Variation in Radiologists' Follow-Up Imaging Recommendations for Small Cystic Pancreatic Lesions

Neena Kapoor; Ronilda Lacson; Mahsa Eskian; Laila Cochon; Daniel Glazer; Ivan Ip; Ramin Khorasani

doi:10.1016/j.jacr.2021.06.007

Variation in Radiologists' Follow-Up Imaging Recommendations for Small Cystic Pancreatic Lesions

J Am Coll Radiol. 2021 Oct;18(10):1405-1414. doi: 10.1016/j.jacr.2021.06.007. Epub 2021 Jun 24.

Authors

Neena Kapoor¹, Ronilda Lacson², Mahsa Eskian³, Laila Cochon³, Daniel Glazer⁴, Ivan Ip⁵, Ramin Khorasani⁶

Affiliations

¹ Director of Diversity, Equity, and Inclusion, Quality and Patient Safety Officer, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: nkapoor@partners.org.
² Director of Education, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Director of Clinical Informatics, Harvard Medical School Library of Evidence, Boston, Massachusetts.
³ Research Fellow, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
⁴ Medical Director of CT, and Director, Cross-Sectional Interventional Radiology (CSIR), Department or Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
⁵ Faculty, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
⁶ Director, Center for Evidence-Based Imaging, and Vice Chair of Quality/Safety, Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

PMID: 34174205
DOI: 10.1016/j.jacr.2021.06.007

Abstract

Objective: This study aimed to determine the incidence, identify imaging and patient factors, and measure individual radiologist variation associated with follow-up recommendations for small focal cystic pancreatic lesions (FCPLs), a common incidental imaging finding.

Methods: This institutional review board-approved retrospective study analyzed 146,709 reports from abdominal CTs and MRIs performed in a large academic hospital from July 1, 2016, to June 30, 2018. A trained natural language processing tool identified 4,345 reports with FCPLs, which were manually reviewed to identify those containing one or more <1.5-cm pancreatic cysts. For these patients, patient, lesion, and radiologist features and follow-up recommendations for FCPL were extracted. A nonlinear random-effects model estimated degree of variation in follow-up recommendations across radiologists at department and division levels.

Results: Of 2,872 reports with FCPLs < 1.5 cm, 708 (24.7%) had FCPL-related follow-up recommendations. Average patient age was 67 years (SD ± 11). In all, 1,721 (60.0%) reports were for female patients; 59.3% of patients had only one cyst. In multivariable analysis, older patients had slightly lower follow-up recommendation rates (odds ratio [OR]: 0.98 [0.98-1.00] per additional year), and lesions associated with main duct dilatation and septation were more likely to have a follow-up recommendation (ORs: 1.93 [1.11-3.36] and 2.88 [1.89-4.38], respectively). Radiologist years in practice (P = .51), trainee presence (P = .21), and radiologist gender (P = .52) were not associated with increased follow-up recommendations. There was significant interradiologist variation in the Abdominal Imaging Division (P = .04), but not in Emergency Radiology (P = .31) or Cancer Imaging Divisions (P = .29).

Discussion: Interradiologist variation significantly contributes to variability in follow-up imaging recommendations for FCPLs.

Keywords: Follow-up imaging; natural language processing; pancreatic cyst.

MeSH terms

Aged
Female
Follow-Up Studies
Humans
Magnetic Resonance Imaging
Pancreatic Cyst* / diagnostic imaging
Pancreatic Neoplasms* / diagnostic imaging
Radiologists
Retrospective Studies