Lack of standardized PSMA PET/CT reporting hindering patient care
A new analysis suggests a lack of standardized PSMA PET/CT reporting could be hindering patient care.
Published in RSNA's Radiology, the assessment details numerous discrepancies between PSMA PET/CT scoring systems and interpretation frameworks. Authors of the new paper caution these inconsistencies could have a negative impact on patient care.
“Findings suggest substantial real-world heterogeneity and underutilization of standardized interpretation frameworks for PSMA PET reporting in the United States, which can potentially lead to misinterpretation and diagnostic errors, inconsistent follow-up or work-up, and management delays,” Herbert Alberto Vargas, MD, with the Department of Radiology at New York University Langone Health, and colleagues noted. “PSMA reporting guidelines are relatively new (first published in 2017), and there may be lack of familiarity or access to educational resources on their use. There are also more than seven different scoring systems or frameworks, and lack of guidance on when to use a particular one may hinder uptake.”
The group examined 111 PSMA PET/CT reports from 42 U.S. institutions. They compared the length, content, structure, readability and utilization of different scoring systems, taking note of what each framework focused on in terms of imaging findings.
Of the reports included, 52% were from academic organizations, 45% from community or private practice, and 2.7% from Veterans Affairs hospitals. The group unearthed significant variability in report length and readability. Report structure also varied widely, and just 11% utilized some sort of standardized formatting. Less than half of the reports (39%) included longitudinal assessments for all identified lesions.
Reporting of lesions, lymph nodes and metastatic disease was heterogeneous as well. While most (92%) reported standardized uptake value for lesions, few noted lesion size or likelihood of extracapsular extension and seminal vesicle invasion. Just 37% reported on nodal or distant metastases, and of those that did, most lacked detailed information on lesion size and CT features.
Incidental findings were mentioned in 89% of the reports. However, less than 20% included recommendations regarding management of said findings.
The group believes their results highlight the critical need for the integration of existing scoring frameworks into a single set of recommendations. The good news is that the Standardized PSMA PET Analysis and Reporting Consensus (SPARC) initiative that is currently in progress will do just that. That system, which is being developed by dozens of multidisciplinary experts, seeks to establish a common lexicon for PSMA PET, improving research efficiency, prioritizing key issues, reducing field variability and confusion, and unifying the efforts put forth in current reporting frameworks.
Until such recommendations are finalized, the group advises that “multidisciplinary communication within each institution is crucial to implement validated scoring systems and interpretation frameworks for PSMA PET reporting.”
Read more about the results in the Radiological Society of North America's flagship journal here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.