Recommendations in Clinical F-Fluoro-2-Deoxy-D-Glucose PET/CT Reports: Referring Physicians' Compliance and Diagnostic Yield

PURPOSE: To investigate how frequently and when referring physicians follow the recommendation in an 18F-fluoro-2-deoxy-D-glucose PET/CT (FDG-PET/CT) report and to determine the diagnostic yield of these recommendations.

MATERIALS AND METHODS: This retrospective study included 2,496 clinical FDG-PET/CT scans that were performed at a tertiary care academic medical center in a 1.5-year period. The following variables were extracted from each report that contained a recommendation: patient age, patient gender, hospital status (inpatient versus outpatient), indication for FDG-PET/CT scanning, descriptive clarity of the recommendation, type of recommendation (additional imaging versus other), and compliance of the referring physician with the recommendation.

RESULTS: The 2,496 FDG-PET/CT reports contained 193 recommendations (7.7%), of which 120 (62.2%) were followed by the referring physicians. Only the strength of the recommendation (strong versus weak wording) was significantly associated (P = .019) with the referring physicians' compliance with the recommendations in the FDG-PET/CT reports (odds ratio of 2.14 [95% confidence interval: 1.13-4.05]). Of 120 recommendations that were followed, 21 (17.5%) led to a malignancy diagnosis, whereas 3 of the 73 (7.2%) recommendations that were not followed proved to have led to a malignancy diagnosis based on follow-up examinations not related to the recommendation; these proportions were significantly different (P = .006).

CONCLUSIONS: In a nonprofit academic medical center, recommendations for additional radiological and nonradiological examinations in clinical FDG-PET/CT reports are relatively low. Recommendations are mostly followed and lead to a malignant diagnosis in a substantial number of cases. Compliance of the referring physician is influenced by the strength of the recommendation.