Causes of Missed Diagnosis and Misdiagnosis of Abdominal Organ Lesions in Preoperative Transabdominal Ultrasound

  Objective  To analyze the causes of missed diagnosis and misdiagnosis of abdominal organ lesions through reviewing preoperative transabdominal ultrasound reports.

  Methods  Data of the patients who received abdominal operation for abdominal organ lesions (including liver, gallbladder, biliary tract, pancreas, spleen, kidney, adrenal gland, and appendix) in Peking Union Medical College Hospital within the period from March 1 to August 31 in 2013 were exported from pathological workstation. The preoperative ultrasound reports of these patients were reviewed. The missed diagnosis and misdiagnosis cases were recorded, and causes of the mistakes were analyzed.

  Results  Altogether 58 cases of missed diagnosis or misdiagnosis were identified from 1081 ultrasound reports (5.37%, 58/1081), including 6 liver lesions (5.77%, 6/104, all misdiagnosed), 6 gall-bladder and biliary tract lesions (1.30%, 6/462, 5 missed and 1 misdiagnosed), 14 pancreatic lesions (19.72%, 14/71, all missed), 20 kidney and adrenal lesions (6.47%, 20/309, 11 missed and 9 misdiagnosed), and 12 appendical lesions (16.00%, 12/75, 11 missed and 1 misdiagnosed). The average maximum diameter of the missed nodular lesions was significantly smaller than that of the misdiagnosed lesions (P=0.001).

  Conclusions  Missed diagnosis and misdiagnosis of ultrasound are attributable to various causes, including the nature, location, and size of abdominal organ lesions and the limitation of transabdominal ultrasound technology. The clinical ultrasound examination should be carried out very carefully and thoroughly. Ultrasound radiologists should have a thorough understanding of characteristics of different organ lesions and the limitation of ultrasound technique, in order to avoid missed diagnosis and misdiagnosis in clinical practice.