Do MRI structured reports with FIGO classifications of leiomyomas contain adequate information for clinical decision making?

OBJECTIVE

To evaluate if structured reports (SR) of pelvic magnetic resonance imaging (MRI) scans using the PALM-COEIN FIGO (the International Federation of Gynecology & Obstetrics) uterine leiomyomas classification (SR-FIGO) contain adequate information for clinical decision making compared with narrative reports (NR).

METHODS

Three reporting templates for pelvic MRI scans were compared: NR, SR without the PALM-COEIN FIGO classification of leiomyomas, and SR-FIGO, for presence of 19 key-features (KF) deemed relevant for leiomyoma management. Kruskal-Wallis test was used to evaluate KF distribution across the report types. One gynecologist and one gynecologist-in-training evaluated the reports and MRI scans to assess the presence of sufficient information to decide on: (1) treatment type (observation/medical treatment/surgery/uterine artery embolization); (2) surgical approach (hysteroscopic/laparoscopic/robotic/open); (3) surgery type (myomectomy/hysterectomy); (4) necessity to review MRI scans; and (5) time spent reviewing MRI scans. The responses of the gynecologist and gynecologist-in-training to points 1 to 5 among report types were compared using χ2 test.

RESULTS

Twenty NR, 20 SR, and 20 SR-FIGO were reviewed. The number of KF was significantly different among reports (P < 0.001): SR-FIGO had the highest number of KF, followed by SR, and NR. In pairwise comparison, significant differences were observed between NR and SR (P = 0.001) and between NR and SR-FIGO (P = 0.001), but not between SR and SR-FIGO (P = 0.063). There were significant differences in answers to question 1 between the gynecologist and gynecologist-in-training for SR (P = 0.007) and SR-FIGO (P = 0.024), with the gynecologist deeming SR and SR-FIGO to provide enough information for treatment decisions more commonly than the gynecologist-in-training.

CONCLUSION

Although this investigation revealed that SR offers a greater wealth of information in contrast to NR, additional investigation is required to ascertain whether the integration of the PALM-COEIN FIGO classification in SR enhances the clinical decision making capacity of gynecologists.