Second-Opinion Interpretations of Gynecologic Oncologic MRI Examinations by Sub-Specialized Radiologists Influence Patient Care

• Published in: European radiology 2016-07, Vol.26 (7), p.2089-2098
• Main Authors: Lakhman, Yulia, D’Anastasi, Melvin, Miccò, Maura, Scelzo, Chiara, Vargas, Hebert Alberto, Nougaret, Stephanie, Sosa, Ramon E., Chi, Dennis S., Abu-Rustum, Nadeem R., Hricak, Hedvig, Sala, Evis
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Bioengineering; Cancer; Diagnostic Radiology; Female; Genital Neoplasms, Female - diagnosis; Health care delivery; Health care policy; Histopathology; Human health and pathology; Humans; Imaging; Internal Medicine; Interventional Radiology; Life Sciences; Magnetic Resonance Imaging; Medicine; Medicine & Public Health; Middle Aged; Neuroradiology; Nuclear medicine; Observer Variation; Oncology; Patient Care - methods; Patients; Radiologists; Radiology; Referral and Consultation; Retrospective Studies; Surgeons; Surgery; Tomography; Ultrasound; Young Adult
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-015-4040-5

Purpose To determine if second-opinion review of gynaecologic oncologic (GynOnc) magnetic resonance imaging (MRI) by sub-specialized radiologists impacts patient care. Methods 469 second-opinion MRI interpretations rendered by GynOnc radiologists were retrospectively compared to the initial outside reports. Two gynaecologic surgeons, blinded to the reports’ origins, reviewed all cases with discrepancies between initial and second-opinion MRI reports and recorded whether these discrepancies would have led to a change in patient management defined as a change in treatment approach, counselling, or referral. Histopathology or minimum 6-month imaging follow-up were used to establish the diagnosis. Results Second-opinion review of GynOnc MRIs would theoretically have affected management in 94/469 (20 %) and 101/469 (21.5 %) patients for surgeons 1 and 2, respectively. Specifically, second-opinion review would have theoretically altered treatment approach in 71/469 (15.1 %) and 60/469 (12.8 %) patients for surgeons 1 and 2, respectively. According to surgeons 1 and 2, these treatment changes would have prevented unnecessary surgery in 35 (7.5 %) and 31 (6.6 %) patients, respectively, and changed surgical procedure type/extent in 19 (4.1 %) and 12 (2.5 %) patients, respectively. Second-opinion interpretations were correct in 103 (83 %) of 124 cases with clinically relevant discrepancies between initial and second-opinion reports. Conclusions Expert second-opinion review of GynOnc MRI influences patient care. Key points • Outside gynaecologic oncologic MRI examinations are often submitted for a second - opinion review . • One - fifth of MRIs had important discrepancies between initial and second - opinion interpretations . • Second - opinion review of gynaecologic oncologic MRI is a valuable clinical service .