Table 2.
Survey results
|
Section 1—cT staging* Respondents were asked to assign a cT stage for each case |
% consensus | |
| Case 01: tumor limited to the bowel wall (i.e., cT1–2) | 100% | cT1-2 |
| Case 02: tumor penetrating the wall and extending into perirectal fat, wide margin between tumor and MRF (i.e., cT3) | 98% | cT3 |
| Case 03: tumor invading the seminal vesicles and prostate (i.e., cT4b) | 97% | cT4b |
| Case 04: tumor extending into the perirectal fat, invading the MRF (i.e., cT3) | 75% | cT3 |
| Case 05: tumor extending into the perirectal fat, invading the anterior peritoneal reflection (i.e., cT4a) | 94% | cT4a |
| Case 06: tumor extending into the perirectal fat, invading the peritoneum above the peritoneal reflection (i.e., cT4a) | 89% | cT4a |
| Case 07: tumor extending beyond the MRF into the obturator space (without vessel or muscle invasion) | 57% | cT3 |
|
Section 2—anal sphincter and pelvic floor invasion* Respondents were asked to assign a cT stage for each case |
% consensus | |
| Case 08: tumor invading the internal anal sphincter | 45% | cT1-2 |
| Case 09: tumor invading the intersphincteric plane | 68% | cT3 |
| Case 10: Tumor invading the external anal sphincter | 51% | cT4b |
| Case 11: Tumor invading the pelvic floor (levator ani) | 73% | cT4b |
|
Section 3—mesorectal fascia (MRF) involvement Respondents were asked to determine for each case whether the MRF was involved (MRF+) or not involved (MRF−) |
% consensus | |
| Case 12: tumor extending into perirectal fat (below peritoneal reflection), distance of 0 mm between tumor and MRF (i.e., MRF+) | 96% | MRF+ |
| Case 13: tumor extending into perirectal fat (below peritoneal reflection), distance of < 1 mm between tumor and MRF (i.e., MRF+) | 79% | MRF+ |
| Case 14: tumor extending into perirectal fat (below peritoneal reflection), distance of 1–2 mm between tumor and MRF | 79% | MRF- |
| Case 15: tumor extending into perirectal fat anteriorly (above peritoneal reflection), invading the peritoneum (i.e., MRF−) | 51% | MRF- |
| Case 16: tumor extending into perirectal fat posteriorly (above peritoneal reflection), distance of 0 mm between tumor and MRF (i.e., MRF+) | 86% | MRF+ |
| Case 17: N+ lymph node without extracapsular extension directly adjacent to MRF | 57% | MRF- |
| Case 18: N+ lymph node with extracapsular extension directly adjacent to MRF | 85% | MRF+ |
|
Section 4—Nodal staging For case 19–21, respondents were asked to classify each shown lesion as a lymph node or deposit For case 22–27, respondents were asked to assign a cN stage (cN1a, cN1b, cN1c, cN2a, cN2b) for each case |
% consensus | |
| Case 19: nodular lesion in mesorectum | 89% | node |
| Case 20: irregular mass in mesorectum | 84% | deposit |
| Case 21: partly nodular, partly irregular mass in mesorectum | 43% | node |
| Case 22: single metastatic node in mesorectum (i.e., cN1a) | 98% | cN1a |
| Case 23: two metastatic nodes in mesorectum (i.e., cN1b) | 94% | cN1b |
| Case 24: single tumor deposit in mesorectum (no additional nodes) (i.e., cN1c) | 92% | cN1c |
| Case 25: single tumor deposit plus single metastatic node in mesorectum | 52% | cN1c |
| Case 26: seven metastatic lymph nodes in mesorectum (i.e., cN2b) | 95% | cN2b |
| Case 27: four metastatic lymph nodes in mesorectum (i.e., cN2a) | 94% | cN2a |
|
Section 5—regional versus non-regional lymph nodes Respondents were asked to determine whether lymph nodes were regional (N) or non-regional (M) |
% consensus | |
| Case 28: mesorectal lymph node (i.e., regional) | 100% | regional |
| Case 29: obturator lymph node (i.e., regional) | 58% | regional |
| Case 30: external iliac lymph node (i.e., non-regional) | 80% | non-regional |
| Case 31: internal iliac lymph node (i.e., regional) | 67% | regional |
| Case 32: common iliac lymph node (i.e., non-regional) | 85% | non-regional |
| Case 33: inguinal node in distal tumor extending below dentate line (i.e., regional) | 51% | non-regional |
| Case 34: inguinal node in mid-rectal tumor not extending into the anal canal (i.e., non-regional) | 96% | non-regional |
|
Section 6—M staging Respondents were asked to assign a cM stage (cM1a, cM1b, cM1c) |
% consensus | |
| Case 35: common iliac lymph node metastasis (i.e., cM1a) | 94% | cM1a |
| Case 36: liver + para-aortic lymph node metastases (i.e., cM1b) | 94% | cM1b |
| Case 37: unilateral lung metastases (right lung) (i.e., cM1a) | 84% | cM1a |
| Case 38: bilateral lung metastases (right + left lung) (i.e., cM1a) | 56% | cM1b |
| Case 39: liver + renal + spleen metastases (i.e., cM1b) | 86% | cM1b |
| Case 40: peritoneal metastases (i.e., cM1c) | 97% | cM1c |
| Case 41: peritoneal + liver metastases (i.e., cM1c) | 97% | cM1c |
Note, cases that did not reach ≥ 80% consensus among survey respondents are printed in bold and were defined as “problem areas”
*In cases related to cT staging, the answer options cT1, cT2, and cT12 (unable to differentiate between cT1 and cT2) were grouped together for calculation of agreement. In all other cases, agreement was calculated based on individual answer options.