Is There a Role for Structured Radiology Reporting of Cta Pancreas Studies for Surgical Planning of Pancreatic Adenocarcinoma?

Hypothesis: Structured reporting of CT angiography of the pancreas will improve the reporting of findings necessary for staging and operative planning of pancreatic adenocarcinoma compared to unstructured reporting. Methods: Forty-one CTA examinations of the pancreas from October, 2007 through March, 2008, performed for staging and surgical planning of known or suspected pancreatic adenocarcinoma were retrospectively re-interpreted utilizing a standardized template developed in conjunction with surgery and radiology and then compared to the issued unstructured report. The reports were compared using a checklist of essential information necessary for staging and surgical planning. Results: 63% (26/41) of the issued reports contained sufficient information for TNM staging. Only 15% of the issued reports (6/41) described all pertinent information necessary to plan and perform surgical resection. The most common staging omissions were description of relationship to the biliary system and fat planes between adjacent structures when the tumor was extending beyond the pancreas. For surgical planning, the degree of involvement of the SMV and description of celiac axis anatomy (specifically the right hepatic artery) were insufficiently described. Utilization of the template would have provided reporting of all necessary information for staging and surgical planning in all 41 exams. Conclusion: Standardized reporting of staging and surgical criteria may improve the reporting of the clinically pertinent findings in the pre-operative evaluation of pancreatic adenocarcinoma. Prospective evaluation is likely warranted.