Communication in radiology: evaluation of terminology and TNM descriptor use at a cancer center.

Objective: The purpose of our study was to evaluate the transmission of information from radiologists to physicians, focusing on the level of certainty and the use of imaging descriptors from the tumor-node-metastasis (TNM) staging system. Materials and Methods: Radiologists (n = 56) and referring physicians (n = 50) participated in this questionnaire-based, singlecenter study, conducted between March 20, 2020, and January 21, 2021. Participants were presented with terms commonly used by the radiologists at the institution and were asked to order them hierarchically in terms of the level of certainty they communicate regarding a diagnosis, using a scale ranging from 1 (most contrary to) to 10 (most favoring). They then assessed TNM system descriptors and their interpretation. Student's t-tests and the kappa statistic were used in order to compare the rankings of the terms of certainty. Items related to T and N staging were analyzed by Fisher's exact test. The confidence level was set to 97% (p < 0.03). Results: Although overall agreement among the radiologists and referring physicians on term ranking was poor (kappa = 0.10- 0.35), the mean and median values for the two groups were similar. Most of the radiologists and referring physicians (67% and 86%, respectively) approved of the proposal to establish a standard lexicon. Such a lexicon, based on the participant responses, was developed and graphically represented. Regarding the TNM system descriptors, there were significant differences between the two groups in the reporting of lymph node numbers, of features indicating capsular rupture, and of vessel wall irregularities, as well as in the preference for clear descriptions of vascular involvement. Conclusion: Our findings indicate that ineffective communication and differences in report interpretation between radiologists and referring physicians are still prevalent in the fields of radiology and oncology. Efforts to gain a better understanding of those impediments might improve the objectivity of reporting and the quality of care.

Objetivo: O propósito do nosso estudo foi analisar a transmissão das informações de radiologistas para médicos assistentes, com foco no nível de certeza e uso de descritores de imagem do sistema de estadiamento tumor­nódulo­metástase (TNM). Materiais e Métodos: Radiologistas (n = 56) e médicos assistentes (n = 50) participaram neste estudo unicêntrico, baseado em questionários respondidos entre 20 de março de 2020 e 21 de janeiro de 2021. Os participantes ordenaram hierarquicamente termos comumente usados por radiologistas da instituição para descrever o nível de certeza utilizando uma escala que variou de 1 (mais contrário) a 10 (mais favorável). Em seguida, foram avaliados os descritores relacionados ao sistema TNM e sua interpretação. O teste t de Student e o coeficiente de correlação kappa foram empregados para comparar a classificação dos termos. Os itens relacionados aos estadiamentos T e N foram analisados pelo teste exato de Fisher. O nível de confiança foi fixado em 97% (p < 0,03). Resultados: A concordância geral entre radiologistas e médicos assistentes na classificação hierárquica dos termos foi baixa (kappa = 0,10­0,35), porém, os valores médios e medianos dos dois grupos foram semelhantes. A maioria dos médicos (86%) e radiologistas (67%) foi receptiva à introdução de um léxico padronizado. Uma proposta de léxico foi elaborada com base nas respostas dos participantes e representada graficamente. Em relação aos descritores do sistema TNM, diferenças estatisticamente significativas foram observadas nos seguintes itens: forma de relatar o número de linfonodos; menção a características indicativas de ruptura capsular nodal; menção de irregularidades nas paredes vasculares; e preferência por descrições sucintas para comprometimento de estruturas vasculares. Conclusão: Falhas de comunicação e diferenças na interpretação de laudos entre radiologistas e médicos assistentes ainda são prevalentes em radiologia e oncologia. Esforços para melhor compreendê-los podem melhorar a objetividade do laudo radiológico e a qualidade do atendimento médico.

