Structured radiology reports are crucial for adrenal incidentaloma workups

New research published in the Journal of the American College of Radiology suggests a structured and thorough radiology report with the use of standardized terminology should be used to increase an adequate adrenal incidentaloma workup. This may lead to increased adherence to international guidelines.

At present, inconsistent terms are used in radiology reports to describe adrenal incidentalomas. They are sometimes described using specific terms, including “module” or “lesion,” but are also described using vague terms, such as “prominent” or “plump.” About 80 percent of patients with adrenal incidentaloma have a nonfunctioning adenoma, but workup is still required to determine if these masses are malignant or will cause hormonal hyperfunction.

“The unclear descriptions for adrenal incidentalomas may confuse referring physicians and lead to different treatment policies,” wrote lead researcher Jacob J. Visser, MD, PhD, of the Erasmus Medical Center in Rotterdam, The Netherlands, and colleagues. “Therefore, terminology used for adrenal incidentaloma in radiology reports needs a closer look.”

Visser and colleagues explored the terms used to describe adrenal incidentalomas and also sought to determine what reporting factors are associated with clinicians adhering to international guidelines.

In this retrospective study, adrenal incidentaloma cases were identified from CT reports between 2010 and 2012. The reports were filtered based on terminology used to describe the adrenal mass at initial presentation. The researchers divided the cases into two groups—masses described with specific terms and greater than 1 cm in diameter and those described in nonspecific term.

Of more than 1.100 cases used in the analysis, 604 had a specific description of the adrenal mass—patients of this group had a significantly larger mass. The referral frequency was also higher. About 99 percent of the nonspecific masses were greater than 1 cm in diameter, compared with 98 percent of the specific masses.

Visser et al. noted a diagnostic workup was more likely to occur when: (1) specific terminology was used; (2) when Houndsfield unit, size of the mass, and diagnostic recommendation were reported and (3) when adrenal incidentaloma findings were repeated in the conclusion of the report.

International guidelines mandate the use of the term “adrenal incidentaloma,” should the nodule size be greater than 1 cm. The authors noted that term was never utilized in the reports they analyzed—indicating many radiologists do not adhere to international guidelines.

While only a few patients may benefit from the early detection of adrenal incidentaloma, the researchers noted it is still necessary to assess adrenal incidentaloma for malignancy or hyperfunctionality.

A more standardized and structured way of adrenal incidentaloma reporting by radiologists may prevent the dilemma of which patients need additional follow-up. Standardized radiology reports, the authors said, would reduce the number of terms that can be used for adrenal incidentaloma description and provide a more patient-centered radiology assessment.

“Vague and highly variable terms should be avoided in radiology reporting,” the authors concluded. “Our study shows that inconsistent use of terms in radiology reports has to be avoided to increase adequate adrenal incidentaloma workup.”