Variation seen in radiologist recommendations for small cystic pancreatic lesions

Reuters Health - 09/07/2021 -Variability in radiologists' follow-up imaging recommendations for small cystic pancreatic lesions may depend at least in part on the radiology division where specialists work, a new study suggests.

Researchers examined data on 2,872 radiology reports involving focal cystic pancreatic lesions less 1.5 cm. Overall, a total of 708 reports (24.7%) had follow-up recommendations related to the finding of focal cystic pancreatic lesions.

Individual patient characteristics did appear to influence the odds of follow-up imagining recommendations.

For example, certain types of lesions, including those associated with main duct dilation and separation were significantly more likely to have follow-up imaging recommendations (odds ratio 1.93 and 2.88, respectively). In addition, older patients were significantly less likely to receive follow-up imaging recommendations (OR 0.98 per additional year of age).

However, the analysis found differing levels of variability between the radiologists with the lowest and highest probability of follow-up recommendation based on where cases where handled. There was a 3.3-fold difference among radiologists in the Abdominal Imaging Division, but no statistically significant difference among the clinicians in Emergency Radiology or the Cancer Imaging Division.

Radiologist years in practice, trainee presence, and radiologist gender were not associated with increased follow-up recommendations, the study team reports in the Journal of the American College of Radiology.

"It is possible that greater inter-radiologist variation in follow-up recommendations was observed in our Abdominal Imaging Division because our academic abdominal radiologists, the majority of whom are subspecialty trained and frequently work with gastroenterologists, pancreatologists, and pancreatic surgeons, are aware of the existing debate regarding pancreatic cyst management and are comfortable diverging from guideline recommendations," said lead study author Dr. Neena Kapoor, a radiologist at Brigham and Women's Hospital and an assistant professor at Harvard Medical School in Boston.

"As a result, the uniformity in follow-up imaging recommendations that might be expected across radiologists who rely heavily or exclusively on guidelines may not be observed in a highly sub-specialized group," Dr. Kapoor said by email.

One limitation of the study is that it was conducted at a single large academic center, and results may not be generalizable to other settings. The authors also did not examine certain clinician factors that might influence the outcomes, such as awareness of imaging-based guidelines or history of malpractice claims.

"I am surprised by the findings - I would have expected a lot of variation in all the radiologist recommendations given that there is no clear consensus and multiple guidelines proposing different follow up in pancreatic cysts," said Dr. Julia McNabb-Baltar, co-director of the Center for Pancreatic Disease at Brigham and Women's Hospital and an assistant professor of medicine at Harvard Medical School in Boston, who wasn't involved in the study.

It's possible that the lack of inter-radiologist variation in the emergency department or in cancer care might be due to differences between those patient populations, Dr. Mc-Nabb-Baltar said by email.

For example, a patient seen in the ED may have less imaging to compare so it is possible that the recommendation will be to obtain an MRI, Dr. McNabb-Baltar said. In cancer, patients undergo frequent surveillance and therefore the pancreas cyst may not impact the frequency of imaging.

"I think we need to get better consensus guidelines involving radiology, GI and surgery so that there is more of a consensus which I think would help decrease the inter-radiologist variations," Dr. McNabb-Baltar said.

SOURCE: https://bit.ly/3qXo20A Journal of the American College of Radiology, online June 23, 2021.

By Lisa Rapaport



Posted on 9 July 202119 July 2021