Abstract 3575: Frequency of imaging findings suspicious for and suggestive of cancer between three different hospitals within a single health system
Authors: Comisar Lauren F. , Zafar Hanna M. , Lalevic Darco , Pizzurro Christopher , Kahn Charles E. , Schnall Mitchell , Cook Tessa S. 
Published: July 2017

Outpatient imaging rates have risen over the past two decades. Imaging findings representing possible cancer are commonly detected on these exams and require follow-up. Our health system utilizes a standardized coding scheme, similar to the breast imaging and reporting data system (BI-RADS), to classify the malignant potential of masses on all abdominal and pelvic imaging exams; two of these categories are suspicious (for masses that clearly represent malignancy) and suggestive (for masses that may represent malignancy). These codes are used at three hospitals in a single health system: a university hospital, a community hospital, and a Level 1 trauma center. Our objective was to evaluate the frequency of imaging findings suspicious for or suggestive of malignancy in the liver, kidneys, pancreas, and adrenals between outpatients and inpatients at these three hospitals. Over 1600 suspicious and suggestive masses were discovered in one year: 843 in the liver, 499 in the kidneys, 152 in the pancreas, and 137 in the adrenal glands. Masses suspicious for cancer were unevenly distributed by patient location. In the liver and kidneys, suspicious masses were more common in outpatients at all three hospitals; in the pancreas and adrenal glands, suspicious masses were more common in inpatients. Suspicious masses were unevenly distributed by modality. The proportion of MRI exams where at least one organ was coded as suspicious was higher than the proportion of CT exams. Masses suspicious for cancer were unevenly distributed across the three hospitals. Liver masses suspicious for cancer were twice as likely to be discovered at the university hospital compared to the community hospital and the Level 1 trauma center (present in 2% vs. 0.7% vs. 0.6% of all livers evaluated, respectively). Adrenal masses suspicious for cancer were also more commonly detected at the university hospital (present in 0.3% vs. 0.1% vs. 0.1% of adrenal glands evaluated, respectively). A similar trend was observed for renal and pancreatic lesions. Masses coded as suggestive of malignancy (rather than clearly suspicious for malignancy) were more frequently detected at the university hospital. This was particularly evident in adrenal lesions where 0.3% of adrenal glands evaluated at the university hospital were suggestive of malignancy compared to 0.06% at the community hospital and 0.03% at the Level 1 trauma center. A similar trend was observed for pancreatic lesions. In conclusion, this novel database of standardized codes for abdominal masses provides insight into how masses suspicious for and suggestive of cancer are coded variably by organ, patient location, and modality between three different hospitals within the same urban academic health system. Further investigation will be needed to determine the influence of patient case mix, referral patterns, and radiologist characteristics that contribute to these observed differences.

Citation Format: Lauren F. Comisar, Hanna M. Zafar, Darco Lalevic, Christopher Pizzurro, Charles E. Kahn, Mitchell Schnall, Tessa S. Cook. Frequency of imaging findings suspicious for and suggestive of cancer between three different hospitals within a single health system [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3575. doi:10.1158/1538-7445.AM2017-3575