Background: Imaging exams performed on hospitalized patients commonly reveal findings representing possible cancer and requiring follow-up. Our objective was to quantify how often indeterminate or suspicious masses are detected on inpatient abdominal and pelvic imaging exams by exam type and organ.
Methods: Our health system uses a standardized coding scheme, similar to the Breast Imaging Reporting and Data System (BI-RADS) to classify masses as benign, indeterminate, or suspicious for cancer on all abdominal and pelvic imaging exams. A database was created to study the distribution of these findings in hospitalized patients at three hospitals within our health system.
Results: Over the course of a year, more than 9,000 abdominal and pelvic imaging studies were performed in hospitalized patients across three hospitals in a single health system: a university hospital, a community hospital, and a Level 1 trauma center. The most commonly ordered studies were abdominopelvic CT with contrast, retroperitoneal ultrasound, abdominopelvic CT without contrast, abdominal ultrasound, and abdominal MRI, in order of descending frequency. Masses indeterminate or suspicious for cancer were detected in at least one organ in 12% of all abdomen and pelvic imaging exams overall, and in 25% of abdominal MRIs, 18% of abdominopelvic CTs with contrast, 6% of abdominopelvic CTs without contrast, and 5% of abdominal ultrasounds and retroperitoneal ultrasounds. The frequency of these findings differed by organ as well as by exam type. Indeterminate or suspicious liver masses were found in 11% of abdominal MRIs, 7% of abdominopelvic CTs with contrast, and 4% of abdominal ultrasounds; liver masses found on abdominal MRI were more likely to be suspicious rather than indeterminate. Indeterminate or suspicious pancreas masses were found in 8% of abdominal MRIs and 2% of abdominopelvic CTs with contrast. Suspicious renal masses were found in 3% of abdominal MRIs and 1% of abdominopelvic CTs with contrast, though indeterminate renal masses were more likely to be found in abdominopelvic CTs than abdominal MRIs (5% vs. 2%). Indeterminate or suspicious adrenal masses were found in 2% of abdominal MRIs and 3% of abdominopelvic CTs with contrast. Masses indeterminate or suspicious for cancer were unevenly distributed across the three hospitals. Abdominal MRIs performed at the community hospital were more likely to show indeterminate lesions in the liver and pancreas and much less likely to identify clear cancers in these two organs when compared with the other two hospitals.
Conclusions: Masses indeterminate or suspicious for cancer occur in 12% of inpatient abdominal and pelvic imaging exams. These findings are frequently detected on abdominal MRIs and abdominopelvic CTs with contrast in the liver and pancreas. Ultimately, this data could be used to notify physicians when patients with possible abdominopelvic cancers miss recommended follow-up, so patients can have early diagnoses and better outcomes.
