Radiologists’ varying opinions on managing incidental cysts may be impacting downstream imaging
Radiologists’ varying opinions on how to best handle incidental cysts are contributing to potentially harmful variations in follow-up imaging guidance, according to a new single-center analysis.
Cross-sectional imaging growth has led to more incidentally detected pancreatic cysts, experts explained Wednesday in JACR. These findings are difficult to diagnose and no single set of guidelines, of which there are many, are widely used. As a result, appropriate imaging surveillance is hotly debated.
And these approaches change from radiologist to radiologist, the authors noted. Looking over more than 2,500 reports with small focal cystic pancreatic lesion (FCPLs) recommendations, disagreement among abdominal imaging specialists greatly contributed to discrepancies in follow-up recommendations.
This lack of standards may have consequences that aren’t readily apparent, according to Neena Kapoor, MD, and colleagues with Brigham and Women’s Hospital’s Center for Evidence-Based Imaging.
“Our work adds to the growing body of literature showing that there is interradiologist variation in recommendations for follow-up imaging, which may impact quality and patient experience of care as well as downstream imaging costs,” the Harvard Medical School radiologists added.
For their retrospective investigation, Kapoor et al. analyzed 2,872 abdominal CT and MRI reports performed in a large academic hospital from July 2016 to June 2018. The final pool consisted of 708 reports with FCPLs less than 1.5 centimeters.
Overall, the follow-up recommendation rate for these cysts was 24.7%, aligning with other studies. But the team found substantial interradiologist variation within the abdominal imaging division, with follow-up rates ranging from 25% to 85%. Both emergency radiology and cancer imaging divisions demonstrated more consistency.
Multivariable analysis found older patients had slightly lower follow-up rates, and lesions associated with main duct dilatation and separation were more likely to garner follow-up guidance.
Why the disagreement among abdominal specialists? There are likely many reasons, the authors noted. But the variation partly reflects the different perspectives among specialties and between professional society guidelines.
At the same time, Kapoor and co-authors noted this may be an institution-specific problem. Either way, further research is needed to limit this unwanted variation.
“A better understanding of factors that lead to radiologists to vary in their follow-up recommendations for small pancreatic cysts is needed because these cysts can be followed for long periods of time and often require high-cost imaging for surveillance.”
Read the entire paper here.
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.