NCRI demonstrator radiology pathology

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NCRI demonstrator radiology -pathology
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Survival - Curative Resections (R0)
Soreide, Wibe et al
TME All Conventional
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Swedish data
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Programmes

• Norway
• Stockholm
• Holland
• England
• Wales
• Belgium
• Only the rest of the world including

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• radiology-------------- biology pathway

Radiology Pathology - lots of possibilities
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This project

• Integration
• MRI
• Macro photos
• Quality
• Slices
• Digital slides
• Consider video
• Surgery
• Pathology
• Quantitation/ 3D modelling of imaging
• Can be applied to other cancers/diseases

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Surgery varies
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• Leeds digital pathology
• New technique
• Future of pathology
• 1 to 6 machines
• Scanning capacity increased
• 240 standard/day
• 10 large mount
• Up to x800 mag

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Example of a caseCLINICAL DETAILS

• Mr GH
• 27 year old male, unmarried factory worker
• Persistent bright red rectal bleeding
• No PHx of note. Fit and well
• Family history of CRC paternal uncle

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BASELINE CORONAL OBLIQUE
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INTERSPHINCTERIC PLANE ON RIGHT COMPRESSED
BY TUMOUR BULK
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FULL THICKNESS T2 TUMOUR, POSTERIOR
CRM CONSIDERED AT RISK IF TME IS PERFORMED
DUE LACK OF SPACE BETWEEN POSTERIOR FASCIA AND
MUSCULARIS PROPRIA
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STAGING INVESTIGATIONS

• Post-treatment MRI pelvis
• North Hampshire Hospital
• Presented by Dr Gina Brown

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POST TREATMENT SCANS
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No visible residual tumour, fibrosis in
muscularis propria R lateral rectal wall.
Mucosal oedema.
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PRE VS POST TREATMENT SCANS
gt5MM SPACE IN THE INTERSPHINCTERIC PLANE
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Other uses Clinical trials - Mercury
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ials/MERCURY/Special3X2returnurlcwidth771chei
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Second case
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Tumour above peritoneal reflection and close to
CRM
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Tumour extending close to right CRM
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Opportunities

• Create an integrated system
• Multidisciplinary learning
• Multiple sites - multiplatform trials
• Improved radiology
• 3D reconstructions
• Radiological surgical planes vs achieved planes

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Tumour
Slice 1 Closest to the distal margin with small
area of polypoidal tumour
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Anterior defect
Tumour
Slice 2 with anterior defect
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Anterior defect
Node not involved
Tumour
Node not involved
Slice 3 tumour enlarging, anterior dissection
down onto muscle
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Anterior defect
Tumour
Tumour enlarging anterior area onto muscle
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Anterior defect
Tumour
Slice 4
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Involved node at margin This area cut thinner and
embedded x2
Tumour
Lymph nodes uninvolved
Slice 5
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CRM within 0.5 mm ie half a 1mm grid
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Extra nural vascular invasion
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Lymph node
Tumour
Lymph node
Slice 6
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Suspicious of extramural vascular invasion
Non invoved lymph node close to margin
Slice 7
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Tumour close to CRM but not at it
Suspicious of extramural vascular invasion
Slice 8
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Extramural vascular invasion
Tumour
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Tumour close to CRM but not at it
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Tumour close to CRM but not at it
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Tumour close to CRM but not at it
Start of peritoneal Surface with tumour abutting
it
Non involved lymph node close to margin
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Peritoneum
Peritoneum
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Tumour abutting the serosa over a large area
but not penetrating it
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Tumour abutting peritoneum
Lymph nodes
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Lymph node
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Lymph node
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Lymph nodes
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Lymph nodes
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Final staging

• Long (7cm), large tumour, all quadrants
• pT3 pN1 pM0 R1
• Excised distally
• R1 involved lymph node 0.5mm from CRM anteriorly
• Very close to serosal surface but multiple blocks
  and levels fail to show penetration by tumour
  cells
• Extensive extramural vascular invasion
• Dissection very good apart from anteriorly below
  tumour
• Free text and minimum dataset issued.
• Photos would be shown at MDT as well as histology
  presented