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

• Published in: Cancer research, statistics, and treatment (Online) Vol. 5; no. 4; pp. 652 - 659
• Main Authors: Mahajan, Abhishek, Shukla, Shreya, Mali, Raghvendra, Agarwal, Ujjwal, Sable, Nilesh, Vaish, Richa, Ankathi, Suman, Patil, Vasundhara, Janu, Amit, Prabhash, Kumar, Noronha, Vanita, Pai, Prathamesh, Laskar, Sarbani, Patil, Asawari, Patil, Vijay, Menon, Nandini, Thiagarajan, Shivakumar, Chaturvedi, Pankaj
• Format: Journal Article
• Language: English
• Published: Wolters Kluwer India Pvt. Ltd 01-10-2022; Wolters Kluwer Medknow Publications
• Subjects: head-and-neck radiology; head–neck oncology; radiology review; second opinion; Head-and-neck radiology; second opinion; head-neck oncology; radiology review
• ISSN: 2590-3233; 2590-3225
• DOI: 10.4103/crst.crst_36_22

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.