JOURNAL CLUB: Hepatopancreaticobiliary Imaging Second-Opinion Consultations: Is There Value in the Second Reading?
AJR Am J Roentgenol. 2018 Dec;211(6):1264-1272. doi: 10.2214/AJR.17.19452. Epub 2018 Sep 24.
Shetty AS1, Mittal A2, Salter A3, Narra VR1, Fowler KJ4.
OBJECTIVE: Tertiary care practices increasingly provide second-opinion consultations on reports from outside practices or institutions. This practice of providing a second opinion has been studied in a variety of subspecialties; however, its potential effect on the management of hepatopancreaticobiliary (HPB) disease is not known. The purpose of this study was to assess the rate of significant discrepancies between the initial report and the consultation report, the source of discrepancies, and the frequency of repeat imaging recommendations.
MATERIALS AND METHODS: Retrospective chart review was performed for 480 consecutive CT and MRI consultation reports interpreted between January 2014 and December 2015 for patients with HPB diseases whose initial CT and MRI reports were generated at outside facilities. The initial report and the consultation report were independently reviewed and compared by two abdominal radiologists. Discrepancies between the initial report and the consultation report were divided into minor and major differences in the detection or interpretation of abnormalities. Clinical importance was defined as a change in a finding or interpretation that directly impacted management of the patient.
RESULTS: A major discrepancy between the reports was identified in 27-28% of cases split evenly between detection and interpretation of abnormalities. Interreader agreement for categorization was moderate (weighted kappa value, 0.49). In consensus review, the rate of a major discrepancy occurring increased to 32%. Common sources of discrepancy were interpretation of findings as malignant versus benign (49% of cases) and accuracy of staging (15% of cases). Imaging limitations were described in 16% of cases, commonly as a result of an insufficient protocol or poor image quality.
CONCLUSION: Discrepancies in interpretation resulting in direct implications for clinical management are seen in almost one-third of HPB consultation cases. Second-opinion imaging consultation in the tertiary care setting can frequently impact management.