检测复发性胰腺癌：由放射科亚专科医生进行横断面图像二次解读的价值。
Detection of recurrent pancreatic cancer: value of second-opinion interpretations of cross-sectional images by subspecialized radiologists.
机构信息
Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
Department of Radiology, Univerisità degli Studi di Cagliari, Cagliari, Italy.
出版信息
Abdom Radiol (NY). 2019 Feb;44(2):586-592. doi: 10.1007/s00261-018-1765-z.
PURPOSE
To investigate the value of second-opinion interpretation of cross-sectional images by subspecialized radiologists to diagnose recurrent pancreatic cancer after surgery.
METHODS
The IRB approved and issued a waiver of informed consent for this retrospective study. Initial and second-opinion interpretations of 69 consecutive submitted MRI or CT follow-up after pancreatic cancer resection between January 1, 2009 and December 31, 2013 were evaluated by one oncologic imaging radiologist, who was blinded to patient's clinical details and histopathologic data. The reviewer was asked to classify each interpretation in reference of the diagnosis of PDAC recurrence. It was also recorded if the radiologic interpretation recommended additional imaging studies to confirm recurrence. The diagnosis of recurrence was determined by pathology when available, otherwise by imaging follow-up, clinical, or laboratory assessments. Cohen's kappa statistic was used to assess agreement between initial and second-opinion interpretations. The differences between the initial and second-opinion interpretations were examined using McNemar test or Bowker's test of symmetry.
RESULTS
Disagreement on recurrence between the initial report and the second-opinion interpretation was observed in 32% of cases (22/69; k = 0.44). Second-opinion interpretations had a higher sensitivity and a higher specificity on recurrence compared to the initial interpretations (0.93 vs. 0.75 and 0.90 vs. 0.68, respectively), and the difference in specificity was significant (p = 0.016). Additional imaging studies were recommended more frequently in the initial interpretation (22% vs. 6%, p = 0.006).
CONCLUSIONS
Our study shows the second-opinion interpretation by subspecialized radiologists improves the detection of pancreatic cancer recurrence after surgical resection.
目的
探讨由专业放射科医生对手术后复发性胰腺癌的横断面图像进行二次解读的价值。
方法
本回顾性研究经 IRB 批准并豁免了知情同意。一位肿瘤影像学放射科医生对 2009 年 1 月 1 日至 2013 年 12 月 31 日连续 69 例胰腺癌切除术后提交的 MRI 或 CT 随访的初始和二次解读进行了评估，该放射科医生对患者的临床细节和组织病理学数据不了解。要求审查员根据 PDAC 复发的诊断对每项解读进行分类。还记录了放射学解读是否建议进行额外的影像学研究以确认复发。如果有病理结果，则根据病理结果诊断为复发，否则根据影像学随访、临床或实验室评估进行诊断。采用 Cohen's kappa 统计量评估初始和二次解读之间的一致性。采用 McNemar 检验或 Bowker 检验对称性检验来检验初始和二次解读之间的差异。
结果
在 32%的病例（22/69；k=0.44）中，初始报告与二次解读在复发方面存在分歧。与初始解读相比，二次解读在复发方面具有更高的敏感性和特异性（分别为 0.93、0.75 和 0.90、0.68），且特异性差异具有统计学意义（p=0.016）。在初始解读中，更频繁地推荐进行额外的影像学研究（22%比 6%，p=0.006）。
结论
我们的研究表明，专业放射科医生的二次解读可提高对手术后复发性胰腺癌的检测。
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