Bobbin Mark D, Ip Ivan K, Sahni V Anik, Shinagare Atul B, Khorasani Ramin
Department of Radiology and Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Department of Radiology and Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
J Am Coll Radiol. 2017 Jun;14(6):757-764. doi: 10.1016/j.jacr.2017.01.044. Epub 2017 May 3.
To describe the variation in radiologists' follow-up recommendations for focal cystic pancreatic lesions (FCPL) after publication of the 2010 ACR incidental findings White Paper and determine adherence to guidance of the ACR Incidental Findings Committee.
Institutional Review Board approval was obtained for this retrospective, HIPAA-compliant observational study. Patients with FCPL were identified from abdominal CT and MRI reports generated in 2013 using natural language processing software. Patient-, lesion-, and radiologist-specific variables were recorded. Primary outcome was whether a follow-up recommendation was made, and if it included a specific study or intervention and recommended time for follow-up. χ and logistic regression models were used to identify predictors and controlled for recommendation. These data were compared with 2009 data obtained before the White Paper's publication. Secondary outcome was adherence to the ACR's guidance.
During calendar year 2013, 1,377 reports describing FCPLs were identified in 1,038 patients. After excluding examinations from low-volume readers (n = 80), radiologists recommended follow-up imaging in 13.5% (175/1,297) of cases, a decrease from 2009 when it was recommended in 23.7% (221/933) of cases (P < .001). Findings were consistent across radiologists after controlling for patient- and lesion-specific variables. Variability in follow-up recommendations persists between radiologists (2.4-fold difference in 2013 versus 2.8-fold difference in 2009). Radiologists adhered to ACR guidance principles 47.4% of the time.
Despite published guidance recommendations and reported awareness of them, fewer than half of follow-up recommendations for FCPL are consistent with the guidance and considerable variability persists among radiologists.
描述放射科医生对胰腺局灶性囊性病变（FCPL）的随访建议在2010年美国放射学会（ACR）偶然发现白皮书发表后的变化情况，并确定对ACR偶然发现委员会指南的遵循情况。
本回顾性、符合健康保险流通与责任法案（HIPAA）的观察性研究获得了机构审查委员会的批准。使用自然语言处理软件从2013年生成的腹部CT和MRI报告中识别出患有FCPL的患者。记录患者、病变和放射科医生特定的变量。主要结果是是否提出了随访建议，以及是否包括特定的检查或干预措施以及建议的随访时间。使用χ检验和逻辑回归模型来识别预测因素并对建议进行控制。将这些数据与白皮书发表前的2009年数据进行比较。次要结果是对ACR指南的遵循情况。
在2013日历年期间，在1038名患者中识别出1377份描述FCPL的报告。排除低工作量阅片者的检查（n = 80）后，放射科医生在13.5%（175/1297）的病例中建议进行随访成像，较2009年有所下降，2009年在23.7%（221/933）的病例中建议进行随访成像（P <.001）。在控制了患者和病变特定变量后，放射科医生的结果一致。放射科医生之间随访建议的变异性仍然存在（2013年为2.4倍差异，2009年为2.8倍差异）。放射科医生在47.4%的时间内遵循了ACR指南原则。
尽管有已发表的指南建议且报告了对这些建议的知晓情况，但对FCPL的随访建议中不到一半与指南一致，放射科医生之间仍存在相当大的变异性。
