Nonstandardized terminology to describe focal liver lesions in patients at risk for hepatocellular carcinoma: Implications regarding clinical communication

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Abstract

OBJECTIVE. The purpose of this study is to determine the correlation between malignancy risk of focal liver observations in patients at risk for hepatocellular carcinoma (HCC) implied by phrases used in nonstructured radiology reports with the risk inferred by hepatologists. MATERIALS AND METHODS. We performed a retrospective review of nonstructured radiology reports issued before Liver Imaging and Reporting Data System (LI-RADS) adoption from four-phase liver CT examinations of patients at risk for HCC. The phrase used by the radiologist in the report impression to describe each focal liver observation was recorded. Five hepatologists independently inferred the LI-RADS category from each phrase. Two abdominal radiologists independently reviewed the images and, blinded to all other information, assigned a LI-RADS category to each observation. Discrepancies were resolved by consensus. RESULTS. One hundred five observations in 77 patients were reported by 23 radiologists using 29 phrases. The most common phrase, �consistent with HCC� (n = 20), was applied to radiologist-assigned LR-3 (n = 1), LR-4 (n = 5), LR-5 (n = 11), and LR-5V (n = 3) observations. Eleven phrases were used more than once. Sixteen phrases were associated with LR-4 or higher observations; among these, hepatologists misinterpreted 37% of LR-4 or lower observations as definitely HCC and 46% of LR-5 and LR-5V observations as not definitely HCC. Overall, there was modest correlation (r = 0.69) between radiologist-assigned and hepatolo-gist-inferred categories. CONCLUSION. Nonstandardized terminology results in inaccurate communication of HCC risk. Structured reporting systems such as LI-RADS may improve communication by conveying unambiguous estimates of malignancy risk.

Original languageEnglish (US)
Pages (from-to)85-90
Number of pages6
JournalAmerican Journal of Roentgenology
Volume210
Issue number1
DOIs
StatePublished - Jan 1 2018

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Terminology
Hepatocellular Carcinoma
Communication
Liver
Radiology
Observation
Information Systems
Neoplasms
Consensus
Radiologists
Gastroenterologists

Keywords

  • Hepatocellular carcinoma
  • Liver Imaging
  • Radiology report
  • Reporting Data System
  • Terminology

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

@article{131b4465bfda4880b2fd26860ffdfee4,
title = "Nonstandardized terminology to describe focal liver lesions in patients at risk for hepatocellular carcinoma: Implications regarding clinical communication",
abstract = "OBJECTIVE. The purpose of this study is to determine the correlation between malignancy risk of focal liver observations in patients at risk for hepatocellular carcinoma (HCC) implied by phrases used in nonstructured radiology reports with the risk inferred by hepatologists. MATERIALS AND METHODS. We performed a retrospective review of nonstructured radiology reports issued before Liver Imaging and Reporting Data System (LI-RADS) adoption from four-phase liver CT examinations of patients at risk for HCC. The phrase used by the radiologist in the report impression to describe each focal liver observation was recorded. Five hepatologists independently inferred the LI-RADS category from each phrase. Two abdominal radiologists independently reviewed the images and, blinded to all other information, assigned a LI-RADS category to each observation. Discrepancies were resolved by consensus. RESULTS. One hundred five observations in 77 patients were reported by 23 radiologists using 29 phrases. The most common phrase, �consistent with HCC� (n = 20), was applied to radiologist-assigned LR-3 (n = 1), LR-4 (n = 5), LR-5 (n = 11), and LR-5V (n = 3) observations. Eleven phrases were used more than once. Sixteen phrases were associated with LR-4 or higher observations; among these, hepatologists misinterpreted 37{\%} of LR-4 or lower observations as definitely HCC and 46{\%} of LR-5 and LR-5V observations as not definitely HCC. Overall, there was modest correlation (r = 0.69) between radiologist-assigned and hepatolo-gist-inferred categories. CONCLUSION. Nonstandardized terminology results in inaccurate communication of HCC risk. Structured reporting systems such as LI-RADS may improve communication by conveying unambiguous estimates of malignancy risk.",
keywords = "Hepatocellular carcinoma, Liver Imaging, Radiology report, Reporting Data System, Terminology",
author = "Corwin, {Michael T} and Lee, {Andrew Y.} and Ghaneh Fananapazir and Loehfelm, {Thomas W} and Souvik Sarkar and Sirlin, {Claude B.}",
year = "2018",
month = "1",
day = "1",
doi = "10.2214/AJR.17.18416",
language = "English (US)",
volume = "210",
pages = "85--90",
journal = "American Journal of Roentgenology",
issn = "0361-803X",
publisher = "American Roentgen Ray Society",
number = "1",