Communication in radiology: evaluation of terminology and TNM descriptor use at a cancer center / Comunicação em radiologia: avaliação da terminologia e uso dos descritores TNM em um centro oncológico

Abstract Objective: The purpose of our study was to evaluate the transmission of information from radiologists to physicians, focusing on the level of certainty and the use of imaging descriptors from the tumor-node-metastasis (TNM) staging system. Materials and Methods Radiologists (n = 56) and referring physicians (n = 50) participated in this questionnaire-based, single-center study, conducted between March 20, 2020, and January 21, 2021. Participants were presented with terms commonly used by the radiologists at the institution and were asked to order them hierarchically in terms of the level of certainty they communicate regarding a diagnosis, using a scale ranging from 1 (most contrary to) to 10 (most favoring). They then assessed TNM system descriptors and their interpretation. Student's t-tests and the kappa statistic were used in order to compare the rankings of the terms of certainty. Items related to T and N staging were analyzed by Fisher's exact test. The confdence level was set to 97% (p < 0.03). Results: Although overall agreement among the radiologists and referring physicians on term ranking was poor (kappa = 0.10-0.35), the mean and median values for the two groups were similar. Most of the radiologists and referring physicians (67% and 86%, respectively) approved of the proposal to establish a standard lexicon. Such a lexicon, based on the participant responses, was developed and graphically represented. Regarding the TNM system descriptors, there were significant differences between the two groups in the reporting of lymph node numbers, of features indicating capsular rupture, and of vessel wall irregularities, as well as in the preference for clear descriptions of vascular involvement. Conclusion: Our findings indicate that ineffective communication and differences in report interpretation between radiologists and referring physicians are still prevalent in the fields of radiology and oncology. Efforts to gain a better understanding of those impediments might improve the objectivity of reporting and the quality of care.

Resumo Objetivo: O propósito do nosso estudo foi analisar a transmissão das informações de radiologistas para médicos assistentes, com foco no nível de certeza e uso de descritores de imagem do sistema de estadiamento tumor-nódulo-metástase (TNM). Materiais e Métodos: Radiologistas (n = 56) e médicos assistentes (n = 50) participaram neste estudo unicêntrico, baseado em questionários respondidos entre 20 de março de 2020 e 21 de janeiro de 2021. Os participantes ordenaram hierarquicamente termos comumente usados por radiologistas da instituição para descrever o nível de certeza utilizando uma escala que variou de 1 (mais contrário) a 10 (mais favorável). Em seguida, foram avaliados os descritores relacionados ao sistema TNM e sua interpretação. O teste t de Student e o coeficiente de correlação kappa foram empregados para comparar a classificação dos termos. Os itens relacionados aos estadiamentos T e N foram analisados pelo teste exato de Fisher. O nível de confança foi fixado em 97% (p < 0,03). Resultados: A concordância geral entre radiologistas e médicos assistentes na classificação hierárquica dos termos foi baixa (kappa = 0,10-0,35), porém, os valores médios e medianos dos dois grupos foram semelhantes. A maioria dos médicos (86%) e radiologistas (67%) foi receptiva à introdução de um léxico padronizado. Uma proposta de léxico foi elaborada com base nas respostas dos participantes e representada graficamente. Em relação aos descritores do sistema TNM, diferenças estatisticamente significativas foram observadas nos seguintes itens: forma de relatar o número de linfonodos; menção a características indicativas de ruptura capsular nodal; menção de irregularidades nas paredes vasculares; e preferência por descrições sucintas para comprometimento de estruturas vasculares. Conclusão: Falhas de comunicação e diferenças na interpretação de laudos entre radiologistas e médicos assistentes ainda são prevalentes em radiologia e oncologia. Esforços para melhor compreendê-los podem melhorar a objetividade do laudo radiológico e a qualidade do atendimento médico.

Molecular and Dynamic Evaluation of Proteins Related to Resistance to Neoadjuvant Treatment with Chemoradiotherapy in Circulating Tumor Cells of Patients with Locally Advanced Rectal Cancer.

The heterogeneity of response to neoadjuvant chemoradiotherapy (NCRT) is still a challenge in locally advanced rectal cancer (LARC). The evaluation of thymidylate synthase (TYMS) and RAD23 homolog B (RAD23B) expression in circulating tumor cells (CTCs) provides complementary clinical information. CTCs were prospectively evaluated in 166 blood samples (63 patients) with LARC undergoing NCRT. The primary objective was to verify if the absence of RAD23B/TYMS in CTCs would correlate with pathological complete response (pCR). Secondary objectives were to correlate CTC kinetics before (C1)/after NCRT (C2), in addition to the expression of transforming growth factor-ß receptor I (TGF-ßRI) with survival rates. CTCs were isolated by ISET and evaluated by immunocytochemistry (protein expression). At C1, RAD23B was detected in 54.1% of patients with no pCR and its absence in 91.7% of patients with pCR (p = 0.014); TYMS- was observed in 90% of patients with pCR and TYMS+ in 51.7% without pCR (p = 0.057). Patients with CTC2 > CTC1 had worse disease-free survival (DFS) (p = 0.00025) and overall survival (OS) (p = 0.0036) compared with those with CTC2 ≤ CTC1. TGF-ßRI expression in any time correlated with worse DFS (p = 0.059). To conclude, RAD23B/TYMS and CTC kinetics may facilitate the personalized treatment of LARC.

