Loevner Laurie A, Sonners Adina I, Schulman Brian J, Slawek Kerstin, Weber Randal S, Rosenthal David I, Moonis Gul, Chalian Ara A
Department of Radiology, University of Pennsylvania School of Medicine, University of Pennsylvania Medical Center, Philadelphia, PA 19104, USA.
AJNR Am J Neuroradiol. 2002 Nov-Dec;23(10):1622-6.
Patients referred to tertiary care centers frequently arrive with images obtained at outside institutions; these images require reinterpretation. We assessed the clinical value of reinterpreting cross-sectional imaging studies of patients with head and neck cancer, in the setting of a multidisciplinary cancer center.
Outside CT and MR images of 136 patients with known or presumed head and neck cancer were reinterpreted by a neuroradiologist. Clinical history and findings on physical examination were available. Reinterpretation was performed before review of outside reports, which were subsequently compared with those generated at the cancer center. Changes in interpretation were noted, and their effects on TNM staging, patient care, and prognosis were assessed. Reliability and statistical significance of rates of change in diagnosis were analyzed with 95% confidence intervals (CIs) and the sign test, respectively. Verification of change in diagnosis was confirmed by pathologic analysis (75%), characteristic radiologic findings (18%), or clinical and imaging follow-up (7%).
Change in interpretation occurred in 56 patients (41%) (95% CI: 33-49%, P <.001). Forty-six patients (34%) had a change in T, N, and/or M staging (26-42%, P <.001). Change in T stage occurred in 27 cases (20%) (13-27%, P <.001) (upstaged in 22, downstaged in five), and a change in N stage in 26 cases (19%) (12-26%, P <.001) (upstaged in 20, downstaged in six). Two patients (1.5%) had missed systemic metastases. Three patients with an initial diagnosis of cancer were found to be cancer-free, and six patients had a diagnosis of new second primary cancers that were missed at original interpretation. One patient had a missed middle cerebral artery aneurysm. Changes in image interpretation altered treatment in 55 (98%) of 56 patients and affected prognosis in 53 patients (95%) (P <.001).
Reinterpretation of cross-sectional images in the setting of a multidisciplinary cancer center has a significant effect on staging, management, and prognosis in patients with head and neck cancer.
转诊至三级医疗中心的患者常常带着在外院获取的影像资料前来；这些影像需要重新解读。我们在一个多学科癌症中心的背景下，评估了对头颈部癌患者的横断面影像研究进行重新解读的临床价值。
一位神经放射科医生对136例已知或疑似头颈部癌患者的外院CT和MR影像进行了重新解读。可获取临床病史和体格检查结果。在查看外院报告之前进行重新解读，随后将其与癌症中心生成的报告进行比较。记录解读的变化，并评估其对TNM分期、患者治疗和预后的影响。分别采用95%置信区间（CI）和符号检验分析诊断变化率的可靠性和统计学意义。通过病理分析（75%）、典型影像学表现（18%）或临床及影像随访（7%）证实诊断变化。
56例患者（41%）（95%CI：33 - 49%，P <.001）出现解读变化。46例患者（34%）的T、N和/或M分期发生变化（26 - 42%，P <.001）。27例（20%）患者的T分期发生变化（13 - 27%，P <.001）（22例分期上调，5例分期下调），26例（19%）患者的N分期发生变化（12 - 26%，P <.001）（20例分期上调，6例分期下调）。2例患者（1.5%）漏诊了全身转移。3例最初诊断为癌症的患者被发现无癌，6例患者被诊断为新的第二原发性癌症，这些在最初解读时被漏诊。1例患者漏诊了大脑中动脉瘤。影像解读的变化改变了56例患者中55例（98%）的治疗，并影响了53例患者（95%）的预后（P <.001）。
在多学科癌症中心对头颈部癌患者的横断面影像进行重新解读，对其分期、治疗和预后有显著影响。
