Impact of structured report on the quality of preoperative CT staging of pancreatic ductal adenocarcinoma: assessment of intra- and inter-reader variability
To evaluate whether a structured radiology report improves the completeness of preoperative CT staging of pancreatic ductal adenocarcinoma (PDA) compared to conventional free-text reports.
We retrospectively included 27 patients (mean age, 64 ± 11.1 years) referred for pancreatic preoperative CT scan for staging of PDA between 2015 and 2018 and in whom a diagnosis of pancreatic adenocarcinoma was ultimately confirmed. Four readers independently reported CT scans with both conventional free-text and structured reports. Differences in reported morphologic and vascular features with the two reports were assessed through McNemar Test. Intra-reader and inter-reader were calculated.
A total of 216 reports were completed by four different readers including 108 free-text and 108 structured reports. Overall, 139 of 540 morphologic characteristics of PDA and 869 of 1188 vascular key features were only described in structured reports. Encasement of left gastric artery, gastroduodenal artery and splenic artery was described in up to 14.8% using free-text reports and in up to 29.6% using structured report, resulting in low-intra-reader agreement (k = 0.033–0.216). Inter-reader agreement improved with structured report compared to free-text one for left gastric artery (ICC = 0.844 vs. ICC = 0.493, respectively), gastroduodenal artery (ICC = 0.730 vs. ICC = 0.449, respectively), portal vein (ICC = 0.847 vs. ICC = 0.638, respectively), portal confluence (ICC = 0.848 vs. ICC = 0.422, respectively) superior mesenteric vein (ICC = 0.765 vs. ICC = 0.695, respectively), and splenic vein (ICC = 0.921 vs. ICC = 0.841, respectively).
Structured reports for PDA staging significantly reduces the number of missing morphological and vascular features of PDA and improves the inter-reader agreement compared to free-text reports.
KeywordsStructured Reporting Pancreatic Ductal Adenocarcinoma Pancreatic Cancer Staging Computed Tomography
No funding was received for this study.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interests.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was waived by the Institutional Review Board.
- 3.NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Pancreatic Adenocarcinoma Version 2.2019 – April 9, 2019 https://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf. Accessed July 30th, 2019.
- 7.Al-Hawary MM, Francis IR, Chari ST, Fishman EK, Hough DM, Lu DS, Macari M, Megibow AJ, Miller FH, Mortele KJ, Merchant NB, Minter RM, Tamm EP, Sahani DV, Simeone DM (2014) Pancreatic ductal adenocarcinoma radiology reporting template: consensus statement of the Society of Abdominal Radiology and the American Pancreatic Association. Radiology 270:248-260.CrossRefGoogle Scholar
- 11.Al-Hawary MM, Francis IR, Chari ST, Fishman EK, Hough DM, Lu DS, Macari M, Megibow AJ, Miller FH, Mortele KJ, Merchant NB, Minter RM, Tamm EP, Sahani DV, Simeone DM (2014) Pancreatic ductal adenocarcinoma radiology reporting template: consensus statement of the society of abdominal radiology and the american pancreatic association. Gastroenterology 146:291-304.e1.CrossRefGoogle Scholar
- 15.Nagakawa Y, Sahara Y, Hosokawa Y, Murakami Y, Yamaue H, Satoi S, Unno M, Isaji S, Endo I, Sho M, Fujii T, Takishita C, Hijikata Y, Suzuki S, Kawachi S, Katsumata K, Ohta T, Nagakawa T, Tsuchida A (2019) Clinical Impact of Neoadjuvant Chemotherapy and Chemoradiotherapy in Borderline Resectable Pancreatic Cancer: Analysis of 884 Patients at Facilities Specializing in Pancreatic Surgery. Ann Surg Oncol 26:1629-1636.CrossRefGoogle Scholar
- 16.Jang JY, Han Y, Lee H, Kim SW, Kwon W, Lee KH, Oh DY, Chie EK, Lee JM, Heo JS, Park JO, Lim DH, Kim SH, Park SJ, Lee WJ, Koh YH, Park JS, Yoon DS, Lee IJ, Choi SH (2018) Oncological Benefits of Neoadjuvant Chemoradiation With Gemcitabine Versus Upfront Surgery in Patients With Borderline Resectable Pancreatic Cancer: A Prospective, Randomized, Open-label, Multicenter Phase 2/3 Trial. Ann Surg 268:215-222.CrossRefGoogle Scholar
- 17.Michelakos T, Pergolini I, Castillo CF, Honselmann KC, Cai L, Deshpande V, Wo JY, Ryan DP, Allen JN, Blaszkowsky LS, Clark JW, Murphy JE, Nipp RD, Parikh A, Qadan M, Warshaw AL, Hong TS, Lillemoe KD, Ferrone CR (2019) Predictors of Resectability and Survival in Patients With Borderline and Locally Advanced Pancreatic Cancer who Underwent Neoadjuvant Treatment With FOLFIRINOX. Ann Surg 269:733-740.CrossRefGoogle Scholar
- 20.Cannella R, Borhani AA, Zureikat AH, Tublin ME (2019) Appleby Procedure (Distal Pancreatectomy With Celiac Artery Resection) for Locally Advanced Pancreatic Carcinoma: Indications, Outcomes, and Imaging. AJR Am J Roentgenol 27:1-10.Google Scholar
- 21.https://www.acr.org/Clinical-Resources/Incidental-Findings. Accessed on July 30th, 2019.