Adrenal Incidentaloma and Adherence to International Guidelines for Workup Based on a Retrospective Review of the Type of Language Used in the Radiology Report.
J Am Coll Radiol. 2019 Jan;16(1):50-55. doi: 10.1016/j.jacr.2018.08.011. Epub 2018 Sep 22.
de Haan RR1, Schreuder MJ1, Pons E2, Visser JJ3.
INTRODUCTION: The purpose of this study is to explore what terms are used to describe adrenal incidentalomas and to determine what reporting factors are associated with clinicians adhering to international guidelines.
METHODS: This retrospective study was approved by the institutional review board, with a waiver of informed consent. Adrenal incidentaloma cases were identified from CT reports between 2010 and 2012 and filtered based on terminology used to describe the adrenal mass at initial presentation. Cases were divided into two groups: masses described with specific terms (ie, nodule, presumably ≥1 cm in diameter) and nonspecific terms (ie, plump, likely to be smaller). P values were calculated using Student's t test and χ2 test. Rate of adherence of clinicians to workup guidelines was determined for both groups and was analyzed.
RESULTS: Of 1,112 cases, 604 had a specific description of the adrenal mass. Patients of the specific group had a significantly larger mass (P < .01) and referral frequency was higher (P < .01). Of the nonspecific masses, 99.2% (504 of 508) were ≥1 cm in diameter, compared with 98.3% of the specific masses (594 of 604). Furthermore, diagnostic workup was more likely to occur when a specific term was used; when Houndsfield unit, size of the mass, and diagnostic recommendation were reported; and when adrenal incidentaloma findings were repeated in the conclusion of the report (all P < .01).
CONCLUSION: Our study shows that inconsistent use of terms in radiology reports has to be avoided to increase adequate adrenal incidentaloma workup. A structured and thorough report with use of standardized terminology may increase adherence to international guidelines.