From the Departments of Radiology (O.R.B., A.B.) and Surgery (T.S.K., N.S.), Beth Israel Deaconess Medical Center, Boston, Mass; Department of Surgery, University of Pennsylvania, Philadelphia, Pa (C.M.V.); and Department of Radiology, University of Texas Southwestern Medical Center, 2201 Inwood Rd, 2nd Floor, Suite 202.Dallas, TX 75390-9085 (I.P.).
Radiology. 2015 Feb;274(2):464-72. doi: 10.1148/radiol.14140206. Epub 2014 Oct 3.
To compare structured versus nonstructured reporting of multiphasic computed tomography (CT) for staging of pancreatic cancer and the effects of both types of reporting on subjective assessment of resectability.
This institutional review board-approved, HIPAA-compliant retrospective study with waiver of informed consent included all patients who were referred for presurgical multiphasic CT of the pancreas between December 2006 and April 2011 at one institution before and after implementation (April 2008) of a structured reporting template. The template was created specifically for reporting multiphasic CT results to stage pancreatic cancer in patients and contained specific information relevant to surgical and oncologic planning. Multiphasic CT reports were assessed for the presence of 12 key features required for staging and surgical planning, including location, size, enhancement, node status, and vascular involvement. Three pancreatic surgeons evaluated the reports to assess resectability, surgical planning, and ease of extracting information before and after reviewing the multiphasic CT images blinded to the patient identifiers. The Student t test and χ(2) test were used for statistical analysis.
Forty-eight (40%) structured and 72 (60%) nonstructured multiphasic CT reports were reviewed. Nonstructured reports contained a mean ± standard deviation of 7.3 key features ± 2.1 (range, 1-11) and structured reports contained 10.6 ± 0.9 (range, 9-12) features (P < .001). Information for surgical planning was deemed easily accessible in 94%, 60%, and 98% of structured and 47%, 54%, and 32% of nonstructured reports by the three surgeons, respectively (P < .001, .79, < .001). Surgeons had sufficient information for surgical planning in 96%, 69%, and 98% of structured and 31%, 43%, and 25% of nonstructured reports (P < .001, .009, and < .001). When surgeons reviewed reports in combination with multiphasic CT images, they were more likely to convert an answer of "unsure" regarding resectability to a definitive answer (ie, resectable or unresectable) when the reports were structured than when they were nonstructured.
Structured reporting of pancreatic multiphasic CT provided superior evaluation of pancreatic cancer and facilitated surgical planning. Surgeons were more confident regarding decisions about tumor resectability when they reviewed structured reports before review of multiphasic CT images.
比较多期 CT 胰腺分期的结构化与非结构化报告，并评估这两种报告方式对可切除性主观评估的影响。
本研究经机构审查委员会批准，并遵守 HIPAA 规定，回顾性分析 2006 年 12 月至 2011 年 4 月在一家机构进行的术前多期 CT 胰腺检查，这些患者在报告模板实施前后（2008 年 4 月）均接受了检查。该模板是专门为报告多期 CT 结果以分期胰腺肿瘤而创建的，其中包含与手术和肿瘤计划相关的特定信息。评估多期 CT 报告是否存在 12 个与分期和手术计划相关的关键特征，包括位置、大小、增强、淋巴结状态和血管侵犯。三位胰腺外科医生在盲法状态下查看患者身份信息之前和之后评估多期 CT 图像，以评估报告的可切除性、手术计划和信息提取的难易程度。采用 Student t 检验和 χ(2)检验进行统计学分析。
共评估了 48 份（40%）结构化和 72 份（60%）非结构化多期 CT 报告。非结构化报告平均包含 7.3 个关键特征±2.1（范围 1-11），而结构化报告平均包含 10.6±0.9 个特征（范围 9-12）（P<0.001）。三位外科医生分别认为，94%、60%和 98%的结构化报告和 47%、54%和 32%的非结构化报告中包含便于获取的手术计划信息（P<0.001、.79、<0.001）。在外科医生根据报告和多期 CT 图像做出评估时，96%、69%和 98%的结构化报告和 31%、43%和 25%的非结构化报告中，外科医生都能获得足够的手术计划信息（P<0.001、.009、<0.001）。当外科医生在查看报告与多期 CT 图像相结合时，与非结构化报告相比，他们在报告为结构化时，将可切除性的“不确定”回答转变为明确回答（即可切除或不可切除）的可能性更高。
多期 CT 胰腺的结构化报告提供了对胰腺肿瘤的更好评估，并有助于手术计划。当外科医生在查看多期 CT 图像之前先查看结构化报告时，他们对肿瘤可切除性的决策更有信心。
