The edition · Radiology
Flagged mammogram recalls reached biopsy in 24 days rather than 45
An expedited pathway let radiologists send highly suspicious BI-RADS 0 findings straight into reserved slots, with a 91% cancer yield. Plus where MRI fits in prostate screening, and nerve plexus invasion on pancreatic CT.
The edition in brief
A US academic centre let screening radiologists flag highly suspicious BI-RADS 0 findings for telephone booking into reserved diagnostic slots. Of 4,647 recalls, 57 were flagged; their median time from screening to diagnostic work-up was 7 days against 25, and to biopsy 24 days against 45, with positive predictive values above 90%. It is a retrospective, single-centre workflow study. An ESUR Prostate MRI Working Group special report concludes that MRI in prostate screening, particularly biparametric MRI as a reflex after a raised PSA, finds more clinically significant cancer with fewer unnecessary biopsies, but long-term mortality data are lacking. In 89 resected pancreatic cancers, CT evidence of extra-pancreatic nerve plexus invasion, especially along the PPC2 pathway or with a mass-with-stranding pattern, was associated with shorter survival, including in stage I. The pearl covers what a pancreatic protocol CT report should state.
Prostate screening with MRI: reflex biparametric scans after PSA look most feasible
If MRI joins a prostate screening pathway, use it as a reflex biparametric scan after PSA, with agreed thresholds and audit.
Nerve plexus invasion on CT was linked to shorter survival, even in stage I pancreatic cancer
Report extra-pancreatic nerve plexus invasion by pathway and pattern on pancreatic CT, even in small tumours.
What a pancreatic protocol CT report should state
Use a synoptic pancreatic CT report that always states vessel contact in degrees, arterial variants and plexus involvement.
An expedited recall pathway cut time to biopsy for highly suspicious mammograms
Consider letting screening readers flag highly suspicious recalls into reserved slots, and audit the yield.
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