Inconsistencies of Diagnostic Reports

Today, I encountered two incidents of diagnostic reports which contained what I think are “inconsistencies.”

Upon discovery of “inconsistencies” in the two sets of reports, I told the patients involved that different radiologists have different styles and ways of making a report.  They have different styles and ways of reporting the results.

Case in point – First set: Thyroid Ultrasound, one done in 2014 and the other done in 2015, read by different radiologists.

uts_thyroid_martinez_14feb12

uts_thyroid_martinez_15aug6

In 2014, radiologist 1 reported in the impression: complex nodules. In 2015, radiologist 2 reported in the impression: two solid nodules.  However, if one looks at the reported findings, there is a statement: “small cystic degeneration is seen in each of the (solid) thyroid nodules.” This, in effect, makes the nodules, complex.  Thus, the findings in 2014 and 2015 should essentially be the same (complex nodules).  However, what was reported in the impression by the radiologist in 2015 was solid nodules.

As the clinician, supposed to be the final decision-maker, after correlating all the diagnostic reports and the clinical findings, I decided the nodules are complex.  I decided to continue my medical treatment without going to ultrasound-guided fine-needle biopsy as recommended by radiologist 2.

Case in Point – Second set: Breast Ultrasound, one done in January 2015 and the other done in September 2015 read by different radiologists.

uts_breast_kristine_15jan

uts_breast_kristine_15sept

In January 2015, radiologist 1 reported well-defined bilateral solid nodules and gave an assessment of BIRADS 3 (probably benign).  In September 2015, radiologist 2 reported circumscribed (well-defined) bilateral solid nodules, some with gently lobulated borders. He gave an assessment of BIRADS 4 A (low suspicion for malignancy).

With how the report was written, radiologist 2 gave the clinician the perception that the assessment of BIRADS 4 was based on the increase of the size of the mass.  In the impression statement, he did not state the “gently lobulated border” which could be his / her basis for BIRADS 4.

As the clinician, supposed to be the final decision-maker, after correlating all the diagnostic reports and the clinical findings, I decided the 10 o’clock mass was a fibroadenoma, a benign condition.

Consistency means agreement or logical coherence among things or parts. There is correspondence among related parts.

In the above reports, there are inconsistencies which the clinician has to manage to interpret.  Time is consumed in reading between the lines.

What is actually more objectionable is the anxiety brought about by inconsistencies of the report.  The thyroid patient was anxious of the recommendation of the needle-biopsy by radiologist 2.  The  breast patient could not sleep because of the BIRADS 4A assessment of radiologist 2 based on size.

The moral of the story:

  1. Radiologists should be consistent in their reports.
  2. Clinicians should scrutinize the reports of the radiologists and make a decision after correlating all available data (particularly the clinical findings).
  3. Radiologists should stick to the radiologic diagnosis and not make any recommendations on other different diagnostic tests.  They should leave it to the clinicians whether another diagnostic test is needed or not.

My thoughts, perceptions, opinions, and recommendations for the day.

ROJ@15sept17

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