Rosenkrantz Andrew B
1 Department of Radiology, Center for Biomedical Imaging, NYU School of Medicine, NYU Langone Medical Center, 660 First Ave, 3rd Fl, New York, NY 10016.
AJR Am J Roentgenol. 2017 Jan;208(1):140-143. doi: 10.2214/AJR.16.16633. Epub 2016 Sep 22.
The purpose of this article is to compare radiologists', referring physicians', and patients' interpretations of expressions within radiology reports to describe findings of likely low clinical significance.
Surveys were completed by abdominal radiologists (n = 13), physicians referring patients for abdominal CT (n = 59), and outpatients awaiting imaging (n = 51) at a large urban academic medical center. Surveys presented 10 expressions for describing an incidental 5-mm liver lesion and asked respondents to select from a list of choices their perceived likelihood that the lesion represented malignancy. Radiologists and referrers were asked supplemental questions.
Compared with radiologists' concern, referrers' and patients' concerns were higher for four and seven of the 10 expressions. Only the expression "benign cyst" was associated with no concern in all groups; "most likely a cyst" and "too small to characterize" were associated with median levels of concern of 0% for radiologists, > 0% to 1% for referrers, and > 2% to 5% for patients. Expressions containing the phrase "not excluded" had the highest concern in all groups. Referrers' likelihood of ordering follow-up imaging varied widely for the expressions (e.g., "benign cyst," 2%; "cyst," 22%; "most likely a cyst," 46%; "most likely a cyst, although tumor not excluded," 75%). Overall, the preferred phrase for a 5-mm liver lesion with benign features in normal-risk patients was "cyst" among radiologists and "benign cyst" among referrers. Seventy-six percent of referring physicians thought that radiology reports should indicate whether follow-up imaging is recommended for such lesions.
Ambiguity in radiologists' language for incidental low-risk findings may contribute to increased patient anxiety and follow-up testing, warranting greater radiologist attention and potentially new practice or reporting strategies.
本文旨在比较放射科医生、转诊医生和患者对放射学报告中描述可能临床意义不大的检查结果的表述的理解。
在一家大型城市学术医疗中心，腹部放射科医生（n = 13）、为患者安排腹部CT检查的医生（n = 59）以及等待成像检查的门诊患者（n = 51）完成了调查。调查给出了10种描述一个偶然发现的5毫米肝脏病变的表述，并要求受访者从一系列选项中选择他们认为该病变为恶性的可能性。向放射科医生和转诊医生提出了补充问题。
与放射科医生的担忧相比，转诊医生和患者对10种表述中的4种和7种的担忧更高。只有“良性囊肿”这一表述在所有组中都与不担忧相关；“很可能是囊肿”和“太小无法定性”在放射科医生中担忧的中位数水平为0%，在转诊医生中为>0%至1%，在患者中为>2%至5%。包含“不能排除”这一短语的表述在所有组中担忧程度最高。对于这些表述，转诊医生安排后续成像检查的可能性差异很大（例如，“良性囊肿”为2%；“囊肿”为22%；“很可能是囊肿”为46%；“很可能是囊肿，尽管不能排除肿瘤可能”为75%）。总体而言，对于正常风险患者中具有良性特征的5毫米肝脏病变，放射科医生首选的表述是“囊肿”，转诊医生首选的表述是“良性囊肿”。76%的转诊医生认为放射学报告应指明是否建议对这类病变进行后续成像检查。
放射科医生对于偶然发现的低风险检查结果的语言表述存在模糊性，这可能会导致患者焦虑增加和后续检查增多，需要放射科医生给予更多关注，并可能需要新的实践或报告策略。
