Clinical importance of second-opinion interpretations by radiologists specializing in gynecologic oncology at a tertiary cancer center: magnetic resonance imaging for endometrial cancer staging

Abstract Objective: To determine whether there are substantive differences between the initial interpretations of magnetic resonance imaging (MRI) scans acquired at outside facilities and the second-opinion interpretations of radiologists specializing in gynecologic oncology at a tertiary cancer center, among patients referred for endometrial cancer staging. Materials and Methods: This was a retrospective, comparative analysis of 153 initial and second-opinion MRI reports for endometrial cancer staging officially submitted for review by radiologists specializing in gynecologic oncology. For each case, the relationship between the initial and second-opinion reports, regarding the suggested diagnosis and the clinically relevant MRI findings reported, was categorized as "agreement" or "disagreement". Histopathology was used in order to establish the definitive diagnosis. Results: Disagreement was found in 58 (37.9%) of the 153 cases. Second-opinion interpretations reported findings that affected the preoperative cancer staging and could have led to a change in treatment in 38 cases (24.8%); that did not affect the preoperative staging but provided information that was more accurate in 8 (5.2%); and that suggested a new cancer diagnosis in 12 (7.8%). In 37 cases (24.2%), there was a potential for changes in patient care. Among the 58 cases of disagreement, a definitive (histopathological) diagnosis was made in 41 (70.7%). In 31 (75.6%) of those 41 cases, the second-opinion report was more accurate than was the initial report. Conclusion: Discordant interpretations of MRI examinations, which can have a substantial effect on the clinical management of patients, appear to be common.

摘要 研究目的：旨在明确在转诊行子宫内膜癌分期的患者中，外院获取的磁共振成像（magnetic resonance imaging, MRI）初始解读，与三级癌症中心内妇科肿瘤学专科放射医师出具的第二意见解读之间是否存在实质性差异。

材料与方法：本研究为回顾性对比分析，纳入153份用于子宫内膜癌分期的初始MRI报告及第二意见报告，均由妇科肿瘤学专科放射医师正式提交审核。针对每例病例，将初始报告与第二意见报告在提示诊断及报告的临床相关性MRI表现方面的一致性分为"一致"或"不一致"两类。以组织病理学作为确诊金标准。

结果：153例病例中，58例（37.9%）存在解读不一致。第二意见报告中，38例（24.8%）的影像学发现可影响术前癌症分期，进而可能改变治疗方案；8例（5.2%）未影响术前分期，但提供了更为准确的信息；12例（7.8%）提示存在新的癌症诊断。37例（24.2%）存在改变患者诊疗方案的潜在可能。在58例不一致病例中，41例（70.7%）获得了明确的组织病理学诊断。在这41例中，31例（75.6%）的第二意见报告比初始报告更为准确。

结论：可对患者临床管理产生实质性影响的MRI检查解读不一致情况，似乎较为常见。