title: Reinterpretation of radiological imaging in patients referred to a tertiary referral centre with a suspected pancreatic or hepatobiliary malignancy: impact on treatment strategy.
abstract: Our objective was to determine the clinical importance of reinterpretation of radiological investigations performed in a referring hospital and the value of additional investigations in a referral centre. A panel of four experts retrospectively evaluated the technical quality of radiological investigations and made reinterpretation reports, of 78 patients referred with a suspected pancreatic or hepatobiliary malignancy. The value of additional radiological investigations performed in the referral centre was assessed. The quality of ultrasound and CT examinations was sufficient for reinterpretation in (36 of 69) 52% and (42 of 60) 70%, respectively. The reinterpretation reports of the ultrasound investigations were scored as "in accordance" in (30 of 36) 83%, as "minor discordance" in (3 of 36) 8% and as "major discordance" in (3 of 36) 8%. For CT proportions of (29 of 42) 69%, (8 of 42) 19% and (5 of 42) 12%, respectively, were found. Additional ultrasound ( n=55) showed no additional findings in 16%, minor additional findings in 53% and major additional findings in 31% of cases. For additional spiral CT scan ( n=47) results were of 21, 47 and, 32%, respectively. Reinterpretation of ultrasound and CT resulted in a change in treatment strategy for 7 patients (9%). Additional ultrasound or CT resulted in a change in treatment strategy for 24 patients (30%). Improved communication and reinterpretation of radiological investigations may reduce unnecessary referral.
authors.affiliation: Department of Surgery of the Academic Medical Center Amsterdam, Suite G4-144, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
authors.forename: Esther H B M
authors.initials: EH
authors.lastname: Tilleman
authors.forename: Saffire S K S
authors.initials: SS
authors.lastname: Phoa
authors.forename: Otto M
authors.initials: OM
authors.lastname: Van Delden
authors.forename: Erik A J
authors.initials: EA
authors.lastname: Rauws
authors.forename: Thomas M
authors.initials: TM
authors.lastname: van Gulik
authors.forename: Johan S
authors.initials: JS
authors.lastname: Laméris
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Gouma
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging* / Q000473:pathology*; D018281:Cholangiocarcinoma / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D012017:Referral and Consultation; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler