Carter Brett W, Erasmus Jeremy J, Truong Mylene T, Shepard Jo-Anne O, Hofstetter Wayne, Clarke Ryan, Munden Reginald F, Steele Joseph R
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
J Am Coll Radiol. 2017 Aug;14(8):1109-1118. doi: 10.1016/j.jacr.2017.02.004. Epub 2017 Apr 21.
Patients referred to tertiary cancer centers often present with imaging studies performed and interpreted at other health care institutions. Although reinterpretation of imaging performed at another health care institution can reduce repeat imaging, unnecessary radiation dose, and cost, the benefit is uncertain. The purpose of this study is to evaluate the quality of initial imaging studies of patients seeking a second opinion at a tertiary cancer center, to compare the accuracy of initial interpretations to reinterpretations performed by subspecialty trained radiologists at a tertiary oncologic center, and to determine the potential impact on patient management.
An institutional review board-approved retrospective, single-institution database review was performed in 120 new patients presenting to the thoracic surgery clinics at our institution from 2010 through 2013, with initial chest CTs performed at another institution. Two thoracic radiologists blinded to the interpretation independently assessed the quality and performed a reinterpretation of 52 CTs. Fisher's exact tests were used to compare the frequency with which clinically important staging parameters appeared in the reinterpretations and initial reports. Discrepancies between the reinterpretations and initial interpretations were adjudicated independently by two thoracic radiologists at different tertiary cancer institutions to determine which interpretations were more accurate. The impact of discrepancies on clinical management was evaluated based on National Comprehensive Cancer Network guidelines.
Of the 52 CTs, 32 (62%) were of inadequate image quality for staging. In 17 of 52 (33%), discrepancies were identified between reinterpretations and initial interpretations. For discrepancies, the reinterpretation was judged to be more accurate for staging than the initial interpretation. In nine of these patients, staging parameters were omitted in the initial interpretations that precluded adequate staging. In the remaining eight patients, six were upstaged, one was downstaged, and one was unchanged by the reinterpretation.
Imaging studies from outside institutions are of variable image quality and often not adequate for appropriate staging of thoracic malignancies. Reinterpretation can decrease repeat imaging and associated technical costs. Additionally, the accuracy of staging is improved by reinterpretation of CTs by subspecialty trained radiologists and can significantly impact clinical management.
转诊至三级癌症中心的患者通常已在其他医疗机构进行并解读过影像学检查。尽管重新解读在其他医疗机构进行的影像学检查可减少重复成像、不必要的辐射剂量和成本，但其益处尚不确定。本研究的目的是评估在三级癌症中心寻求二次诊断的患者初始影像学检查的质量，比较初始解读与由三级肿瘤中心经过亚专业培训的放射科医生进行的重新解读的准确性，并确定对患者管理的潜在影响。
对2010年至2013年期间在我院胸外科门诊就诊的120例新患者进行了一项经机构审查委员会批准的回顾性、单机构数据库审查，这些患者的初始胸部CT是在其他机构进行的。两名对解读结果不知情的胸科放射科医生独立评估图像质量，并对52例CT进行重新解读。采用Fisher精确检验比较重新解读和初始报告中临床重要分期参数出现的频率。重新解读与初始解读之间的差异由不同三级癌症机构的两名胸科放射科医生独立判定，以确定哪种解读更准确。根据美国国立综合癌症网络指南评估差异对临床管理的影响。
在52例CT中，32例（62%）图像质量不足以进行分期。在52例中的17例（33%）中，重新解读与初始解读之间存在差异。对于差异情况，重新解读在分期方面被判定比初始解读更准确。在这些患者中的9例中，初始解读遗漏了分期参数，从而无法进行充分分期。在其余8例患者中，6例分期上调，1例分期下调，1例重新解读后分期不变。
外部机构的影像学检查图像质量参差不齐，通常不足以对胸段恶性肿瘤进行适当分期。重新解读可减少重复成像及相关技术成本。此外，经过亚专业培训的放射科医生对CT进行重新解读可提高分期的准确性，并可显著影响临床管理。
