Interdisciplinary Implementation of a Synoptic Reporting Template for Melanoma Nodal Surveillance Ultrasound.

Autor: Montgomery KB; Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA. kmontgomery@uabmc.edu., Duncan ZN; Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA., Holder AM; Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA., Burgan CM; Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA., Galgano SJ; Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA., Broman KK; Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA.; Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2024 Nov; Vol. 31 (12), pp. 8222-8229. Date of Electronic Publication: 2024 Jul 02.
DOI: 10.1245/s10434-024-15630-0
Abstrakt: Background: With nodal surveillance increasingly used for sentinel lymph node-positive (SLN+) melanoma following the Second Multicenter Selective Lymphadenectomy Trial (MSLT-II), high-quality nodal ultrasonography (U/S) has become a critical need. Previous work has demonstrated low utilization of MSLT-II U/S criteria to define abnormal lymph nodes requiring intervention or biopsy. To address this gap, an evidence-based synoptic template was designed and implemented in this single-center study.
Methods: Sentinel lymph node-positive patients undergoing nodal surveillance at a tertiary cancer center from July 2017 to June 2023 were identified retrospectively. Ultrasound reporting language was analyzed for MSLT-II criteria reported and clinically actionable recommendations (e.g., normal, abnormal with recommendation for biopsy). Following a multidisciplinary design process, the synoptic template was implemented in January 2023. Postimplementation outcomes were evaluated by using U/S reports and provider surveys.
Results: A total of 337 U/S studies were performed on 94 SLN+ patients, with a median of 3 U/S per patient (range 1-12). Among 42 synoptic-eligible U/S performed postimplementation, 32 U/S (76.0%) were reported synoptically. Significant increases were seen in the number of MSLT-II criteria reported (Pre 0.5 ± 0.8 vs. Post 2.5 ± 1.0, p < 0.001), and clinically actionable recommendations for abnormal findings (Pre 64.0% vs. Post 93.0%, p = 0.04). Nearly all surgeon and radiologist survey respondents were "very" or "completely" satisfied with the clinical utility of the synoptic template (90.0%).
Conclusions: Following implementation of a synoptic template, U/S reports were significantly more likely to document MSLT-II criteria and provide an actionable recommendation, increasing usefulness to providers. Efforts to disseminate this synoptic template to other centers are ongoing.
(© 2024. The Author(s).)
Databáze: MEDLINE
Externí odkaz: