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. 2020 Nov;45(11):3800-3808.
doi: 10.1007/s00261-020-02587-3.

Expert radiologist review at a hepatobiliary multidisciplinary tumor board: impact on patient management

Ryan Chung  1 , Andrew B Rosenkrantz  1 , Krishna P Shanbhogue  2
Affiliations

Expert radiologist review at a hepatobiliary multidisciplinary tumor board: impact on patient management

Ryan Chung et al. Abdom Radiol (NY). 2020 Nov.

Abstract

Purpose: To identify the frequency, source, and management impact of discrepancies between the initial radiology report and expert reinterpretation occurring in the context of a hepatobiliary multidisciplinary tumor board (MTB).

Methods: This retrospective study included 974 consecutive patients discussed at a weekly MTB at a large tertiary care academic medical center over a 2-year period. A single radiologist with dedicated hepatobiliary imaging expertise attended all conferences to review and discuss the relevant liver imaging and rated the concordance between original and re-reads based on RADPEER scoring criteria. Impact on management was based on the conference discussion and reflected changes in follow-up imaging, recommendations for biopsy/surgery, or liver transplant eligibility.

Results: Image reinterpretation was discordant with the initial report in 19.9% (194/974) of cases (59.8%, 34.5%, 5.7% RADPEER 2/3/4 discrepancies, respectively). A change in LI-RADS category occurred in 59.8% of discrepancies. Most common causes of discordance included re-classification of a lesion as benign rather than malignant (16.0%) and missed tumor recurrence (13.9%). Impact on management occurred in 99.0% of discordant cases and included loco-regional therapy instead of follow-up imaging (19.1%), follow-up imaging instead of treatment (17.5%), and avoidance of biopsy (12.4%). 11.3% received OPTN exception scores due to the revised interpretation, and 8.8% were excluded from listing for orthotopic liver transplant.

Conclusion: Even in a sub-specialized abdominal imaging academic practice, expert radiologist review in the MTB setting identified discordant interpretations and impacted management in a substantial fraction of patients, potentially impacting transplant allocation. The findings may impact how abdominal imaging sections best staff advanced MTBs.

Keywords: Discrepancy; HCC; Hepatocellular carcinoma; LI-RADS; Liver tumor board; Multidisciplinary tumor board.

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