NSMC Radiology Practice Quality Improvement: Pancreatic pseudocyst reporting

1. NSMC Radiology Practice Quality Improvement: Pancreatic pseudocyst reporting Alvin Yamamoto, MD December 1, 2010

2. Introduction • Cystic pancreatic lesions were frequently called pseudocysts without a documented history of pancreatitis • At our prior meeting in February 2009 • Review of abd CTs 10/07-9/08, keyword “pseudocyst” • 22% of cases in which a pseudocyst was described, there was no imaging or clinical history of prior pancreatitis and no ddx of cystic neoplasm was provided • JM and BS provided a review of pancreatic cystic lesions with specific attention to IPMN

3. Prelim vs f/ustudy • 13,108 abd CTs between 10/07 – 9/08 • 12,508 abd CTs between 3/09 – 3/10 • Keyword search “pseudocyst”, excluding “no pseudocyst” • 96 cases (0.7%) previously • 36 cases (0.3%) on f/u • Unclear what accounts for difference in # of pseudocysts between 2 cohorts

4. 96 “pseudocyst” cases prelim63 “pseudocyst” cases f/u • Hx pancreatitis (definite or very likely pseudocyst) • 58 (60%) • 31 (49%) • No hx pancreatitis, DDx of neoplasm given • 17 (18%) • 28 (44%) • No hx pancreatitis, DDx of neoplasm not given • 21 (22%) CTs in 18 pts • 4 (6%) CTs in 3 pts

5. IPMN • Are we doing a better job describing IPMN? • Keyword search of all abd CT including “IPMN”, “IPMT”, “intraductal papillary mucinous” • 10/07 – 9/08: 9 cases • 3/09 – 3/10: 44 cases

6. Follow up

7. Summary • Practice Quality Improvement: Appropriate diagnosis and follow up of cystic lesions of the pancreas • Following presentation of initial data and review of imaging characteristics in Feb 2009 • 83% decrease in potentially misdiagnosing a cystic neoplasm as a pseudocyst • 78% → 93% accuracy of appropriately reporting a “pseudocyst” • Significant increase in recognizing potential IPMNs

8. Acknowledgements • Brittany DiGangi, Radiology Provider Coordinator, performed the keyword search, tabulation, and printing of reports for the follow up study