -Distance of tumor involvement of hep. artery from celiac axis • MESENTERIC VEINS • - Venous anatomy: • - SMV, SV and Portal venous system • - Tumor abutment (less than or equal to 180 degrees or

encasement (greater than 180 degrees) • - Distance from tumor to first jejunal vein branch • LOCOREGIONAL SPREAD - Lymph nodes, peritoneum, omentum, ascites • DISTANT SPREAD: - Focal liver lesion, lung, etc. *M Al-Hawary et al ( Work in Progress)

PANCREATIC CARCINOMA Resectability Criteria

� No distant metastases � No SMV or PV abutment,

distortion, encasement or occlusion/thrombus

� Clear fat planes around the celiac axis, hepatic artery and SMA

* NCCN Guidelines version 2.2012

Small resectable tumor No abutment/encasement of CA,HA, SMA or SMV and PV

Radiology Reporting Templates Structured Reporting

American Pancreatic Association • PRIMARY TUMOR

- 2 cm , low density in head with no PD or CBD diln. or upstream atrophy • MESENTERIC ARTERIES - No abutment or encasement of celiac artery, SMA, and

hepatic artery - Standard hepatic arterial anatomy - MESENTERIC VEINS • - No venous tumor abutment or encasement of SMV or PV • LOCOREGIONAL SPREAD - no enlarged lymph nodes. No local tumor extension into

adjacent organs DISTANT SPREAD: - No focal hepatic lesions, omental/peritoneal nodules or

ascites *M Al-Hawary et al ( Work in Progress)

PANCREATIC CARCINOMA Unesectability Criteria

• HEAD: • Distant metastases, >1800 encasement of

SMA, CA abutment, occluded PV/SMV, aortic invasion

• BODY: • Distant metastases, >1800 encasement of

CA, SMA, occluded SMV/PV, aortic invasion

• TAIL: • Distant metastases, >1800 encasement

of CA, SMA

* NCCN Guidelines version 2.2012

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UNRESECTABLE PANCREATIC CARCINOMA- BODY >180 encasement of CA, HA, SMA and retroperitoneal ext.

> 180 degrees encasement of SMA

UNRESECTABLE PANCREATIC CARCINOMA- UNCINATE >180 degrees encasement of SMA-Tethered/occluded SMV

PANCREATIC CARCINOMA Borderline Resectability Criteria

� No distant metastases � SMV or PV abutment, distortion,

encasement or short segment occlusion/thrombus of SMV or PV but with suitable proximal and distal landing sites for venous reconstruction

� GDA encasement up to origin from HA, and short segment encasement or abutment of HA without CA involvement

� SMA abutment not to exceed 180 degrees

* NCCN Guidelines version 2.2012

BORDERLINE RESECTABLE PANCREATIC CARCINOMA SHORT SEGMENT CONTACT WITH HA

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Obstacles to use of Structured Reporting

• Time consuming- decreased efficiency and productivity

• Structured reports are difficult to standardize across centers as consensus difficult to achieve

• Even with complex exams as in cardiac imaging (CCTA), SR’s are adapted to suit individual centers • For ex. cardiologists main interest is in the

coronary arteries in a coronary CTA, but radiologists have to interpret the whole exam- so a template suited to the cardiologists may not be ideal for the radiologist

• Benefits mainly are to referring clinicians, and possibly hospital administrator and insurance company

* Bosman JML at al Insights Imaging 2012

Radiology Reporting Templates Structured Reporting

• PRIMARY TUMOR

• MESENTERIC ARTERIES - CA, HA, SA, SMA - Arterial variants

• MESENTERIC VEINS - SV, SMV, PV • LOCOREGIONAL SPREAD • DISTANT SPREAD