Common reasons radiologists missed head and neck cancer diagnoses on cross-sectional imaging
Physicians missed an opportunity to diagnose head and neck cancer on an earlier imaging exam in about 4% of cases, according to a new analysis published Tuesday.
The sixth most common malignancy worldwide, about 450,000 individuals die from this form of the disease each year. Early detection is crucial to improving outcomes, and patients often undergo head and neck imaging for various nonspecific symptoms, presenting opportunity for intervention, experts wrote in the Canadian Association of Radiologists Journal.
Wanting to better understand this challenge, researchers retrospectively reviewed cases from a regional head and neck cancer database, spanning five years. All told, 46 patients out of nearly 1,200 in the sample were diagnosed with cancer when the disease could have been caught on earlier scans, with a median delay to diagnosis of 153 days.
In about 70% of such misses, cancer was evident on prior CT or MRI and the physician overlooked it, while the other 30% were the result of misinterpretation.
“Unfortunately, perceptual errors plague both experienced and novice readers and can be due to a variety of factors such as high work volumes, reader fatigue, and workplace distractions,” Fangshi Lu, MD, and John Lysack, MD, both with the University of Calgary’s Department of Radiology, wrote Feb. 15. “General awareness of commonly missed cancer locations may help influence radiologists to perform a secondary review of possible blind spots.”
On plain CT scans of the head, many of the missed tumors in the study were in the nasopharynx or salivary glands. Both are in the peripheral field of view, the authors noted, and likely not scrutinized as thoroughly as the brain parenchyma. Provided patient histories correctly indicated a concern for malignancy but were dismissed by docs in 37% of cases. Meanwhile, misleading histories suggesting infection or inflammation were present in 28% of the 46 instances.
Lu and Lysack noted that interpretative errors can often stem from cognitive biases arising from the patient’s care history.
“We found this to be a particular problem for CT sinus studies, where a history of chronic sinusitis was provided, and a tumor was misinterpreted as a benign inflammatory polyp in the majority of cases,” the authors advised. “In these cases, there was clear evidence of osseous destruction or invasion of adjacent structures, which should raise the alarm for more aggressive pathologies.”
Read the full research letter in CARJ here.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.