American Journal of Roentgenology, Vol 171, 1571-1576, Copyright © 1998 by American Roentgen Ray Society

ARTICLES

Assessing the resectability of pancreatic carcinoma: the value of reinterpreting abdominal CT performed at other institutions

CL Kalbhen, EM Yetter, MC Olson, HV Posniak and GV Aranha
Stritch School of Medicine, Cardinal Bernadin Cancer Center, Loyola University Medical Center, Maywood, IL 60153, USA.

OBJECTIVE: The purpose of this study was to determine the value of reinterpreting abdominal CT performed at other institutions when assessing the resectability of pancreatic carcinoma. MATERIALS AND METHODS: Fifty-three patients (30 men, 23 women; mean age, 62 years) referred to our tertiary care institution with newly diagnosed pancreatic carcinoma had formally reinterpreted abdominal CT scans and available initial reports. CT was performed at community hospitals (n = 47), university hospitals (n = 4), an outpatient clinic (n = 1), and an imaging center (n = 1); reinterpretation was performed by university radiologists with subspecialty expertise in abdominal imaging. On the basis of the initial and reinterpretation reports, the patients were categorized as having resectable or nonresectable disease. Medicare reimbursement rates were assessed. RESULTS: The initial and reinterpretation reports agreed in 36 (68%) of the 53 patients, with the disease of 16 patients considered resectable and 20 unresectable by both reports. In 17 patients (32%), we found discrepancies between the initial and the reinterpretation reports. All discrepancies involved the initial report indicating resectability and the reinterpretation report consistent with nonresectable disease. Discrepancies were resolved by findings at surgery (n = 9), percutaneous biopsy (n = 3), dedicated pancreatic CT (n = 3), dedicated liver CT (n = 1), and follow- up abdominal CT (n = 1); the reinterpretation reports were correct in 16 (94%) of 17 patients. Reimbursement for outside CT reinterpretation, repeated abdominal CT, and an exploratory laparotomy were estimated at $46.45, $414.47, and $16,996.44, respectively. CONCLUSION: Reinterpretation of outside abdominal CT was valuable for determining pancreatic carcinoma resectability and inexpensive when compared with repeating the CT examination or performing an exploratory laparotomy.
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				M. Mullerad, H. Hricak, L. Wang, H.-N. Chen, M. W. Kattan, and P. T. Scardino Prostate Cancer: Detection of Extracapsular Extension by Genitourinary and General Body Radiologists at MR Imaging Radiology, July 1, 2004; 232(1): 140 - 146. [Abstract] [Full Text] [PDF]

				S. Gangi, J. G. Fletcher, M. A. Nathan, J. A. Christensen, W. S. Harmsen, B. S. Crownhart, and S. T. Chari Time Interval Between Abnormalities Seen on CT and the Clinical Diagnosis of Pancreatic Cancer: Retrospective Review of CT Scans Obtained Before Diagnosis Am. J. Roentgenol., April 1, 2004; 182(4): 897 - 903. [Abstract] [Full Text] [PDF]

				J. G. Fletcher, M. J. Wiersema, M. A. Farrell, J. L. Fidler, L. J. Burgart, T. Koyama, C. D. Johnson, D. H. Stephens, E. M. Ward, and W. S. Harmsen Pancreatic Malignancy: Value of Arterial, Pancreatic, and Hepatic Phase Imaging with Multi-Detector Row CT Radiology, October 1, 2003; 229(1): 81 - 90. [Abstract] [Full Text] [PDF]

				L. Berlin Potential Legal Ramifications of Whole-Body CT Screening: Taking a Peek into Pandora's Box Am. J. Roentgenol., February 1, 2003; 180(2): 317 - 322. [Full Text] [PDF]