Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, PO Box 7057, 1007 MB, Amsterdam, the Netherlands.
Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, the Netherlands.
Eur Radiol. 2023 Jan;33(1):483-492. doi: 10.1007/s00330-022-08968-0. Epub 2022 Jul 8.
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.
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.
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.
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.
• 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.
在直肠癌患者中，侧方淋巴结（LLN）的大小和位置与增加侧方局部复发率相关。因此，充分了解和准确测量这些特征至关重要。本研究旨在评估培训前后 LLN 测量和解剖分类的变化。
53 名荷兰放射科医生检查了 3 例直肠 MRI 扫描并完成了一份问卷。报告了 LLN 的存在、位置、大小和可疑性。在经过 2 小时的在线培训后，相同的放射科医生使用相同的 3 例病例加 3 例附加病例重复了评估。3 名专家放射科医生独立评估了这 6 例病例，并作为参考标准。
在病例 1（62%至 77%，p=0.077）和病例 2（46%至 72%，p=0.007）中，正确识别解剖位置的能力有所提高，但在病例 3 中（92%至 74%，p=0.453）有所下降。与前 3 例相比，病例 4、5 和 6 的初始共识率分别为 73%、79%和 85%。经过培训后，病例 1-3 的短轴测量的平均绝对偏差更接近-尽管没有显著意义-专家参考值，范围和标准差更小。参与者和专家之间对恶性肿瘤的主观判断具有很高的一致性。
尽管在确定 LLN 的恶性肿瘤方面存在高度共识，但在短轴测量和解剖位置分类方面存在差异，且经过培训后得到了改善。充分的培训将有助于适当评估 LLN 所面临的挑战。
在评估侧方淋巴结的解剖位置和短轴大小方面存在差异。
在某些情况下，与专家参考值相比，短轴测量和解剖位置的准确性在培训后得到了提高。
在培训前后，关于 LLN 是否被主观认为可疑恶性的判断存在高度共识。
