Impact of neuroradiologist second opinion on staging and management of head and neck cancer

Journal of Otolaryngology-Head & Neck Surgery

Joseph C Dort³  T Wayne Matthews³  Shamir P Chandarana³  Steven C Nakoneshny³  Mark E Hudon¹  Monica Hoy⁴  John T Lysack² 

[1] Division of Neuroradiology, University of Calgary, Calgary, Alberta, Canada;Department of Diagnostic Imaging, Foothills Medical Centre, 1403-29 Street NW, Calgary, AB T2N 2T9, Canada;The Ohlson Research Initiative, University of Calgary, Calgary, Alberta, Canada;Division of Otolaryngology-Head and Neck Surgery, University of Calgary, Calgary, Alberta, Canada

关键词: Quality improvement;    Head and neck cancer;    Cancer staging;    Radiology;    Second opinion;   

Others  :  861731
DOI  :  10.1186/1916-0216-42-39

 received in 2013-03-06, accepted in 2013-05-25,  发布年份 2013

【 摘 要 】

Objective

Patients with head and neck cancer frequently present to academic tertiary referral centers with imaging studies that have been performed and interpreted elsewhere. At our institution, these outside head and neck imaging studies undergo formal second opinion reporting by a fellowship-trained academic neuroradiologist with expertise in head and neck imaging. The purpose of this study was to determine the impact of this practice on cancer staging and patient management.

Methods

Our institutional review board approved the retrospective review of randomized original and second opinion reports for 94 consecutive cases of biopsy proven or clinically suspected head and neck cancer in calendar year 2010. Discrepancy rates for staging and recommended patient management were calculated and, for the 32% (30/94) of cases that subsequently went to surgery, the accuracies of the reports were determined relative to the pathologic staging gold standard.

Results

Following neuroradiologist second opinion review, the cancer stage changed in 56% (53/94) of cases and the recommended management changed in 38% (36/94) of patients with head and neck cancer. When compared to the pathologic staging gold standard, the second opinion was correct 93% (28/30) of the time.

Conclusion

In a majority of patients with head and neck cancer, neuroradiologist second opinion review of their outside imaging studies resulted in an accurate change in their cancer stage and this frequently led to a change in their management plan.