Locoregional recurrence of Frantz' tumor: a case report and review of the literature.

Frantz' tumours or solid pseudopapillary tumours of the pancreas are rare neoplasms with low malignant potential. Young women in the second to third decades of life are more frequently affected. The treatment of choice is resection of the lesion, which is often curative. The recurrence is uncommon when radical surgical resection is used. Radiological characteristics are important for the correct diagnosis, since the preoperative planning is fundamental to obtain the cure. The objective of this study is to report a rare case of locoregional recurrence and to review the radiological findings of solid pseudopapillary tumours of the pancreas in the literature, as well to know the incidence and risk factors of tumor recurrence. This case report is from a 37-year-old female patient evaluated at an Oncologic Hospital, in the city of São Paulo, Brazil, who presented an uncommon evolution of the disease, characterized by local recurrence despite the complete resection of the primary lesion with free margins.

Locoregional recurrence of Frantz' tumor: a case report and review of the literature

SUMMARY Frantz' tumours or solid pseudopapillary tumours of the pancreas are rare neoplasms with low malignant potential. Young women in the second to third decades of life are more frequently affected. The treatment of choice is resection of the lesion, which is often curative. The recurrence is uncommon when radical surgical resection is used. Radiological characteristics are important for the correct diagnosis, since the preoperative planning is fundamental to obtain the cure. The objective of this study is to report a rare case of locoregional recurrence and to review the radiological findings of solid pseudopapillary tumours of the pancreas in the literature, as well to know the incidence and risk factors of tumor recurrence. This case report is from a 37-year-old female patient evaluated at an Oncologic Hospital, in the city of São Paulo, Brazil, who presented an uncommon evolution of the disease, characterized by local recurrence despite the complete resection of the primary lesion with free margins.

RESUMO Os tumores de Frantz ou tumores pseudopapilares sólidos do pâncreas são neoplasias raras, que apresentam baixo potencial maligno. A maioria acomete mulheres jovens na segunda a terceira década de vida. O tratamento de escolha é a ressecção da lesão, uma vez que é frequentemente curativa. A recidiva é incomum quando é empregada ressecção cirúrgica completa. As características radiológicas são importantes para a hipótese diagnóstica, uma vez que o planejamento pré-operatório é fundamental para a obtenção da cura. O presente estudo tem como objetivo relatar um caso raro de recidiva locorregional e rever na literatura os achados radiológicos dos tumores pseudopapilares sólidos do pâncreas, assim como conhecer a incidência e os fatores de risco da recorrência tumoral. Este relato de caso é de uma paciente do sexo feminino, de 37 anos, avaliada em um hospital de referência oncológica, na cidade de São Paulo, Brasil, que apresentou uma evolução incomum da doença, caracterizada pela recorrência locorregional, apesar da ressecção da lesão primária com margens livres.

Evaluation of the indications for performing magnetic resonance imaging of the female pelvis at a referral center for cancer, according to the American College of Radiology criteria.

