Adnexal mass staging CT with a disease-specific structured report compared to simple structured report

Abstract

Objectives

To assess a disease-specific structured report (dsSR) for CT staging of ovarian malignancy compared to a simple structured report (sSR).

Methods

This is a HIPAA-compliant, IRB-approved study with waiver of informed consent. An adnexal mass-specific structured reporting CT template was developed in collaboration between gynecologic oncologists and diagnostic radiologists. The study population included 24 consecutive women who had a staging CT prior to undergoing debulking surgery for a primary ovarian malignancy. Objective evaluation by radiologists for the presence of 19 key features and subjective evaluation by gynecologic oncologists were performed to assess the clarity and usefulness for procedural planning of dsSR and sSR. Accuracy, sensitivity, and specificity were assessed using operating room notes and pathology reports as the reference standard.

Results

Fewer key features were missing from dsSR than sSR: 0.2 ± 0.8 (range 0–2) vs.10.2 ± 1.7 (range 7–14), respectively (p < 0.0001). Compared to sSR, gynecologic oncologists deemed dsSR more helpful (4.3 ± 0.7 vs. 3.7 ± 0.8, p < 0.0001) and easier to understand (4.3 ± 0.6 vs. 3.9 ± 0.7, p = 0.0057) (on a scale 0–5, 0 not helpful/very difficult to understand; 5 extremely helpful/very clear to understand). Gynecologic oncologists reported a higher rate of potential to modify their surgical approach based on dsSR (33–42%) compared to sSR (13–17%), p = 0.004.

Conclusions

Disease-specific structured reports were more reliable than simple structured reports in describing key features essential for procedural planning. dsSR was described as more helpful and easier to understand and more likely to lead to modification of the surgical approach by gynecologic oncologists compared to sSR.

Key Points

• Disease-specific structured report is easier to understand and more helpful for planning gynecological surgery as compared with simple structured report.

• Disease-specific structured report for pre-operative evaluation of ovarian cancer provides better documentation of essential features required for surgical planning as compared with simple structured report.

• Disease-specific structured report has the potential to modify the surgical approach as assessed by gynecologic oncologists.

Appendices

Appendix 1: Sample of a simple structured report at our Institution

EXAMINATION: CT abdomen pelvis with contrast

INDICATION: 38 year old woman with bilateral ovarian masses, elevated CA125. Patient with bilateral ovarian masses worrisome for ovarian carcinoma seen on pelvic ultrasound dated 7/24/2015, elevated CA125 of 388, please evaluate formets.

COMPARISON: None.

FINDINGS:

LOWER CHEST: Visualized lung fields are within normal limits. There is no evidence of pleural or pericardial effusion.

ABDOMEN:

HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There is no evidence of focal lesionsThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder is within normal limits, without stones or gallbladder wall thickening.

PANCREAS: The pancreas has normal attenuation throughout, without evidence of focal lesions or pancreatic ductal dilatation. There is no peripancreatic stranding.

SPLEEN: The spleen shows normal size and attenuation throughout, without evidence of focal lesions.

ADRENALS: The right and left adrenal glands are normal in size and shape.

URINARY: The kidneys are of normal and symmetric size with normal nephrogram.

There is no evidence of stones, focal renal lesions, or hydronephrosis. There are no urothelial lesions in the kidneys or ureters. There is no perinephric abnormality.

GASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness and enhancement throughout. The colon and rectum are within normal limits. The appendix is not visualized. There is no evidence of mesenteric lymphadenopathy.

RETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.

VASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden in the abdominal aorta and great abdominal arteries.

PELVIS: The urinary bladder and distal ureters are unremarkable. There is no evidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.

REPRODUCTIVE ORGANS: A heterogeneously enhancing soft tissue mass measuring7.7 × 3.9 × 9.5 cm arises from the left adnexa (series 6, image 101, and series 9, image 20). On the right, heterogeneous soft tissue mass measures 3.5 × 2.4 × 3.8 cm (series 6, image 101, and series 9, image 21). Endometrial stripe measures 6 mm.

BONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions. The abdominal and pelvic wall is within normal limits.

IMPRESSION: 1. No evidence of metastatic disease.

2.Heterogeneously enhancing masses arising from bilateral adnexa measures 7.7× 3.9 × 9.5cm on the left and on the right, 3.5 × 2.4 × 3.8 cm.

Appendix 2: Questionnaire to Gyncecologic oncologists

• 1. Does this report provide sufficient information for pre-operative staging purposes?

  

• 2. Does this report provide sufficient information to make next clinical management decision?

  

• 3. Based on this report, if you decide to operate, would you modify your surgical approach?

  

• 4. How helpful is this report for surgical planning (1- not helpful, 5 - extremely helpful)?

  

• 5. How easy to understand is this report (1 - very difficult, 5 - very clear)?