Second-Opinion Interpretations of Gynecologic Oncologic MRI Examinations by Sub-Specialized Radiologists Influence Patient Care.
OBJECTIVE
To determine if second-opinion review of gynaecologic oncologic (GynOnc) magnetic resonance imaging (MRI) by sub-specialized radiologists impacts patient care.


METHODS
469 second-opinion MRI interpretations rendered by GynOnc radiologists were retrospectively compared to the initial outside reports. Two gynaecologic surgeons, blinded to the reports' origins, reviewed all cases with discrepancies between initial and second-opinion MRI reports and recorded whether these discrepancies would have led to a change in patient management defined as a change in treatment approach, counselling, or referral. Histopathology or minimum 6-month imaging follow-up were used to establish the diagnosis.


RESULTS
Second-opinion review of GynOnc MRIs would theoretically have affected management in 94/469 (20 %) and 101/469 (21.5 %) patients for surgeons 1 and 2, respectively. Specifically, second-opinion review would have theoretically altered treatment approach in 71/469 (15.1 %) and 60/469 (12.8 %) patients for surgeons 1 and 2, respectively. According to surgeons 1 and 2, these treatment changes would have prevented unnecessary surgery in 35 (7.5 %) and 31 (6.6 %) patients, respectively, and changed surgical procedure type/extent in 19 (4.1 %) and 12 (2.5 %) patients, respectively. Second-opinion interpretations were correct in 103 (83 %) of 124 cases with clinically relevant discrepancies between initial and second-opinion reports.


CONCLUSIONS
Expert second-opinion review of GynOnc MRI influences patient care.


CONCLUSIONS
• Outside gynaecologic oncologic MRI examinations are often submitted for a second-opinion review. • One-fifth of MRIs had important discrepancies between initial and second-opinion interpretations. • Second-opinion review of gynaecologic oncologic MRI is a valuable clinical service.
Department of Radiology, Breast and Imaging Center, Memorial Sloan Kettering Cancer Center, 300 East 66 Street, New York, NY, USA. lakhmany@mskcc.org.
Yulia
Y
Lakhman
Department of Radiology, Breast and Imaging Center, Memorial Sloan Kettering Cancer Center, 300 East 66 Street, New York, NY, USA.|Institute for Clinical Radiology, University Hospitals Munich - Campus Grosshadern, Munich, Germany.
Melvin
M
D'Anastasi
Department of Bioimaging and Radiological Science, Catholic University "A. Gemelli" Hospital, Rome, Italy.
Maura
M
Miccò
Surgery Department, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy.
Chiara
C
Scelzo
Department of Radiology, Breast and Imaging Center, Memorial Sloan Kettering Cancer Center, 300 East 66 Street, New York, NY, USA.
Hebert Alberto
HA
Vargas
Department of Imaging, CHU Montpellier, St. Eloi Hospital, Montpellier, France.|Institut de Recherche en Cancérologie de Montpellier (IRCM), Montpellier, France.
Stephanie
S
Nougaret
Department of Radiology, Breast and Imaging Center, Memorial Sloan Kettering Cancer Center, 300 East 66 Street, New York, NY, USA.
Ramon E
RE
Sosa
Gynecologic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Dennis S
DS
Chi
Gynecologic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Nadeem R
NR
Abu-Rustum
Department of Radiology, Breast and Imaging Center, Memorial Sloan Kettering Cancer Center, 300 East 66 Street, New York, NY, USA.
Hedvig
H
Hricak
Department of Radiology, Breast and Imaging Center, Memorial Sloan Kettering Cancer Center, 300 East 66 Street, New York, NY, USA.
Evis
E
Sala
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005833:Genital Neoplasms, Female / Q000175:diagnosis*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D015588:Observer Variation; D005791:Patient Care / Q000379:methods*; D000072177:Radiologists; D012017:Referral and Consultation; D012189:Retrospective Studies; D055815:Young Adult
Cancer; Gynaecologic oncologic imaging; Magnetic resonance imaging; Second opinion; Subspecialty radiologists