Second-opinion imaging consultations impact care for patients with HPB disease
Second-opinion imaging consultations can directly impact the management of patients with hepatopancreaticobiliary (HPB) disease, according to new research published in the American Journal of Roentgenology.
“The practice of providing second-opinion reports is somewhat novel at our institution and many other centers,” wrote Anup S. Shetty, MD, Mallinckrodt Institute of Radiology at Washington University School of Medicine in St. Louis, and colleagues. “To better understand the implications and benefit of second-opinion consultations, we aimed to evaluate the rate of significant change in diagnosis and the potential impact on patient management.”
The authors retrospectively reviewed data from 480 consecutive CT and MRI consultation reports interpreted in 2014 and 2015 for patients with HPB disease when the initial exam was performed at another facility. Overall, a major discrepancy between the original exam and the second-opinion exam was identified in 27 to 28 percent of the cases. In 49 percent of cases, the discrepancy was related to whether the finding was malignant or benign. The discrepancy was related to the accuracy of staging in 15 percent of cases.
“These discrepancies highlight the nature and added value of subspecialty radiology and the importance of the multidisciplinary environment for patients with complex HPB disease who may benefit from high high-risk, high-reward procedures,” the authors wrote.
In 16 percent of cases, the outside facility’s imaging was considered “limited.” Common limitations include a lack of IV contrast medium, incomplete imaging protocols or poor image quality. Such instances potentially lead to repeat imaging.
“Unfortunately, there is wide variability in the sequences, acquisition parameters, scanner quality, and protocols that may not be optimized outside the subspecialty environment,” the authors wrote. “It should be noted that outside facilities face added challenges when patients present in the emergent or acute setting without a prior diagnosis. This often leads to a more general protocol to capture a wide differential.”
Shetty and colleagues noted that their research did have certain limitations. For instance, it is a single-institution study that may not represent trends in other areas. Also, they did not focus on cost-effectiveness or cost savings in this study, though they said future studies should look more closely at that aspect of this specific issue.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.