New radiology reporting system decreased time to pancreatic cancer diagnoses

Kaiser Permanente research builds on national guidelines for early detection of these silent cancers

 

By Sue Rochman

Radiologists are trained to use descriptive words to explain what they see in or on the pancreas on an abdominal scan. But a new Kaiser Permanente study shows that having radiologists use standardized terms and hashtags to describe what they see creates a clearer path for physician follow-up that can lead to earlier detection of pancreatic cancer.

Eleanor L. Ormsby, MD, MPH, diagnostic radiologist, The Permanente Medical Group.

“This study showed that our system that standardizes how suspicious findings on the pancreas are reported, and that alerts a clinician promptly to these findings, has increased the number of cancers we have detected earlier,” said lead author Eleanor L. Ormsby, MD, MPH, a diagnostic radiologist with The Permanente Medical Group. “This is clinically significant because a patient who has a pancreatic cancer detected early is more likely to survive longer than one whose cancer is detected late.”

The study, published in April in Clinical Gastroenterology and Hepatology, included more than 318,300 members of Kaiser Permanente Northern California (KPNC) who had a computed tomography (CT) or magnetic resonance imaging (MRI) scan that included the abdomen from 2016 through 2019. Overall, 1,523 patients were diagnosed with pancreatic cancer. The study found that the new system was associated with a nearly 50% greater odds of a patient having their pancreatic cancer diagnosed within 60 days.

 

This reporting system takes advantage of our electronic medical records and integrated care to speed diagnosis of a cancer that is not easy to find.

 — Lisa Herrinton, PhD

 

“If the radiologist’s description is not easily understood by the physician who ordered the scan, it may take longer for suspicious findings to be acted upon,” said senior author Lisa Herrinton, PhD, a research scientist at the Kaiser Permanente Division of Research. “This reporting system takes advantage of our electronic medical records and integrated care to speed diagnosis of a cancer that is not easy to find.”

Lisa Herrinton, PhD, research scientist, Division of Research.

The new reporting system, developed by a multidisciplinary team of KPNC surgeons, gastroenterologists, and radiologists based on the latest research, was rolled out across KPNC from May 2017 to November 2018. The new system streamlined how suspicious findings on scans were reported and automatically referred patients with suspicious findings to a multidisciplinary care team for rapid review and follow-up.

The patients included in the study had an MRI or CT scan of the abdomen ordered by a physician for a variety of reasons. About 121,000 of the patients had their scans reviewed under the new system and about 197,300 had their scans reviewed under the older system.

There is no screening test for pancreatic cancer. But tumors or cysts in the pancreas are sometimes noticed on abdominal scans. Currently, most patients with pancreatic cancer are not diagnosed until the tumor is large and has spread. Only about 10% of these patients will be alive after 5 years. But when the cancer is diagnosed early, about 44% of patients will be alive after 5 years, according to the National Cancer Institute Surveillance, Epidemiology, and End Results Program.

“Free dictation by radiologists of findings we may see on the pancreas is standard,” said Ormsby. “The system we created is unique to Kaiser Permanente Northern California. There is a lot of excitement about what we have done because our study showed that by alerting the clinician promptly we can increase the number of cancers detected early.”

The study was funded by The Permanente Medical Group Delivery Science and Applied Research (DARE) program.

Co-authors include Teresa Y Lin, MPH, of the Division of Research; and Kourosh Kojouri, MD, Patrick C Chang, MD, Brooke Vuong, MD, Rene M Ramirez, MD, Kristin M Schueler, MD, and Clifford F Sweet, MD, of The Permanente Medical Group.

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About the Kaiser Permanente Division of Research

The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. It seeks to understand the determinants of illness and well-being, and to improve the quality and cost-effectiveness of health care. Currently, DOR’s 600-plus staff is working on more than 450 epidemiological and health services research projects. For more information, visit divisionofresearch.kaiserpermanente.org or follow us @KPDOR.

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