The lexicon of PET/CT reports in prostate patients: Evaluating confidence.

Abstract

232 Background: Pet/CT scans are increasingly used to evaluate prostate cancer patients with biochemical failure following surgery or radiation therapy for localized prostate cancer. We assessed the language used in report impressions to characterize the reader's confidence for lesions in various anatomic sites. Methods: Between 2015 and 2021, 419 fluciclovine PET/CT scan reports were identified in our institutional outcomes database. Thirteen phrases routinely used in the report impression section by radiologists at least once to characterize a lesion of interest were identified. The phrases were categorized in the following confidence categories: Definitive (positive, negative), Likely (consistent with, most likely, favors, probable), and Unsure (suspicious for, concerning for, non-specific, conspicuous, compatible with, borderline, unknown). The final analysis set included 353 reports where the prescan PSA value was known within the prior 90 days of the scan. Descriptive statistics, stratified by prescan PSA value, were used to characterize this language for the following anatomic regions: bone, regional lymph nodes, prostate fossa, prostate gland/seminal vesicles, other soft tissue. Results: Overall, definitive language was used between 34.6% to 87.1% of the time, depending on the anatomic context (table). The intact prostate was the least likely site to use definitive language (34.6%), whereas bone was most likely (87.1%). Intact prostates in post-radiation patients had the most uncertainty to the persistence of disease (42.3% unsure, 23.1% likely). The highest degree of definitive certainty occurred in impressions of persons with PSA <0.5 (89.2%), whereas the least definitive certainty was in patients with PSA >1 (66.2%). Overall, definitive, likely and unsure findings were reported in 68.6, 9.7%, and 21.7% of scans. Conclusions: Fluciclovine PET/CT scans routinely result in equivocal findings, which vary by anatomic site of interest and prescan PSA level. The language utilized in these reports has not been standardized. Future work aims to create a clear confidence level lexicon standard to assist radiologists and providers in reporting standardization.[Table: see text]