COMMENTARY

How You Convey a Low-Risk Incidental Finding Matters

Hossein Jadvar, MD, PhD, MPH, MBA

Disclosures

February 27, 2017

The Study

Perceptions of radiologists, referring physicians, and patients can differ when it comes to interpreting key phrases that appear in radiology reports. A new study puts numbers to this issue, by surveying 13 abdominal radiologists, 59 referring physicians, and 51 patients in a large urban academic medical center.[1]

The study cohort was asked to rate concern, using a graded scale that was provided to them, in relation to 10 different hypothetical descriptions of an incidental 5-mm liver lesion.

Only the expression of "benign cyst" was associated with no concern in all three groups. Other final impressions—such as "most likely a cyst," "too small to characterize," and "tumor not excluded"—were associated with some level of concern by referrers and patients and higher likelihood of further follow-up imaging or other tests.

Viewpoint

The objective of this investigation was to compare radiologists', referring physicians', and patients' perceptions of interpretive expressions in radiology reports describing findings of probably low clinical significance. Incidental findings on cross-sectional imaging are relatively common.[2] These findings, when reported without expression of level of clinical significance or need for follow-up, can not only lead to confusion among referring physicians and anxiety among patients but also waste healthcare resources, generate unnecessary costs, and result in possible morbidity.[3]

The survey found that, indeed, the language used in the final description of a low-risk incidental finding can make a difference in how that finding is perceived by referring physicians and patients. In this particular case, if the expression "benign cyst" was not used, any other expression was associated with some level of concern.

There have been attempts to address this issue through recommendations from radiology organizations and experts to avoid use of "jargon, clichés, defensive language, 'cannot exclude' or meaningless phrases."[4,5] This article nicely highlights the importance of radiology reports that are increasingly available to patients.

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