Expert radiologist review at a hepatobiliary multidisciplinary tumor board: impact on patient management
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HEPATOBILIARY
Expert radiologist review at a hepatobiliary multidisciplinary tumor board: impact on patient management Ryan Chung1 · Andrew B. Rosenkrantz1 · Krishna P. Shanbhogue1
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose To identify the frequency, source, and management impact of discrepancies between the initial radiology report and expert reinterpretation occurring in the context of a hepatobiliary multidisciplinary tumor board (MTB). Methods This retrospective study included 974 consecutive patients discussed at a weekly MTB at a large tertiary care academic medical center over a 2-year period. A single radiologist with dedicated hepatobiliary imaging expertise attended all conferences to review and discuss the relevant liver imaging and rated the concordance between original and re-reads based on RADPEER scoring criteria. Impact on management was based on the conference discussion and reflected changes in follow-up imaging, recommendations for biopsy/surgery, or liver transplant eligibility. Results Image reinterpretation was discordant with the initial report in 19.9% (194/974) of cases (59.8%, 34.5%, 5.7% RADPEER 2/3/4 discrepancies, respectively). A change in LI-RADS category occurred in 59.8% of discrepancies. Most common causes of discordance included re-classification of a lesion as benign rather than malignant (16.0%) and missed tumor recurrence (13.9%). Impact on management occurred in 99.0% of discordant cases and included loco-regional therapy instead of follow-up imaging (19.1%), follow-up imaging instead of treatment (17.5%), and avoidance of biopsy (12.4%). 11.3% received OPTN exception scores due to the revised interpretation, and 8.8% were excluded from listing for orthotopic liver transplant. Conclusion Even in a sub-specialized abdominal imaging academic practice, expert radiologist review in the MTB setting identified discordant interpretations and impacted management in a substantial fraction of patients, potentially impacting transplant allocation. The findings may impact how abdominal imaging sections best staff advanced MTBs. Keywords Multidisciplinary tumor board · Discrepancy · Liver tumor board · Hepatocellular carcinoma · HCC · LI-RADS
Introduction Discrepancy in radiology is known to be a significant factor contributing to the errors in medicine due to the prevalence of radiologic studies and the reliance on radiologists’ interpretations for diagnosis [1]. With approximately one billion radiologic studies performed annually worldwide [2] and an estimated real-time day-to-day radiologist error * Krishna P. Shanbhogue [email protected] Ryan Chung [email protected] Andrew B. Rosenkrantz [email protected] 1
Department of Radiology, NYU Langone Health, 660 First Ave, New York, NY 10016, USA
rate between 3-5% [3], conservative estimates for radiologist errors total 30 million errors annually. Radiologic discrepancies can be attributed to radiologist-specific and system-specific causes, s
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