A Tale of Two Pathologies

Abstract

Background: In workup for a tumor in an individual, a second pathology is discovered at times, which can complicate further management. Cross-sectional imaging is widely utilized in gastrointestinal tumors leading to identification of incidentalomas, and we audited our multidisciplinary team (MDT) meeting data in order to analyze the implications and refine the approach in the presence of dual pathology. Materials and Methods: This study was a retrospective assessment of a prospectively maintained single institute gastrointestinal tumor board MDT database between June 2019 and June 2020. Results: Of the 76 patients discussed in the gastrointestinal MDT, 21 patients associated with clinically relevant second pathology were included in the study group. Positron emission tomography–computed tomography (PET-CT) was the most common modality responsible for detection of the second pathology. Additional workup to better characterize these findings was needed in 10 (47.6%) patients. Eleven patients had dual neoplasms, of which four accounted for dual malignant neoplasms. MDT resulted in a change in plan in 6 (28.6%) patients, which was mainly related to radiology review, thereby downstaging to the correct stage. Conclusions: PET-CT increases detection of a second pathology in gastrointestinal tumors. Appropriate review of radiology, supplementing with additional imaging and/or biopsy, and wait and reassess in selected situations in an MDT is pivotal in management of a double pathology.