OBJECTIVE: To evaluate the indications for performing magnetic resonance imaging of the female pelvis at a referral center for cancer. MATERIALS AND METHODS: This was a retrospective, single-center study, conducted by reviewing medical records and imaging reports. We included 1060 female patients who underwent magnetic resonance imaging of the pelvis at a cancer center between January 2013 and June 2014. The indications for performing the examination were classified according to the American College of Radiology (ACR) criteria. RESULTS: The mean age of the patients was 52.6 ± 14.8 years, and 49.8% were perimenopausal or postmenopausal. The majority (63.9%) had a history of cancer, which was gynecologic in 29.5% and nongynecologic in 34.4%. Of the patients evaluated, 44.0% had clinical complaints, the most common being pelvic pain (in 11.5%) and bleeding (in 9.8%), and 34.7% of patients had previously had abnormal findings on ultrasound. Most (76.7%) of the patients met the criteria for undergoing magnetic resonance imaging, according to the ACR guidelines. The main indications were evaluation of tumor recurrence after surgical resection (in 25.9%); detection and staging of gynecologic neoplasms (in 23.3%); and evaluation of pelvic pain or of a mass (in 17.1%). CONCLUSION: In the majority of the cases evaluated, magnetic resonance imaging was clearly indicated according to the ACR criteria. The main indication was local recurrence after surgical treatment of pelvic malignancies, which is consistent with the routine protocols at cancer centers.

OBJETIVO: Comparar as indicações de ressonância magnética da pelve feminina num centro de referência oncológico. MATERIAIS E MÉTODOS: Estudo retrospectivo, unicêntrico, realizado por revisão de prontuários e laudos de exames de imagem. Foram incluídas 1060 pacientes que realizaram ressonância magnética da pelve, de janeiro de 2013 a junho de 2014, num centro oncológico. As indicações dos exames foram classificadas segundo os critérios do American College of Radiology (ACR). RESULTADOS: A idade média das pacientes foi 52,6 ± 14,8 anos, com 49,8% na perimenopausa ou pós-menopausa. A maioria (63,9%) apresentava antecedente de câncer, sendo 29,5% ginecológicos e 34,4% não ginecológicos. Das pacientes com queixa clínica (44%), os sintomas mais relatados foram dor pélvica (11,5%) e sangramento (9,8%). Em 34,7% das pacientes havia alteração ultrassonográfica prévia. A maioria das pacientes (76,7%) apresentou indicação adequada para o exame, segundo os critérios do ACR. As principais indicações foram: avaliação da recorrência tumoral após ressecção (25,9%), detecção e estadiamento de neoplasias ginecológicas (23,3%) e avaliação de dor ou massa pélvica (17,1%). CONCLUSÃO: A maioria dos exames avaliados apresentou indicação adequada segundo os critérios do ACR. A principal indicação foi a pesquisa de recidiva local após tratamento cirúrgico de neoplasias pélvicas, compatível com a rotina num centro oncológico.

Evaluation of the indications for performing magnetic resonance imaging of the female pelvis at a referral center for cancer, according to the American College of Radiology criteria / Avaliação das indicações de ressonância magnética da pelve feminina em um centro de referência oncológico, segundo os critérios do Colégio Americano de Radiologia

Abstract Objective: To evaluate the indications for performing magnetic resonance imaging of the female pelvis at a referral center for cancer. Materials and Methods: This was a retrospective, single-center study, conducted by reviewing medical records and imaging reports. We included 1060 female patients who underwent magnetic resonance imaging of the pelvis at a cancer center between January 2013 and June 2014. The indications for performing the examination were classified according to the American College of Radiology (ACR) criteria. Results: The mean age of the patients was 52.6 ± 14.8 years, and 49.8% were perimenopausal or postmenopausal. The majority (63.9%) had a history of cancer, which was gynecologic in 29.5% and nongynecologic in 34.4%. Of the patients evaluated, 44.0% had clinical complaints, the most common being pelvic pain (in 11.5%) and bleeding (in 9.8%), and 34.7% of patients had previously had abnormal findings on ultrasound. Most (76.7%) of the patients met the criteria for undergoing magnetic resonance imaging, according to the ACR guidelines. The main indications were evaluation of tumor recurrence after surgical resection (in 25.9%); detection and staging of gynecologic neoplasms (in 23.3%); and evaluation of pelvic pain or of a mass (in 17.1%). Conclusion: In the majority of the cases evaluated, magnetic resonance imaging was clearly indicated according to the ACR criteria. The main indication was local recurrence after surgical treatment of pelvic malignancies, which is consistent with the routine protocols at cancer centers.

