ASSESSING THE RESECTABILITY OF PANCREATIC-CARCINOMA - THE VALUE OF REINTERPRETING ABDOMINAL CT PERFORMED AT OTHER INSTITUTIONS

OBJECTIVE. The purpose of this study was to determine the value of rei nterpreting abdominal CT performed at other institutions when assessin g the resectability of pancreatic carcinoma. MATERIALS AND METHODS. Fi fty-three patients (30 men, 23 women; mean age, 62 years) referred to our tertiary care institution with newly diagnosed pancreatic carcinom a had formally reinterpreted abdominal CT scans and available initial reports. CT was performed at community hospitals (n = 47), university hospitals (n = 4), an outpatient clinic (n = 1), and an imaging center (n = 1); reinterpretation was performed by university radiologists wi th subspecialty expertise in abdominal imaging. On the basis of the in itial and reinterpretation reports, the patients were categorized as h aving resectable or nonresectable disease. Medicare reimbursement rate s were assessed. RESULTS. The initial and reinterpretation reports agr eed in 36 (68%) of the 53 patients, with the disease of 16 patients co nsidered resectable and 20 unresectable by both reports. In 17 patient s (32%), we found discrepancies between the initial and the reinterpre tation reports. All discrepancies involved the initial report indicati ng resectability and the reinterpretation report consistent with nonre sectable disease. Discrepancies were resolved by findings at surgery ( n = 9), percutaneous biopsy (n = 3), dedicated pancreatic CT (n = 3), dedicated liver CT (n 1), and follow-up abdominal CT (n = 1); the rein terpretation reports were correct in 16 (94%) of 17 patients. Reimburs ement for outside CT reinterpretation, repeated abdominal CT, and an e xploratory laparotomy were estimated at $46.45, $414.47, and $16,996.4 4, respectively. CONCLUSION. Reinterpretation of outside abdominal CT was valuable for determining pancreatic carcinoma resectability and in expensive when compared with repeating the CT examination or performin g an exploratory laparotomy.