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Reuters Health Information: Radiology subpecialties differ in advice on incidental liver lesions

Radiology subpecialties differ in advice on incidental liver lesions

Last Updated: 2020-02-11

By Will Boggs MD

NEW YORK (Reuters Health) - Breast- and abdominal-radiology subspecialists often differ in their follow-up recommendations for incidental liver lesions found on breast MRI, a retrospective study found.

"Because imaging studies often cross subspecialties, there is an opportunity for improvement in the quality of patient care by calling on the expertise of other relevant subspecialists (through decision support, consulting relevant colleagues, or AI tools in the future) to make best practice decisions," Dr. Pamela J. DiPiro of Dana Farber Cancer Institute and Harvard Medical School in Boston told Reuters Health by email.

Up to 28% of breast MRIs have incidental liver lesions. These lesions might be identified by breast-radiology subspecialists or abdominal-radiology subspecialists, but whether their recommendations for follow-up differ has not been studied.

To investigate, Dr. DiPiro and colleagues looked at follow-up advice from breast- and abdominal-imaging subspecialists as recorded in electronic health records and radiology reports from one academic medical center.

Among the 30 cases with incidental liver lesions (ILLs) for which breast subspecialists made follow-up recommendations, abdominal subspecialists agreed with only two. In two additional cases, abdominal subspecialists recommended MRI where breast subspecialists recommended ultrasound evaluation.

On the other hand, among 30 cases with ILLs for which the breast subspecialists did not make follow-up recommendations, the abdominal subspecialists agreed that no follow-up recommendations were necessary in 29, but they did recommend follow-up for the remaining case (which had remained stable for at least four years).

Among the 30 cases for which the breast subspecialists detected no liver lesions, abdominal subspecialists noted two lesions (a 4-mm cyst requiring no additional follow-up and an indeterminate 1.2-cm left hepatic lesion that was unchanged for more than two years on repeat breast MRI).

Clinicians followed the breast subspecialists' recommendations in 53% of cases (16/30). Of these, 94% (15/16) of ILLs were proved benign and one malignant, the authors report in the Journal of the American College of Radiology.

"The phenomenon of having subspecialty radiologists evaluate body parts outside their area of expertise is widely generalizable - including thoracic radiologists interpreting ILLs on chest CT, neuroradiologists interpreting lung findings or abdominal findings on spine MRI, abdominal radiologists interpreting lung findings on abdominal CT scans," Dr. DiPiro said. "Thus, the opportunity for improvement to patient care crosses all radiology subspecialty divisions."

Dr. Priya K. Shah of Northwell Health System, in Manhasset, New York, who recently evaluated the rate of malignancy in ILLs detected on breast MRI, told Reuters Health by email the study "confirms that incidental findings on imaging studies continue to be a relevant issue in our field. Radiologists can ease the potential burden of incidental findings on referring physicians and patients by utilizing best-practice recommendations, both local and from the American College of Radiology, and by collaborating across radiology subspecialties on efforts to educate one another."

"To our referring physicians," she said, "when in doubt about ordering an additional study, call your local radiologists. It is good for patient care, and we welcome the opportunity to be involved."

"Cross-specialty collaboration is key - and it works!" said Dr. Shah, who was not involved in the new research. "After we studied the incidence of incidental liver lesions at breast MRI, we have anecdotally noted a shift in practice patterns amongst our breast imagers: fewer overall recommendations are being made for abdominal imaging, and breast imagers are also more inclined to consult with their abdominal radiology colleagues before recommending additional studies."

SOURCE: https://bit.ly/2OMf6t9 Journal of the American College of Radiology, online January 28, 2020.

 
 
 
 
                               
 
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