Radiology report standardization betters pancreatic ductal adenocarcinoma management

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 - Digestive system

The standardization of radiology reports in pancreatic ductal adenocarcinoma (PDA) should improve the decision-making process for the management of patients with PDA and should also aid in the generation of research and clinical trial design, according to a special report published in the January 2014 issue of Radiology.

PDA, the second most common gastrointestinal malignancy after colorectal cancer, is the fourth most common cause of cancer-related death in the U.S. for both men and women. Treatment is limited for the malignancy, thus making accurate staging at the time of presentation incredibly important for finding the best treatment option and for facilitating more accurate clinical trial enrollment. Though imaging evaluation is vital in the initial decision-making process of patients with PDA, limitations exist in the current way the imaging studies are reported.

Lead author Mahmoud M. Al-Hawary, MD, of the University of Michigan Health System in Ann Arbor and colleagues wrote, “These include variability of the descriptive terminology that attempts to define disease extent and incomplete documentation of disease sites which may affect prognosis and adversely affect treatment planning by surgeons, medical and radiation oncologists, and gastroenterologists.”

A multi-institutional group of 15 experts held a consensus conference at the annual meeting of the American Pancreatic Association meeting in Chicago during November 2011. A consensus statement was created to suggest the integration of appropriate descriptive terms to define the stage based on disease extent, propose a lexicon for reporting of the imaging findings, and exhibit a structured template to improve radiology reporting’s completeness in cases of PDA.

Al-Hawary and colleagues contended that radiology reports for cases of PDA should follow structured reporting in order to improve PDA management in patients. “The radiology report must document the lesion size, location, presence and detailed extent of vascular involvement, presence of arterial variants with or without tumor contact, and presence of nodal or metastatic disease,” wrote the authors. They believe that imaging features that define the extent of disease should be based on established criteria with appropriate levels of sensitivity and specificity. Standardized reporting, which has shown favor with oncologists, surgeons, and radiologists, is meant to better the completeness, accessibility, and interpretability of radiologic reports for referring physicians.

“The adoption of this suggested standardized imaging reporting template using universally accepted and agreed on terms should improve the preoperative staging and surgical decision making for the management of patients with PDA,” wrote Al-Hawary and colleagues. “The imaging reporting template should summarize all the pertinent findings; however, the decision regarding resectability status should be decided in consensus at multidisciplinary meetings/discussions. Standardized reporting can also help facilitate research and clinical trial design by classifying patients’ resectability status based on precise imaging parameters and can also facilitate comparison of results among different institutions.”