title: Structured reporting of multiphasic CT for pancreatic cancer: potential effect on staging and surgical planning.
abstract: OBJECTIVE
  To compare structured versus nonstructured reporting of multiphasic computed tomography (CT) for staging of pancreatic cancer and the effects of both types of reporting on subjective assessment of resectability.
  
  
  METHODS
  This institutional review board-approved, HIPAA-compliant retrospective study with waiver of informed consent included all patients who were referred for presurgical multiphasic CT of the pancreas between December 2006 and April 2011 at one institution before and after implementation (April 2008) of a structured reporting template. The template was created specifically for reporting multiphasic CT results to stage pancreatic cancer in patients and contained specific information relevant to surgical and oncologic planning. Multiphasic CT reports were assessed for the presence of 12 key features required for staging and surgical planning, including location, size, enhancement, node status, and vascular involvement. Three pancreatic surgeons evaluated the reports to assess resectability, surgical planning, and ease of extracting information before and after reviewing the multiphasic CT images blinded to the patient identifiers. The Student t test and χ(2) test were used for statistical analysis.
  
  
  RESULTS
  Forty-eight (40%) structured and 72 (60%) nonstructured multiphasic CT reports were reviewed. Nonstructured reports contained a mean ± standard deviation of 7.3 key features ± 2.1 (range, 1-11) and structured reports contained 10.6 ± 0.9 (range, 9-12) features (P < .001). Information for surgical planning was deemed easily accessible in 94%, 60%, and 98% of structured and 47%, 54%, and 32% of nonstructured reports by the three surgeons, respectively (P < .001, .79, < .001). Surgeons had sufficient information for surgical planning in 96%, 69%, and 98% of structured and 31%, 43%, and 25% of nonstructured reports (P < .001, .009, and < .001). When surgeons reviewed reports in combination with multiphasic CT images, they were more likely to convert an answer of "unsure" regarding resectability to a definitive answer (ie, resectable or unresectable) when the reports were structured than when they were nonstructured.
  
  
  CONCLUSIONS
  Structured reporting of pancreatic multiphasic CT provided superior evaluation of pancreatic cancer and facilitated surgical planning. Surgeons were more confident regarding decisions about tumor resectability when they reviewed structured reports before review of multiphasic CT images.
authors.affiliation: From the Departments of Radiology (O.R.B., A.B.) and Surgery (T.S.K., N.S.), Beth Israel Deaconess Medical Center, Boston, Mass; Department of Surgery, University of Pennsylvania, Philadelphia, Pa (C.M.V.); and Department of Radiology, University of Texas Southwestern Medical Center, 2201 Inwood Rd, 2nd Floor, Suite 202.Dallas, TX 75390-9085 (I.P.).
authors.forename: Olga R
authors.initials: OR
authors.lastname: Brook
authors.forename: Alexander
authors.initials: A
authors.lastname: Brook
authors.forename: Charles M
authors.initials: CM
authors.lastname: Vollmer
authors.forename: Tara S
authors.initials: TS
authors.lastname: Kent
authors.forename: Norberto
authors.initials: N
authors.lastname: Sanchez
authors.forename: Ivan
authors.initials: I
authors.lastname: Pedrosa
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D010347:Patient Care Planning; D011996:Records; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*