Rads urged to overcome ‘stage fright’ when interpreting cancer images

Radiologists have a key role to play in cancer staging, but many seem to need a nudge to get on with it. They get one in the form of an opinion piece in the January Radiology penned by radiology-department representatives of nine academic medical institutions plus the National Cancer Institute.

When asked why they choose not to stage cancer, subspecialist radiologists sometimes respond, “It’s not my job,” write Christine M. Glastonbury, MBBS, of UC-San Francisco, and colleagues.

But the final clinical stage for some tumors is almost entirely based on imaging findings—so this answer is all but groundless, the authors maintain.

“In this value-based era of medicine, radiologists and nuclear medicine physicians need to understand that this is their job,” they continue.

“Perhaps for some imagers,” they add, “‘stage fright’ reflects a lack of familiarity with the staging tables and with what oncologists and surgeons want to know.”

Glastonbury et al. state that the avoidance presents an opportunity for the profession to learn by reading, doing and openly sharing structured staging reports based on manuals published by the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC).

Why should radiologists include staging information in their reports?

The authors answer their own question by articulating the most obvious response: Staging information is frequently requested by name on imaging requisition forms.

Moreover, “[t]he patient is referred to us for our opinion on their cancer stage,” the authors note. “How can we possibly choose not to answer this question?”

When radiologists and nuke-med docs do not report staging information, their inaction “forces oncologists (and cancer registries) to reinterpret imaging reports that may be intentionally or unintentionally ambiguous,” the authors write.

“With current shifts in our healthcare system and a growing national discussion around the concept of the value of imaging, it is time for radiologists and nuclear medicine physicians to recognize and accept our role in the multidisciplinary oncology team,” they conclude.

“Our surgeons, our medical and radiation oncologists, and our patients need us to step out of the wings and onto the stage. It is time to overcome our discomfort with cancer staging.”

The commentary comes as the AJCC and UICC get underway with work to publish the eighth edition of the AJCC Cancer Staging Manual. This will include board-level input on staging from rads and nuke-med docs, and it will identify imaging as an increasingly important aspect of staging rules, according to the commentary.