17 Pearls and pitfalls of structured staging and reporting of rectal cancer on MRI 2 strategy. To ensure that these key elements of staging are adequately represented in radiological reports, various organizations such as the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), Society of Abdominal Radiology (SAR), Radiological Society of North America (RSNA), and different national radiological societies, have introduced standardized (structured) reporting templates that are typically largely based on the Tumour Node Metastasis (TNM) staging system proposed by the American Joint Committee on Cancer (AJCC) / Union for International Cancer Control (UICC).1–4 Recent studies have shown that radiologists have increasingly adopted these structured reporting templates for routine clinical reporting 3,5–7 , which has led to enhanced completeness of reporting and improved satisfaction levels of referring clinicians.5,7–10 Another goal of structured reporting is to increase the overall level of uniformity in radiological reporting. To what extent this is successfully accomplished, is not well documented. We know from previous literature that MRI has its limitations, for example when it comes to lymph node staging.11 In addition, there are several other pitfalls and controversies that may lead to inconsistencies in reporting despite the availability of standardized reporting templates.12,13 This multicentre study aims to investigate the level of uniformity in the radiological staging of rectal cancer using a structured reporting template, and establish its main limitations and areas for improvement on a large scale, by testing the reproducibility among a group of more than 20 radiologists from different nationalities and with different clinical expertise levels. Methods Study design This study concerns a retrospective multicentre diagnostic study approved by the local institutional review board of the principal investigating centre. Informed consent was waived. Patient and study reader accrual Twenty-one radiologists from 12 countries participated as study readers. Readers were accrued via an open call to the ESGAR membership (in particular members with a known interest in rectal cancer imaging). The study included n=75 patients who were treated for newly diagnosed rectal cancer in one out of 10 centres in the Netherlands (1 university hospital, 8 teaching hospitals and 1 comprehensive cancer centre). Patients were selected from an existing and previously published multicentre study database7, 14, 15 based on the following inclusion criteria; [1] biopsy-proven rectal carcinoma, and
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