SAR Primary Rectal Cancer Staging Template - v.2021 - For Biopsy-Proven Adenocarcinoma

Q: What kind of rectal cancer cases is this template intended for?

Use it only for biopsy-proven adenocarcinoma of the rectum.

Q: How is the tumor T category determined in this template?

The template maps imaging findings to MR-T categories ranging from Tx/T1–T3 subtypes to T4a and T4b, based on penetration and involvement of the anterior peritoneal reflection or adjacent organs/structures.

Q: What parameters are required for EMVI and MRF reporting?

EMVI is recorded as No/Yes with location (series and image number). For MRF, the template requires the shortest tumor distance to MRF (including image and series) for T3 tumors, plus whether there is a separate threatening or invading tumor deposit/LN/EMVI within specified millimeter thresholds.

Sep 1, 2026

Upload by Jacob

SAR primary rectal cancer staging template (v.2021) for biopsy-proven rectal adenocarcinoma, structured for comprehensive MRI reporting. It captures primary tumor morphology and location relative to the anal verge and sphincter complex, including craniocaudal extent and positional descriptors. The template provides detailed MR-T categorization guidance, low rectal sphincter invasion assessment, EMVI evaluation, and mesorectal fascia (MRF) risk stratification for T3 disease. It also records tumor deposits and lymph node status using size and morphologic criteria, ending with an MRI stage and impression summary.

LanguageEnglish

CategoryPaper Templates

FormatDOCX

Pages4

Reading Time2 min

AccessFree to download

PRIMARY TUMOR: MORPHOLOGY, LOCATION, AND CHARACTERISTICS

Distance and location parameters

Morphology and mucinous composition

MR-T category guidance

Low rectal tumors: anal sphincter complex invasion

EMVI assessment

MRF assessment (T3 only)

Tumor deposits

Lymph nodes

Impression

SAR Primary Rectal Cancer Staging Template - v.2021 (To be used only for biopsy-proven adenocarcinoma of the rectum) CLINICAL INFORMATION: [Free text] TECHNIQUE: [Free text] COMPARISON: [] PRIMARY TUMOR: MORPHOLOGY, LOCATION, AND CHARACTERISTICS: Distance to the anal verge: [] cm Distance to the top of sphincter complex/anorectal junction: [] cm Relationship to anterior peritoneal reflection: ☐ Above ☐ Straddles ☐ Below Craniocaudal length: [] cm Tumor location: ☐ Upper (10-15 cm) ☐ Mid (5-10 cm) ☐ Lower (0-5 cm) [Free text: use descriptors such as “anterior”, “posterior”, “left lateral”, right lateral”, or clock face depending on institutional preference] Morphology: ☐ Polypoid ☐ Annular ☐ Partly annular Mucinous composition: ☐ No mucin ☐ Some mucin ☐ Mostly mucin MR-T CATEGORY1: Tx (tumor not seen, post transanal excision/polypectomy) T1/2 (tumor confined to rectal wall) T3a (tumor penetrates < 1 mm beyond muscularis propria) T3b (tumor penetrates 1- 5 mm beyond muscularis propria) T3c (tumor penetrates >5-15 mm beyond muscularis propria) T3d (tumor penetrates > 15 mm beyond muscularis propria) ☐T4a (visible tumor signal thickening and/or nodularity of the anterior peritoneal reflection – may also apply to tumor signal extending laterally along peritoneal reflection) T4b* (tumor invades or adherent to adjacent organs or structures) * For T4b, structures with possible invasion include: [free text] 1 T2 vs. early T3 category has been removed from the template based on group discussion. This is considered an inherent limitation of the modality with limited accuracy, therefore the group has decided to not use this category in the report. However, in challenging cases, the interpreting radiologist can discuss the T-stage in the multidisciplinary setting, in which case other factors may be used to reach a final decision on patient management. FOR LOW RECTAL TUMORS - Invasion of anal sphincter complex: Absent Invades internal sphincter (IS) only Invades IS and extends into intersphincteric space (ISS) Invades IS + ISS + extends into or through external sphincter (describe involved structures below) Area of involvement, if present: ☐ Upper anal canal ☐ Mid anal canal ☐ Distal anal canal Description of external sphincter involvement: [] EMVI: ☐No ☐Yes Location of EMVI (indicate series and image number): [] MESORECTAL FASCIA (MRF) (FOR T3 TUMORS ONLY) Shortest distance of tumor to MRF: [ ] mm (location), [image and series number] N/A: (tumor at peritonealized portion of the rectum) Is there a separate tumor deposit, LN or EMVI threatening (≥ 1mm and ≤2 mm) or invading (< 1 mm) the MRF? ☐ No ☐ Yes (if yes, note location) TUMOR DEPOSITS2: ☐ None identified ☐ Yes, series and image number: [] Free text: [Describe number and location of tumor deposits] 2 Note: This de novo section has been added because recent literature indicates that tumor deposits (TD) have a distinct appearance relative to lymph nodes and are defined as the following: “nodules of tumor within the mesorectum which appear to directly interrupt their course when seen on two orthogonal views”. TD and LN have unique prognostic features (TD likely worse than LN), hence the separation into two distinct categories. Please see updated SAR User’s Guide for additional details. LYMPH NODES: Mesorectal/superior rectal lymph nodes and/or tumor deposits: ☐ N0 (no visible lymph nodes/deposits) N+ (short axis ≥ 9 mm) N+ (short axis 5 - 8.9 mm AND at least 2 suspicious morphologic criteria*) N+ (short axis <5 mm AND all 3 suspicious morphologic criteria*) Nx (indeterminate, all other cases) *Suspicious morphologic criteria: (1) round shape, (2) irregular borders, (3) heterogeneous signal intensity Suspicious extra mesorectal lymph nodes: No Yes (if yes, indicate short axis diameter and select location from list below:) Short axis diameter: [] Series and image number: [] Select lymph node location or indicate N/A: Locoregional:☐ N/A [Right/left] internal iliac, [] mm [Right/lef

FAQs

What kind of rectal cancer cases is this template intended for?

Use it only for biopsy-proven adenocarcinoma of the rectum.

How is the tumor T category determined in this template?

The template maps imaging findings to MR-T categories ranging from Tx/T1–T3 subtypes to T4a and T4b, based on penetration and involvement of the anterior peritoneal reflection or adjacent organs/structures.

What parameters are required for EMVI and MRF reporting?

EMVI is recorded as No/Yes with location (series and image number). For MRF, the template requires the shortest tumor distance to MRF (including image and series) for T3 tumors, plus whether there is a separate threatening or invading tumor deposit/LN/EMVI within specified millimeter thresholds.

Sep 1, 2026

Upload by Jacob