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

Abstract

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.

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Abbreviations

CA:

carcinoma

CI:

confidence interval

CT:

computed tomography

FIGO:

International Federation of Gynaecology and Obstetrics

GYN:

gynaecologic

GynOnc:

gynaecologic oncologic

MR:

magnetic resonance

MRI:

magnetic resonance imaging

PET:

positron emission tomography

SCC:

squamous cell carcinoma

US:

ultrasound

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Acknowledgments

The scientific guarantor of this publication is Evis Sala, MD, Ph.D., FRCR. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This research was funded in part through the MSK Cancer Center Support Grant/Core Grant (P30 CA008748). The authors thank Chaya Moskowitz PhD who kindly provided statistical advice for this manuscript and Ada Muellner MS who provided editorial support. Approval from the institutional review board of Memorial Sloan Kettering Cancer Center was obtained. Written informed consent was waived by the institutional review board. Methodology: retrospective, performed at one institution.

This study was a part of Melvin D’Anastasi’s doctoral thesis. Yulia Lakhman MD, Melvin D’Anastasi MD, Hedwig Hricak MD PhD, and Evis Sala MD PhD FRCR contributed equally to this study.

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Correspondence to Yulia Lakhman.

Additional information

Yulia Lakhman, Melvin D’Anastasi, Hedvig Hricak and Evis Sala contributed equally to this work.

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Lakhman, Y., D’Anastasi, M., Miccò, M. et al. Second-Opinion Interpretations of Gynecologic Oncologic MRI Examinations by Sub-Specialized Radiologists Influence Patient Care. Eur Radiol 26, 2089–2098 (2016). https://doi.org/10.1007/s00330-015-4040-5

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  • DOI: https://doi.org/10.1007/s00330-015-4040-5

Keywords

  • Magnetic resonance imaging
  • Gynaecologic oncologic imaging
  • Second opinion
  • Subspecialty radiologists
  • Cancer