Comparing Breast and Abdominal Subspecialists' Follow-Up Recommendations for Incidental Liver Lesions on Breast MRI.
Comparing Breast and Abdominal Subspecialists' Follow-Up Recommendations for Incidental Liver Lesions on Breast MRI.
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DOI：
10.1016/j.jacr.2019.12.024
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发表时间：
2020-06
期刊：
影响因子：
--
通讯作者：
Khorasani R
中科院分区：
文献类型：
--
作者：
DiPiro PJ;Alper DP;Giess CS;Glazer DI;Lee LK;Lacson R;Khorasani R
本研究的目的是比较乳腺成像专科医生对乳腺MRI上偶然肝脏病变（ILL）的随访建议与腹部专科放射科医生根据最佳实践建议提出的意见。在一个学术医学中心的这项回顾性研究中，自然语言处理在2015年完成的2,181项乳腺MRI研究中识别出了ILL报告。电子健康记录和放射学报告审查了30例患者随机分组的抽象恶性肿瘤存在或不存在、既往影像学检查和乳腺专科医生关于ILL的建议：ILL有随访建议、ILL无建议和无ILL。两名腹部放射科医生评估了MRI肝脏结果，并一致提出了随访建议。主要结局是与未接受ILL随访建议的患者相比，乳房和腹部亚专科医生之间的一致性（χ2分析）。次要结局是报告ILL时亚专科医生之间的一致性以及转诊临床医生对随访建议的依从性。11.3%的乳腺MRI报告（2,181例中的247例）确定了ILL;其中12%（247例中的30例）的乳腺专科医生提出了随访建议。当ILL不需要随访时，腹部专科医生同意乳腺专科医生的意见（30例中的29例），但不同意30例乳腺专科医生的随访建议（30例中的29例与30例中的2例，P < .0001）。当乳腺成像仪报告没有ILL时，93%的病例（30例中的28例）的亚专科医生同意。总体而言，30名乳腺专科医生中有16名接受了随访建议; 15名ILL为良性。腹部专科医生经常与乳腺专科医生就乳腺MRI ILL的随访建议存在分歧。腹部专科会诊或在乳腺成像报告工作流程中嵌入肝脏成像决策支持可减少不必要的成像并改善护理。其他跨子专业口译工作流程中可能存在改进机会。
The aim of this study was to compare breast imaging subspecialists’ follow-up recommendations for incidental liver lesions (ILLs) on breast MRI with abdominal subspecialty radiologists’ opinions informed by best-practice recommendations. In this retrospective study at an academic medical center, natural language processing identified reports with ILLs among 2,181 breast MRI studies completed in 2015. Electronic health record and radiology report reviews abstracted malignancy presence or absence, prior imaging, and breast subspecialists’ recommendations regarding ILLs for random sets of 30 patients: ILLs with follow-up recommendations, ILLs without recommendations, and without ILLs. Two abdominal radiologists evaluated MRI liver findings and offered follow-up recommendations in consensus. The primary outcome was agreement between breast and abdominal subspecialists in patients with ILL follow-up recommendations compared with those without (χ2 analysis). Secondary outcomes were agreement between subspecialists when ILLs were reported and referring clinicians’ adherence to follow-up recommendations. ILLs were identified in 11.3% of breast MRI reports (247 of 2,181); breast subspecialists made follow-up recommendations in 12% of them (30 of 247). Abdominal subspecialists agreed with breast subspecialists when ILLs required no follow-up (29 of 30 cases) but disagreed with 28 of 30 breast subspecialists’ follow-up recommendations (agreement proportion 29 of 30 versus 2 of 30, P < .0001). Subspecialists agreed in 93% of cases (28 of 30) when breast imagers reported no ILLs. Overall, 16 of 30 breast subspecialists’ follow-up recommendations were performed; ILLs were benign in 15. Abdominal subspecialists disagreed frequently with breast subspecialists regarding follow-up recommendations for ILLs on breast MRI. Abdominal subspecialty consultation or embedding liver imaging decision support in breast imaging reporting workflow may reduce unnecessary imaging and improve care. Improvement opportunities may exist in other cross-subspecialty interpretation workflows.
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