Imaging-Based Disease Assessment and Management Recommendations: Impact of Multidisciplinary Sarcoma Tumor Board

Abstract

Multidisciplinary tumor boards (MTBs) facilitate decision-making among subspecialists in the care of oncology patients, but the mechanisms by which they enhance outcomes remain incompletely understood. Our aim was to measure the agreement between sarcoma MTBs and radiology reports' disease assessment and management recommendations. This single-center IRB-approved retrospective study evaluated cases presented at a weekly sarcoma MTB from 1 August 2020 to 31 July 2021. Cases without clinical notes, imaging studies, or radiology reports were excluded. The data collected included the patient's clinical status at the time of the MTB, the treatment response assessment by the MTB and radiologists (stable disease; partial response; complete response; progressive disease/recurrence), and the recommendations of the radiology reports and of the MTB. The agreement between the initial radiologist review and MTB on disease assessment and recommendations was analyzed using kappa statistics. In total, 283 cases met the inclusion criteria. Radiology reports provided recommendations in 34.3% of cases, which were adhered to by the ordering providers in 73.2% of cases. The agreement between MTBs and radiology reports was moderate in disease assessment (86.2% agreement; κ = 0.78; p < 0.0001) and negligible in recommendations (36% agreement; κ = 0.18; p < 0.0001). Radiologists were more likely to assign progressive disease/recurrence than MTBs (54.4% vs. 44.4%; p < 0.001) and to recommend short-term imaging follow-up more commonly than MTBs (46.4% vs. 21.7%; p < 0.001). At a tertiary care center, radiologists' isolated interpretations of imaging findings and management recommendations frequently differ from the MTB's consensus, reflecting the value of multidisciplinary discussions incorporating the patient's clinical status and the available treatment options into the final radiographic assessment.

Keywords: medical oncology; radiology; radiology reports; sarcoma.

Figure 1

Flowchart of patient enrollment, exclusion criteria, and final study population.

Figure 2

Discrepancy between radiology report and multidisciplinary tumor board assessment. A 55-year-old man with a metastatic high-grade undifferentiated pleomorphic sarcoma. Axial CT images (A,B) obtained at the time of diagnosis show two hypodense masses in the right posterior gluteal region and in the anterior abdominal wall (arrows). Axial CT images (C,D) obtained after 4 cycles of gemcitabine/taxotere show the mildly increased size of the masses but a decreased internal density and areas of fluid–fluid level within the anterior abdominal wall mass (arrowhead). The radiology report suggested the progression of the disease given the increase in the size of the lesions. The case was reviewed at a multidisciplinary tumor board and the consensus was that the increased tumor size was likely due to increased necrosis and possibly internal bleeding, suggesting a response to treatment. The findings were interpreted as stable disease. The patient was kept on gemcitabine/taxotere. Follow-up PET images (E,F) show only mild peripheral FDG uptake within the two masses (dashed arrows), suggesting a response to treatment.