title: Impact of neuroradiologist second opinion on staging and management of head and neck cancer.
abstract: OBJECTIVE
  Patients with head and neck cancer frequently present to academic tertiary referral centers with imaging studies that have been performed and interpreted elsewhere. At our institution, these outside head and neck imaging studies undergo formal second opinion reporting by a fellowship-trained academic neuroradiologist with expertise in head and neck imaging. The purpose of this study was to determine the impact of this practice on cancer staging and patient management.
  
  
  METHODS
  Our institutional review board approved the retrospective review of randomized original and second opinion reports for 94 consecutive cases of biopsy proven or clinically suspected head and neck cancer in calendar year 2010. Discrepancy rates for staging and recommended patient management were calculated and, for the 32% (30/94) of cases that subsequently went to surgery, the accuracies of the reports were determined relative to the pathologic staging gold standard.
  
  
  RESULTS
  Following neuroradiologist second opinion review, the cancer stage changed in 56% (53/94) of cases and the recommended management changed in 38% (36/94) of patients with head and neck cancer. When compared to the pathologic staging gold standard, the second opinion was correct 93% (28/30) of the time.
  
  
  CONCLUSIONS
  In a majority of patients with head and neck cancer, neuroradiologist second opinion review of their outside imaging studies resulted in an accurate change in their cancer stage and this frequently led to a change in their management plan.
authors.affiliation: Division of Neuroradiology, University of Calgary, Calgary, Alberta, Canada. john.lysack@ucalgary.ca.
authors.forename: John T
authors.initials: JT
authors.lastname: Lysack
authors.forename: Monica
authors.initials: M
authors.lastname: Hoy
authors.forename: Mark E
authors.initials: ME
authors.lastname: Hudon
authors.forename: Steven C
authors.initials: SC
authors.lastname: Nakoneshny
authors.forename: Shamir P
authors.initials: SP
authors.lastname: Chandarana
authors.forename: T Wayne
authors.initials: TW
authors.lastname: Matthews
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Dort
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging; D003951:Diagnostic Errors / Q000517:prevention & control; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009485:Neuroradiography; D011871:Radiology; D012017:Referral and Consultation; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D014057:Tomography, X-Ray Computed