【 授权许可】

   
2013 Lysack et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM: Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010, 127:2893-2917.
• [2]DiPiro PJ, VanSonnenberg E, Tumeh SS, Ros PR: Volume and impact of second-opinion consultations by radiologists at a tertiary care cancer center: data. Acad Radiol 2002, 9:1430-1433.
• [3]AJCC: Head and neck. In AJCC cancer staging manual. 7th edition. Edited by Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. New York, NY: Springer; 2010:21-100.
• [4]Fleiss JL: Measuring nominal scale agreement among many raters. Psychol Bull 1971, 76:378-382.
• [5]Agresti A, Coull BA: Approximate is better than "exact" for interval estimation of binomial proportions. Am Stat 1998, 52:119-126.
• [6]Fisher RA: On the interpretation of χ2 from contingency tables, and the calculation of P. J R Stat Soc 1922, 85:87-94.
• [7]Landis JR, Koch GG: The measurement of observer agreement for categorical data. Biometrics 1977, 33:159-174.
• [8]Loevner LA, Sonners AI, Schulman BJ, Slawek K, Weber RS, Rosenthal DI, Moonis G, Chalian AA: Reinterpretation of cross-sectional images in patients with head and neck cancer in the setting of a multidisciplinary cancer center. AJNR Am J Neuroradiol 2002, 23:1622-1626.
• [9]Wheless SA, McKinney KA, Zanation AM: A prospective study of the clinical impact of a multidisciplinary head and neck tumor board. Otolaryngol Head Neck Surg 2010, 143:650-654.
• [10]Loughrey GJ, Carrington BM, Anderson H, Dobson MJ, Lo Ying Ping F: The value of specialist oncological radiology review of cross-sectional imaging. Clin Radiol 1999, 54:149-154.
• [11]Tilleman EH, Phoa SS, Van Delden OM, Rauws EA, Van Gulik TM, Lameris JS, Gouma DJ: Reinterpretation of radiological imaging in patients referred to a tertiary referral centre with a suspected pancreatic or hepatobiliary malignancy: impact on treatment strategy. Eur Radiol 2003, 13:1095-1099.
• [12]Gollub MJ, Panicek DM, Bach AM, Penalver A, Castellino RA: Clinical importance of reinterpretation of body CT scans obtained elsewhere in patients referred for care at a tertiary cancer center. Radiology 1999, 210:109-112.
• [13]Briggs GM, Flynn PA, Worthington M, Rennie I, McKinstry CS: The role of specialist neuroradiology second opinion reporting: is there added value? Clin Radiol 2008, 63:791-795.
• [14]Zan E, Yousem DM, Carone M, Lewin JS: Second-opinion consultations in neuroradiology. Radiology 2010, 255:135-141.
• [15]Newman EA, Guest AB, Helvie MA, Roubidoux MA, Chang AE, Kleer CG, Diehl KM, Cimmino VM, Pierce L, Hayes D, Newman LA, Sabel MS: Changes in surgical management resulting from case review at a breast cancer multidisciplinary tumor board. Cancer 2006, 107:2346-2351.
• [16]Brook OR, Hakmon T, Brook A, Dudnik E, Kuten A, Engel A: The effect of a radiology conference consultation on cancer patients management. Ann Oncol 2011, 22:1204-1208.
• [17]Kronz JD, Westra WH, Epstein JI: Mandatory second opinion surgical pathology at a large referral hospital. Cancer 1999, 86:2426-2435.
• [18]Bruner JM, Inouye L, Fuller GN, Langford LA: Diagnostic discrepancies and their clinical impact in a neuropathology referral practice. Cancer 1997, 79:796-803.
• [19]Coblentz TR, Mills SE, Theodorescu D: Impact of second opinion pathology in the definitive management of patients with bladder carcinoma. Cancer 2001, 91:1284-1290.
• [20]Lueck N, Jensen C, Cohen MB, Weydert JA: Mandatory second opinion in cytopathology. Cancer 2009, 117:82-91.
• [21]Selman AE, Niemann TH, Fowler JM, Copeland LJ: Quality assurance of second opinion pathology in gynecologic oncology. Obstet Gynecol 1999, 94:302-306.
• [22]Bejarano PA, Koehler A, Sherman KE: Second opinion pathology in liver biopsy interpretation. Am J Gastroenterol 2001, 96:3158-3164.
• [23]Layfield LJ, Jones C, Rowe L, Gopez EV: Institutional review of outside cytology materials: a retrospective analysis of two institutions' experiences. Diagn Cytopathol 2002, 26:45-48.
• [24]Hahm GK, Niemann TH, Lucas JG, Frankel WL: The value of second opinion in gastrointestinal and liver pathology. Arch Pathol Lab Med 2001, 125:736-739.
• [25]Westra WH, Kronz JD, Eisele DW: The impact of second opinion surgical pathology on the practice of head and neck surgery: a decade experience at a large referral hospital. Head Neck 2002, 24:684-693.
• [26]Hamady ZZ, Mather N, Lansdown MR, Davidson L, Maclennan KA: Surgical pathological second opinion in thyroid malignancy: impact on patients' management and prognosis. Eur J Surg Oncol 2005, 31:74-77.
• [27]Bajaj J, Morgenstern N, Sugrue C, Wasserman J, Wasserman P: Clinical impact of second opinion in thyroid fine needle aspiration cytology (FNAC): A study of 922 interinstitutional consultations. Diagn Cytopathol 2012, 40:422-429.
• [28]Jones K, Jordan RC: Patterns of second-opinion diagnosis in oral and maxillofacial pathology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010, 109:865-869.
• [29]Wieske L, Wijers D, Richard E, Vergouwen MD, Stam J: Second opinions and tertiary referrals in neurology: a prospective observational study. J Neurol 2008, 255:1743-1749.
• [30]Srinivasan A, Mohan S, Mukherji SK: Biologic imaging of head and neck cancer: the present and the future. AJNR Am J Neuroradiol 2012, 33:586-594.
• [31]Manion E, Cohen MB, Weydert J: Mandatory second opinion in surgical pathology referral material: clinical consequences of major disagreements. Am J Surg Pathol 2008, 32:732-737.
• [32]Borgstede JP, Lewis RS, Bhargavan M, Sunshine JH: RADPEER quality assurance program: a multifacility study of interpretive disagreement rates. J Am Coll Radiol 2004, 1:59-65.
• [33]Berlin L: Accuracy of diagnostic procedures: has it improved over the past five decades? AJR Am J Roentgenol 2007, 188:1173-1178.
• [34]Babiarz LS, Yousem DM: Quality control in neuroradiology: discrepancies in image interpretation among academic neuroradiologists. AJNR Am J Neuroradiol 2012, 33:37-42.