ABSTRACT
OBJECTIVES: The PRECISE criteria for serial multiparametric magnetic resonance imaging (MRI) of the prostate during active surveillance recommend the use of a dedicated scoring system (PRECISE score) to assess the likelihood of clinically significant radiological change. This pilot study assesses the effect of an interactive teaching course on prostate MRI during active surveillance in assessing radiological change in serial imaging. METHODS: Eleven radiology fellows and registrars with different experience in prostate MRI reading participated in a dedicated teaching course where they initially evaluated radiological change (based on their previous training in prostate MRI reading) independently in fifteen patients on active surveillance (baseline and follow-up scan), and then attended a lecture on the PRECISE score. The initial scans were reviewed for teaching purposes and afterwards the participants re-assessed the degree of radiological change in a new set of images (from fifteen different patients) applying the PRECISE score. Receiver operating characteristic analysis was performed. Confirmatory biopsies and PRECISE scores given in consensus by two radiologists (involved in the original draft of the PRECISE score) were the reference standard. RESULTS: There was a significant improvement in the average area under the curve (AUC) for the assessment of radiological change from baseline (AUC: 0.60 [Confidence Intervals: 0.51-0.69] to post-teaching (AUC: 0.77 [0.70-0.84]). This was an improvement of 0.17 [0.016-0.28] (p = 0.004). CONCLUSIONS: A dedicated teaching course on the use of the PRECISE score improves the accuracy in the assessment of radiological change in serial MRI of the prostate.
ABSTRACT
Initial staging of rectal cancer. Rectal cancers are one of the most frequent digestive cancers. Most of them are diagnosed during organized cancer screening or based on evocative symptoms. After a thorough clinical examination including rectal examination, the next step is to confirm the diagnosis by colonoscopy with biopsies. Once diagnosis is confirmed, other imaging exams are necessary to assess loco-re¬gional extension and metastatic spread. Rectal magnetic resonance imaging (MRI) and thoracic-abdominal-pelvic computed tomography (CT) are the modalities of choice, respectively for loco-regional and metastatic spread. MRI protocol is standardized, and its report must provide specific information to guide surgical and non-surgical mana¬gement options (especially tumor localization, local poor prognosis factors and node involvement). Thoraco-abdominal-pelvic CT especially seeks for liver and lung metas¬tasis. Other imaging modalities (such as endoscopic ultrasound and positron emission tomography scan) are reserved for specific cases.
Bilan initial et stadification du cancer du rectum. Les cancers du rectum font partie des cancers digestifs les plus fréquents. Ils peuvent être diagnostiqués en cas de symptômes évocateurs ou dans le cadre du dépistage organisé. Après un examen clinique comportant systématiquement un toucher rectal, l'examen complémentaire de première intention est la coloscopie, avec des biopsies pour confirmer le diagnostic. Les examens d'imagerie interviennent dans un second temps, afin de préciser l'extension locorégionale et à distance de la maladie. Ce bilan comporte deux examens indispensables : l'imagerie par résonnance magnétique (IRM) rectale pour l'extension locorégionale et le scanner thoraco-abdomino-pelvien pour l'extension à distance. Le protocole d'IRM est standardisé, et son compte-rendu doit préciser un certain nombre d'éléments guidant la prise en charge, en particulier la localisation tumorale, la présence d'éléments de mauvais pronostic locaux et l'extension ganglionnaire. Le scanner thoraco- abdomino-pelvien recherche en particulier des métastases hépatiques et pulmonaires. Les autres examens d'imagerie (écho-endoscopie et tomographie par émission de positons (TEP-scan) sont en revanche réservés à certains cas particuliers.
