Temporal Evolution of Diagnostic Code-Narrative Discrepancy in Pancreatic Imaging Surveillance: A Longitudinal...

Radiology reports for pancreatic cystic lesions frequently contain uncertainty expressions (rule-out (R/O), differential diagnosis (DDx)) alongside structured diagnostic codes. While cross-sectional studies have documented the prevalence of such hedging language, the temporal relationship between structured codes and narrative uncertainty during extended surveillance has not been systematically examined. The purpose is to characterize the temporal evolution of diagnostic language in pancreatic imaging reports by integrating structured health screening codes with natural language processing (NLP) and to quantify code-narrative discrepancy patterns over long-term follow-up. This retrospective study analyzed 1791 pancreatic imaging reports from 399 patients (mean 4.49 examinations per patient) obtained between March 2020 and March 2024 at a Korean health examination center. Mean follow-up was 2.72 years (median 1103 days, IQR 700-1446). We developed a regular expression-based NLP algorithm to extract uncertainty expressions from narrative reports. Structured diagnostic codes were standardized into five categories: Cyst, IPMN, Other, Tumor, and R/O Malignancy. Patient-level trajectories were analyzed for code transitions and narrative uncertainty patterns across temporal phases. While 59.4% (237/399) of patients maintained stable diagnostic codes throughout follow-up, 32.7% of patients with uncertainty expressions exhibited persistent narrative uncertainty despite extended surveillance. Uncertainty expression rates showed no significant temporal decline from early (52.1%) to late (62.1%) phases (p = 0.425). Among patients with stable Cyst codes, 33.9% (95/280) continued to receive reports with IPMN-related hedging language. Diagnostic codes changed in 40.6% of patients, with bidirectional transitions observed between consecutive examinations (130 Cyst → IPMN, 121 IPMN → Cyst). First-to-last analysis revealed that 65% (26/40) of patients initially categorized as IPMN were reclassified as Cyst by their final examination. Structured diagnostic codes and narrative uncertainty expressions follow divergent trajectories in pancreatic imaging surveillance. The persistence of hedging language despite code stability suggests that uncertainty reflects reporting practices and risk communication strategies rather than evolving diagnostic confidence, highlighting the need for improved alignment between structured and narrative diagnostic communication.