Structured CEUS-based diagnostic pathway for newly detected splenic lesions: impact on diagnostic latency and
Daniela Tirotta1, Claudia Lena2, Elena Magnani3
1Internal Medicine, Morgagni Pierantoni Hospital, Forli', Italy. danitirotta@libero.it.
Background:
Newly detected splenic lesions represent a challenging diagnostic scenario in internal medicine, particularly when lymphoproliferative disease is suspected. Evidence on the role of contrast-enhanced ultrasound (CEUS) in this setting is limited, and its integration into structured clinical pathways has been poorly explored. This study evaluated the impact of a structured clinical-ultrasound diagnostic pathway incorporating CEUS on diagnostic latency and use of advanced imaging, as well as its exploratory ability to discriminate hematologic/lymphoproliferative from non-hematologic splenic lesions.
Methods:
We conducted a multicenter, procedure-based quality Improvement study including 100 patients with newly detected splenic lesions. Fifty patients underwent a structured pathway based on an integrated clinical, laboratory, and ultrasound tool (intervention group), while 50 received standard management (control group). Primary outcomes were diagnostic latency and number of advanced imaging examinations (CT, MRI, PET). Secondary outcomes included the diagnostic performance of CEUS and of the integrated tool for discriminating hematologic/lymphoproliferative versus non-hematologic splenic lesions.
Results:
Mean diagnostic latency was significantly shorter in the intervention group (13.8 ± 21.2 vs 32.4 ± 35.7 days; p = 0.004). Median latency was 5 [IQR 3-14] versus 14 [IQR 3-30] days (p = 0.002). Early diagnoses (≤ 7 days) were more frequent in the intervention group (58% vs 22%), while delayed diagnoses (> 30 days) were more common in controls (38% vs 10%; p < 0.001). Use of advanced imaging was reduced in the intervention group (CT: 46% vs 100%, p < 0.001; PET: 4% vs 20%, p = 0.018). For the discrimination of hematologic/lymphoproliferative versus non-hematologic lesions, CEUS showed high sensitivity (90.9%) and good specificity (79.5%), whereas the integrated tool improved specificity (94.9%) while maintaining good sensitivity (81.8%).
Conclusions:
A structured CEUS-centered diagnostic pathway appears to shorten diagnostic latency and reduce advanced imaging use while maintaining adequate diagnostic accuracy. The diagnostic performance findings should be interpreted as exploratory and limited to binary stratification of hematologic/lymphoproliferative versus non-hematologic lesions, rather than lesion-specific diagnosis.