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TY - JOUR

T1 - Nonstandardized terminology to describe focal liver lesions in patients at risk for hepatocellular carcinoma

T2 - Implications regarding clinical communication

AU - Corwin, Michael T

AU - Lee, Andrew Y.

AU - Fananapazir, Ghaneh

AU - Loehfelm, Thomas W

AU - Sarkar, Souvik

AU - Sirlin, Claude B.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - OBJECTIVE. The purpose of this study is to determine the correlation between malignancy risk of focal liver observations in patients at risk for hepatocellular carcinoma (HCC) implied by phrases used in nonstructured radiology reports with the risk inferred by hepatologists. MATERIALS AND METHODS. We performed a retrospective review of nonstructured radiology reports issued before Liver Imaging and Reporting Data System (LI-RADS) adoption from four-phase liver CT examinations of patients at risk for HCC. The phrase used by the radiologist in the report impression to describe each focal liver observation was recorded. Five hepatologists independently inferred the LI-RADS category from each phrase. Two abdominal radiologists independently reviewed the images and, blinded to all other information, assigned a LI-RADS category to each observation. Discrepancies were resolved by consensus. RESULTS. One hundred five observations in 77 patients were reported by 23 radiologists using 29 phrases. The most common phrase, �consistent with HCC� (n = 20), was applied to radiologist-assigned LR-3 (n = 1), LR-4 (n = 5), LR-5 (n = 11), and LR-5V (n = 3) observations. Eleven phrases were used more than once. Sixteen phrases were associated with LR-4 or higher observations; among these, hepatologists misinterpreted 37% of LR-4 or lower observations as definitely HCC and 46% of LR-5 and LR-5V observations as not definitely HCC. Overall, there was modest correlation (r = 0.69) between radiologist-assigned and hepatolo-gist-inferred categories. CONCLUSION. Nonstandardized terminology results in inaccurate communication of HCC risk. Structured reporting systems such as LI-RADS may improve communication by conveying unambiguous estimates of malignancy risk.

AB - OBJECTIVE. The purpose of this study is to determine the correlation between malignancy risk of focal liver observations in patients at risk for hepatocellular carcinoma (HCC) implied by phrases used in nonstructured radiology reports with the risk inferred by hepatologists. MATERIALS AND METHODS. We performed a retrospective review of nonstructured radiology reports issued before Liver Imaging and Reporting Data System (LI-RADS) adoption from four-phase liver CT examinations of patients at risk for HCC. The phrase used by the radiologist in the report impression to describe each focal liver observation was recorded. Five hepatologists independently inferred the LI-RADS category from each phrase. Two abdominal radiologists independently reviewed the images and, blinded to all other information, assigned a LI-RADS category to each observation. Discrepancies were resolved by consensus. RESULTS. One hundred five observations in 77 patients were reported by 23 radiologists using 29 phrases. The most common phrase, �consistent with HCC� (n = 20), was applied to radiologist-assigned LR-3 (n = 1), LR-4 (n = 5), LR-5 (n = 11), and LR-5V (n = 3) observations. Eleven phrases were used more than once. Sixteen phrases were associated with LR-4 or higher observations; among these, hepatologists misinterpreted 37% of LR-4 or lower observations as definitely HCC and 46% of LR-5 and LR-5V observations as not definitely HCC. Overall, there was modest correlation (r = 0.69) between radiologist-assigned and hepatolo-gist-inferred categories. CONCLUSION. Nonstandardized terminology results in inaccurate communication of HCC risk. Structured reporting systems such as LI-RADS may improve communication by conveying unambiguous estimates of malignancy risk.

KW - Hepatocellular carcinoma

KW - Liver Imaging

KW - Radiology report

KW - Reporting Data System

KW - Terminology

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U2 - 10.2214/AJR.17.18416

DO - 10.2214/AJR.17.18416

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JO - American Journal of Roentgenology

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