|HEALTH SYSTEMS AND QUALITY IMPROVEMENT
|Year : 2021 | Volume
| Issue : 1 | Page : 61-66
Synoptic reporting in lung cancers using Lung Cancer Reporting and Data System (LC-RADS): The road ahead for standardization of imaging in lung cancer staging
M.D., Fellowship In Cancer Imaging, MRes (KCL, London), Department of Radiodiagnosis & Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
|Date of Submission||20-Apr-2020|
|Date of Decision||04-May-2020|
|Date of Acceptance||09-Jan-2021|
|Date of Web Publication||26-Mar-2021|
Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai - 400 012, Maharashtra
Source of Support: None, Conflict of Interest: None
Words are the most important and sometimes the only medium of communication between a radiologist and a treating physician. The concept of structured reporting in radiology was well received in the face of growing concerns to overcome the limitations of unstructured reporting such as interobserver variations, errors in communication, and lack of standardization of reporting that primarily affect the patients who seek health care away from their diagnostic centers. With the introduction of synoptic reporting in radiology, it is now possible to standardize the reporting of diseases in a more comprehensive and less time-consuming manner, thus magnifying the impact of a radiological report in the further management of the disease under analysis. We aim to develop a standardized synoptic reporting template for lung cancers that would comprise and collate all the required computed tomography (CT) findings and demographic details of the patients. This will help the treating physicians and surgeons to plan the further course of disease management. It will also help to standardize the follow-up CT scans performed for the patients post any given treatment regimen with special reference to the likely complications caused by a particular treatment, such as radiation-related lung injury, immunotherapy-related toxicity, and surgical complications requiring urgent interventions.
Keywords: Computed tomography, lung cancer, Lung Cancer Reporting and Data System, oncology, synoptic reporting, NSCLC
|How to cite this article:|
Mahajan A. Synoptic reporting in lung cancers using Lung Cancer Reporting and Data System (LC-RADS): The road ahead for standardization of imaging in lung cancer staging. Cancer Res Stat Treat 2021;4:61-6
|How to cite this URL:|
Mahajan A. Synoptic reporting in lung cancers using Lung Cancer Reporting and Data System (LC-RADS): The road ahead for standardization of imaging in lung cancer staging. Cancer Res Stat Treat [serial online] 2021 [cited 2021 Apr 23];4:61-6. Available from: https://www.crstonline.com/text.asp?2021/4/1/61/312064
| Introduction|| |
Synoptic reporting involves the documentation of specific and relevant data elements in a standardized, structured format, such that these elements form discrete mineable data fields that most notably help researchers. With the establishment of the Reporting and Data System (RADS), which was mainly inspired by the American College of Radiology's practice guidelines for the communication of diagnostic findings, structured reporting has been increasingly implemented when reporting various systemic pathologies. The Breast Imaging Reporting and Data System by albumin-to-creatinine ratio is one of the earliest examples of a synoptic reporting system. Structured reporting in radiology is a sought-after concept because of the many limitations of unstructured reporting such as interobserver variations, errors in communication, and lack of standardization of reporting affecting patients who seek health care away from centers where diagnostic scans are done to name a few. Synoptic reporting in radiology allows for the standardized and comprehensive reporting of various diseases in a convenient and timely manner, which positively impacts further disease management.
About 20% of the diagnosed lung cancers are localized and treated by surgical resection or definitive radiotherapy in cases where surgical resection is not feasible. In another 20%–25% of the patients with local lymph nodal metastasis, a combination of radiotherapy and chemotherapy is used, with the occasional use of surgery. In the remaining patients with distant metastases, palliative chemotherapy and sometimes radiation therapy is administered. Thus, about two-thirds of the patients with lung cancer require imaging follow-up at regular intervals for charting the disease status. In order to aid the clinical decision-making, the reports should present the most accurate information and answer all the clinically relevant questions in a standardized language that is simple and understandable. A synoptic reporting format is imperative to communicate an accurate depiction of the progression, regression, or stability of the disease to the treating physician. This will further help to enhance and ease the provision of health care to the patients.,
Therefore, we aimed to develop a template for the standardized synoptic reporting of lung cancers that would collate all the required imaging findings and demographic details of the patients that will help the treating physicians and surgeons to plan the further disease management. It will also aid to standardize the follow-up CT scans done for a patient post any given treatment regimen with special reference to the possible complications of a particular regimen such as radiation-related lung injury, immunotherapy-related toxicity, and surgical complications requiring urgent interventions. The reporting tool for communicating computed tomography (CT) findings in lung cancer to the treating physician or surgeon is termed Lung Cancer RADS (LC-RADS) [Table 1].