Resumo Objetivo: Comparar as indicações de ressonância magnética da pelve feminina num centro de referência oncológico. Materiais e Métodos: Estudo retrospectivo, unicêntrico, realizado por revisão de prontuários e laudos de exames de imagem. Foram incluídas 1060 pacientes que realizaram ressonância magnética da pelve, de janeiro de 2013 a junho de 2014, num centro oncológico. As indicações dos exames foram classificadas segundo os critérios do American College of Radiology (ACR). Resultados: A idade média das pacientes foi 52,6 ± 14,8 anos, com 49,8% na perimenopausa ou pós-menopausa. A maioria (63,9%) apresentava antecedente de câncer, sendo 29,5% ginecológicos e 34,4% não ginecológicos. Das pacientes com queixa clínica (44%), os sintomas mais relatados foram dor pélvica (11,5%) e sangramento (9,8%). Em 34,7% das pacientes havia alteração ultrassonográfica prévia. A maioria das pacientes (76,7%) apresentou indicação adequada para o exame, segundo os critérios do ACR. As principais indicações foram: avaliação da recorrência tumoral após ressecção (25,9%), detecção e estadiamento de neoplasias ginecológicas (23,3%) e avaliação de dor ou massa pélvica (17,1%). Conclusão: A maioria dos exames avaliados apresentou indicação adequada segundo os critérios do ACR. A principal indicação foi a pesquisa de recidiva local após tratamento cirúrgico de neoplasias pélvicas, compatível com a rotina num centro oncológico.

Muscular cysticercosis: Case report and imaging findings.

Cysticercosis is a parasitic disease caused by a worm of the Cestoda class. The most prevalent form affects the nervous system. This case report is from a 78-year-old female patient evaluated at Clínica Mult Imagem, in the city of Santos, Brazil, who presented a form of the disease that differed from the classic neurocysticercosis, in this case muscular cysticercosis. This and other forms of manifestation justify further studies to ensure adequate recognition, diagnosis and treatment of this parasitic disease.

Muscular cysticercosis: Case report and imaging findings / Cisticercose muscular: relato de caso e aspectos de imagem

Summary Cysticercosis is a parasitic disease caused by a worm of the Cestoda class. The most prevalent form affects the nervous system. This case report is from a 78-year-old female patient evaluated at Clínica Mult Imagem, in the city of Santos, Brazil, who presented a form of the disease that differed from the classic neurocysticercosis, in this case muscular cysticercosis. This and other forms of manifestation justify further studies to ensure adequate recognition, diagnosis and treatment of this parasitic disease.

Resumo A cisticercose é uma parasitose causada pela classe Cestoda. A forma mais prevalente acomete o sistema nervoso. Este relato de caso, obtido da Clínica Mult Imagem, em Santos, é de uma paciente do sexo feminino de 78 anos que apresentou uma forma diversa de neurocisticercose, a muscular. Outras formas de manifestação da doença, como a apresentada neste relato, justificam a realização de mais estudos para assegurar o reconhecimento, o diagnóstico e o tratamento adequados dessa parasitose.

Bladder exstrophy.

Bladder exstrophy is a rare congenital anomaly resulting from failure of fusion of the middle of the pelvis line tissues during embryogenesis. It is characterized by malformation of the lower abdominal wall involving the genitourinary tract and the musculoskeletal system. Its incidence is estimated at 1:30,000 to 1:50,000 live births, and it is 2 or 3 times more frequent in males. The child's age is important and the best results are obtained when treatment is performed shortly after birth.

Bladder exstrophy / Extrofia vesical

SUMMARY Bladder exstrophy is a rare congenital anomaly resulting from failure of fusion of the middle of the pelvis line tissues during embryogenesis. It is characterized by malformation of the lower abdominal wall involving the genitourinary tract and the musculoskeletal system. Its incidence is estimated at 1:30,000 to 1:50,000 live births, and it is 2 or 3 times more frequent in males. The child’s age is important and the best results are obtained when treatment is performed shortly after birth.

RESUMO A extrofia de bexiga é uma anomalia congênita rara decorrente de falha da fusão dos tecidos da linha média da pelve durante a embriogênese e caracteriza-se por má-formação da região inferior da parede abdominal, envolvendo o trato geniturinário e o sistema musculoesquelético. Apresenta incidência estimada de 1:30.000 a 1:50.000 nascidos vivos, sendo 2 a 3 vezes mais frequente no sexo masculino. A idade da criança é importante e os melhores resultados são obtidos quando o tratamento é realizado logo após o nascimento.