Second opinion interpretations by specialty radiologists in head-and-neck oncology and their impact on clinical management: A retrospective observational study

Abstract

Background: Patients with medical imaging performed and interpreted elsewhere often come to tertiary referral centers for further management. At our tertiary cancer hospital, external imaging studies of patients with head-and-neck cancer undergo formal second opinion reporting by subspecialty oncoradiologists. Objectives: We aimed to audit the second in-house review of outside scans by specialized head-and-neck radiologists to estimate the potential impact on patient management. Our secondary objective was to determine the direct impact of the second opinion by head-and-neck specialist radiologists on the change in diagnosis, stage, and management of patients. We also aimed to determine the indirect impact on the cost–benefit ratio and the time taken for decision making. Materials and Methods: This was a retrospective review of original and second opinion reports for consecutive patients that came with films/compact discs (CDs) and reports of computed tomography (CT), magnetic resonance imaging (MRI), or positron resonance imaging - computed tomography (PET-CT), initially performed and interpreted at another institution, and later, a second opinion review of imaging was done by the in-house subspecialty radiologists in head-and-neck onco-imaging between May 2016 and December 2017. The rates of discrepancy for staging and recommended management and the report accuracy were determined and compared to the gold standard: pathological staging. Results: Following the specialist in-house radiologist's second opinion review, the cancer stage changed in 28% (139/492) cases, and the management recommendation changed in 6.7% (67/492) of the patients with head-and-neck cancer. Compared to the histopathology results that were available for 93/492 (19%) cases, the second opinion interpretation was correct 87% of the time (81/93). The average time saved by the second radiology opinion was 8.6 days. Significant monetary savings amounting to ₹11,35,590 ($13,788.3) were achieved. Conclusion: A second opinion review of outside imaging in patients with head-and-neck cancer by expert in-house onco-radiologists results in a change in the stage of cancer and the management plan in a significant number of cases, saves time by expediting the work-up, and helps to avoid expenditure on repeat imaging.

Keywords

• head-and-neck radiology
• head–neck oncology
• radiology review
• second opinion