|Table 1: The key elements of synoptic reporting in lung cancer using Lung Cancer Reporting and Data System (LC-RADS)|
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| Additional Recommendations|| |
If used in conjunction with a screening positron emission tomography-CT, the standardized uptake value of the tumor should be mentioned along with the sites and sizes of other functional metastatic lesions, if any.,
When reporting the response assessment CT scans of patients who have received radiation therapy as a part of their disease management, the radiologists should document the associated fibrotic changes and pulmonary volume loss due to therapy and distinguish it from a separate fibrosing pathology affecting the lungs, which may require additional treatment in symptomatic individuals. Imaging in the era of immunotherapy further entails the need to communicate the findings of drug-induced lung injury that may manifest in the form of diffuse alveolar damage, nonspecific interstitial pneumonia, spontaneous pneumothorax, pulmonary hemorrhage, bronchiolitis obliterans organizing pneumonia, etc.
Lung cancers, especially the non-small cell lung carcinomas (NSCLCs), commonly metastasize to the brain. Approximately 10%–20% of the patients with NSCLC already have brain metastases at the time of presentation, and an additional 40% develop brain metastases during the course of the disease, thus making brain screening an integral part of lung cancer staging. However, when and how to screen has long been debated; most consensus guidelines recommend screening all Stage III lung cancers., There are variations in the recommendations from various guidelines for performing screening brain magnetic resonance imaging during the earlier stages of the disease. Version 4 of the National Comprehensive Cancer Network criteria 2018 does not advise screening in Stage IA and states that screening is optional in Stage IB and mandatory in Stages II–III. Screening is indicated in all clinically symptomatic patients.
The 8th edition of the American Joint Committee on Cancer tumor-node-metastasis staging of lung cancer is presented for guiding the radiologist in reporting the necessary findings in order to appropriately stage the cancer for further management, thus adding to the concept of personalized medicine [Table 2].,
|Table 2: The American Joint Committee on Cancer tumor-node-metastasis staging of lung cancer 8th edition,|
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| Response Criteria in Lung Cancers Treated With Immunotherapeutic Agents|| |
There is a considerable difference in the response of tumors to immunotherapeutic agents as compared to chemotherapeutic drugs. The Response Evaluation Criteria in Solid Tumors (RECIST) group designed immune RECIST (iRECIST) based on RECIST 1.1 to facilitate the development of guidelines for the assessment of the tumor response to immunotherapeutic agents. A comparative description of the chief differences and similarities between RECIST 1.1 and iRECIST is summarized in [Table 3].,, The terminologies used in iRECIST are as follows:
|Table 3: Comparison of Response Evaluation Criteria in Solid Tumors 1.1 with immune Response Evaluation Criteria in Solid Tumors|
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- Immune complete response
- Immune partial response
- Immune confirmed progressive disease
- Immune unconfirmed progressive disease
- Immune stable disease
- Partial response
- Progressive disease
[Table 4] presents various practical tips and tricks for lung cancer imaging.
| Conclusion|| |
The radiologists play a critical role in the diagnosis, staging, and follow-up of patients with NSCLC. Recognition of the relevant radiologic appearances of lung cancer with an understanding of the appropriateness of staging and awareness of potential imaging pitfalls is crucial for personalized management of the patients. Synoptic reporting in radiology makes it possible to standardize the reporting of diseases in a manner that is more thorough, easy to read, and with the added advantage of providing relevant information without consuming much time and reducing the chances of leaving out on any vital information that may impact on the further management of the disease under analysis.
This reporting system will further generalize the description of radiological imaging features and their clinical relevance across various medical facilities.
I am extremely grateful to Dr Puja Pande and Dr Prerit Sharma for their valuable inputs.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]