Impact of structured report on the quality of preoperative CT staging of pancreatic ductal adenocarcinoma: assessment of intra- and inter-reader variability

  • Mariangela Dimarco
  • Roberto CannellaEmail author
  • Silvia Pellegrino
  • Dario Iadicola
  • Roberta Tutino
  • Francesco Allegra
  • Davide Castiglione
  • Giuseppe Salvaggio
  • Massimo Midiri
  • Giuseppe Brancatelli
  • Federica Vernuccio



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.


Structured 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.

Ethical approval

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

Informed consent was waived by the Institutional Review Board.


  1. 1.
    Gordon-Dseagu VL, Devesa SS, Goggins M, Stolzenberg-Solomon R (2018) Pancreatic cancer incidence trends: evidence from the Surveillance, Epidemiology and End Results (SEER) population-based data. Int J Epidemiol 47:427-439.CrossRefGoogle Scholar
  2. 2.
    Klompmaker S, van Hilst J, Gerritsen SL, et al (2018) Outcomes After Distal Pancreatectomy with Celiac Axis Resection for Pancreatic Cancer: A Pan-European Retrospective Cohort Study. Ann Surg Oncol 25:1440-1447.CrossRefGoogle Scholar
  3. 3.
    NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Pancreatic Adenocarcinoma Version 2.2019 – April 9, 2019 Accessed July 30th, 2019.
  4. 4.
    Somers I, Bipat S (2017) Contrast-enhanced CT in determining resectability in patients with pancreatic carcinoma: a meta-analysis of the positive predictive values of CT. Eur Radiol 27:3408-3435.CrossRefGoogle Scholar
  5. 5.
    Vernuccio F, Borhani AA, Dioguardi Burgio M, Midiri M, Furlan A, Brancatelli G (2016) Common and uncommon pitfalls in pancreatic imaging: it is not always cancer. Abdom Radiol (NY) 41:283-294.CrossRefGoogle Scholar
  6. 6.
    Marcal LP, Fox PS, Evans DB, Fleming JB, Varadhachary GR, Katz MH, Tamm EP (2015) Analysis of free-form radiology dictations for completeness and clarity for pancreatic cancer staging. Abdom Imaging 40:2391-2397CrossRefGoogle Scholar
  7. 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
  8. 8.
    European Society of Radiology (ESR) (2018) ESR paper on structured reporting in radiology. Insights Imaging 9:1-7.CrossRefGoogle Scholar
  9. 9.
    Brook OR, Brook A, Vollmer CM, Kent TS, Sanchez N, Pedrosa I (2015) Structured reporting of multiphasic CT for pancreatic cancer: potential effect on staging and surgical planning. Radiology 274:464-472.CrossRefGoogle Scholar
  10. 10.
    Tamm EP, Silverman PM, Charnsangavej C, Evans DB (2003) Diagnosis, staging, and surveillance of pancreatic cancer. AJR Am J Roentgenol 180:1311-23.CrossRefGoogle Scholar
  11. 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
  12. 12.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159-174.CrossRefGoogle Scholar
  13. 13.
    Brady AP (2018) Radiology reporting-from Hemingway to HAL? Insights Imaging 9:237-246.CrossRefGoogle Scholar
  14. 14.
    Morgan DE, Waggoner CN, Canon CL, Lockhart ME, Fineberg NS, Posey JA 3rd, Vickers SM (2010) Resectability of pancreatic adenocarcinoma in patients with locally advanced disease downstaged by preoperative therapy: a challenge for MDCT. Am J Roentgenol 194:615-622.CrossRefGoogle Scholar
  15. 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. 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. 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
  18. 18.
    Zaky AM, Wolfgang CL, Weiss MJ, Javed AA, Fishman EK, Zaheer A (2017) Tumor-Vessel Relationships in Pancreatic Ductal Adenocarcinoma at Multidetector CT: Different Classification Systems and Their Influence on Treatment Planning. Radiographics 37:93-112.CrossRefGoogle Scholar
  19. 19.
    Klompmaker S, Boggi U, Hackert T, Salvia R, Weiss M, Yamaue H, Zeh HJ, Besselink MG (2018) Distal Pancreatectomy with Celiac Axis Resection (DP-CAR) for Pancreatic Cancer. How I do It. Gastrointest Surg 22:1804-1810.CrossRefGoogle Scholar
  20. 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. 21.
  22. 22.
    Gur D, Rockette HE, Armfield DR, Blachar A, Bogan JK, Brancatelli G, Britton CA, Brown ML, Davis PL, Ferris JV, Fuhrman CR, Golla SK, Katyal S, Lacomis JM, McCook BM, Thaete FL, Warfel TE (2003) Prevalence effect in a laboratory environment. Radiology. 228:10-14.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Mariangela Dimarco
    • 1
  • Roberto Cannella
    • 1
    Email author
  • Silvia Pellegrino
    • 1
  • Dario Iadicola
    • 2
  • Roberta Tutino
    • 2
  • Francesco Allegra
    • 1
  • Davide Castiglione
    • 1
  • Giuseppe Salvaggio
    • 1
  • Massimo Midiri
    • 1
  • Giuseppe Brancatelli
    • 1
  • Federica Vernuccio
    • 3
    • 4
    • 5
  1. 1.Dipartimento di Biomedicina, Neuroscienze e Diagnostica avanzata (BIND)University Hospital of PalermoPalermoItaly
  2. 2.Department of Surgical, Oncological and Oral Sciences (Di. Chir. On. S.)University of PalermoPalermoItaly
  3. 3.Dipartimento Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza “G.D’Alessandro” (PROMISE), University of PalermoPalermoItaly
  4. 4.University Paris Diderot, Sorbonne Paris CitéParisFrance
  5. 5.I.R.C.C.S. Centro Neurolesi Bonino Pulejo, Contrada Casazza, SS113MessinaItaly

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