Multi-institutional analysis of CT and MRI reports evaluating indeterminate renal masses: comparison to a national survey investigating desired report elements
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To determine the need for a standardized renal mass reporting template by analyzing reports of indeterminate renal masses and comparing their contents to stated preferences of radiologists and urologists.
The host IRB waived regulatory oversight for this multi-institutional HIPAA-compliant quality improvement effort. CT and MRI reports created to characterize an indeterminate renal mass were analyzed from 6 community (median: 17 reports/site) and 6 academic (median: 23 reports/site) United States practices. Report contents were compared to a published national survey of stated preferences by academic radiologists and urologists from 9 institutions. Descriptive statistics and Chi-square tests were calculated.
Of 319 reports, 85% (271; 192 CT, 79 MRI) reported a possibly malignant mass (236 solid, 35 cystic). Some essential elements were commonly described: size (99% [269/271]), mass type (solid vs. cystic; 99% [268/271]), enhancement (presence vs. absence; 92% [248/271]). Other essential elements had incomplete penetrance: the presence or absence of fat in solid masses (14% [34/236]), size comparisons when available (79% [111/140]), Bosniak classification for cystic masses (54% [19/35]). Preferred but non-essential elements generally were described in less than half of reports. Nephrometry scores usually were not included for local therapy candidates (12% [30/257]). Academic practices were significantly more likely than community practices to include mass characterization details, probability of malignancy, and staging. Community practices were significantly more likely to include management recommendations.
Renal mass reporting elements considered essential or preferred often are omitted in radiology reports. Variation exists across radiologists and practice settings. A standardized template may mitigate these inconsistencies.
KeywordsRenal mass Structured reporting Multi-institutional Renal cancer Renal cell carcinoma
Compliance with ethical standards
No funding was solicited or used for this work.
Conflict of interest
Matthew Davenport: Royalties from Wolters Kluwer. Zhen Wang: Unrelated stockholder in Nextrast Inc. Andrew Smith: Unrelated: president of Radiostics LLC, president of and patents received and pending for Liver Nodularity LLC, president of and patents received and pending for eRadioMetrics LLC, presidents of and patents received and pending for Color Enhanced Detection LLC. Hersh Chandarana: Unrelated hardware and software support from Siemens Healthcare. Atul Shinagare: Unrelated consultant to Arog Pharmaceuticals and research funding with GTx Inc. David Miller: Salary support from Blue Cross Blue Shield of Michigan for serving as the director of the Michigan Urological Surgery Improvement Collaborative (MUSIC). Eric Hu, Andrew Zhang, Stuart Silverman, Ivan Pedrosa, Ankur Doshi, Erick Remer, Sam Kaffenberger declare that they have no conflict of interest.
All study procedures performed were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.
Institutional review board approval was obtained and subjects consented to participate in the survey.
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