Nonstandardized Terminology to Describe Focal Liver Lesions in Patients at Risk for Hepatocellular Carcinoma: Implications Regarding Clinical Communication
- 1 January 2018
- journal article
- research article
- Published by American Roentgen Ray Society in American Journal of Roentgenology
- Vol. 210 (1), 85-90
- https://doi.org/10.2214/AJR.17.18416
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
This publication has 18 references indexed in Scilit:
- Concordance of hypervascular liver nodule characterization between the organ procurement and transplant network and liver imaging reporting and data system classificationsJournal of Magnetic Resonance Imaging, 2014
- LI‐RADS (Liver Imaging Reporting and Data System): Summary, discussion, and consensus of the LI‐RADS Management Working Group and future directionsJournal of Hepatology, 2014
- LI-RADS Categorization of Benign and Likely Benign Findings in Patients at Risk of Hepatocellular Carcinoma: A Pictorial AtlasAmerican Journal of Roentgenology, 2014
- Repeatability of Diagnostic Features and Scoring Systems for Hepatocellular Carcinoma by Using MR ImagingRadiology, 2014
- New OPTN/UNOS Policy for Liver Transplant Allocation: Standardization of Liver Imaging, Diagnosis, Classification, and Reporting of Hepatocellular CarcinomaRadiology, 2013
- LI-RADS: A Case-based Review of the New Categorization of Liver Findings in Patients with End-Stage Liver DiseaseRadioGraphics, 2012
- Management of hepatocellular carcinoma: An updateJournal of Hepatology, 2011
- Cirrhosis-associated Hepatocellular Nodules: Correlation of Histopathologic and MR Imaging FeaturesRadioGraphics, 2008
- Is Terminology Used Effectively to Convey Diagnostic Certainty in Radiology Reports?Academic Radiology, 2003
- Communication of doubt and certainty in radiological reports.The British Journal of Radiology, 2000