Second-opinion imaging readings alter clinical care for HPB patients

Second-opinion imaging readings can directly affect the clinical management of patients with Hepatopancreaticobiliary (HPB) disease, reported authors of a Sept. 24 study in the American Journal of Roentgenology.

“This practice of providing a second opinion has been studied in a variety of subspecialties; however, its potential effect on the management of HPB disease is not known,” wrote lead author Anup S. Shetty, with Washington University School of Medicine in St. Louis, and colleagues.

The team retrospectively reviewed charts on 480 consecutive CT and MRI consultation reports completed between January 2014 and December 2015 for patients with HPB disease. All patients had initial CT and MRI reports generated at outside facilities.

Overall, a major discrepancy was found between the initial and secondary report in 27 to 28 percent of cases. The most common source of discrepancy was due to interpretation of findings as malignant versus benign (49 percent of cases) and the accuracy of staging (15 percent).

In 16 percent of cases, the outside facilities’ imaging was described as limited, primarily due to insufficient protocol or poor image quality.

“These discrepancies highlight the nature and added value of subspecialty radiology and the importance of the multidisciplinary environment for patients with complex HPB disease who may benefit from high-risk, high-reward procedures,” the authors wrote.

The group highlighted several limitations of the study, including its single-institution setting. Additionally, Shetty et al. noted the study goal was not intended to determine diagnostic accuracy and discrepancy between the original report and the secondary opinion.