Effectiveness of second-opinion radiology consultations to reassess the cervical spine CT scans: a study on trauma patients referred to a tertiary-care hospital

Abstract

M agnetic resonance imaging (MRI) is a widely used diagnostic tool for breast imaging in daily practice, with its high sensitivity to detect primary, recurrent, and residual breast cancer. Breast MRI serves as a reliable problem-solving tool in case of inconclusive mammography and ultrasonography (US) findings. It can be used to monitor the results of neoadjuvant chemotherapy and it may also contribute to preoperative evaluation of known lesions. With increasing use of MRI, number of breast lesions visible only on MRI and need for MRI-guided breast biopsy have increased (1). Second-look US can also be used for re-evaluation of these lesions; because US-guided biopsy is an easier, cheaper, and faster method if these lesions are visible on second-look US. According to a recently published meta-analysis, lesion detection rates with second-look US are variable in the literature (22.6%-82.1%). Mass lesions and malignant lesions were more likely to be detected at second-look US; average detection rates were 66% for masses, 29% for non-mass-like enhancement (NME) (2, 3). However, focal or NME lesions, which are less detectable than masses on second-look US, require MRI-guided biopsy in the majority of cases. According to the MRI-guided biopsy series in the literature, approximately 25%-35% of these lesions are diagnosed as malignant (4-9).Within this context, the aim of the present study is to assess the effectiveness of MRI-guided 10 Gauge (G) vacuum-assisted breast biopsies (VABB) performed at our institution and to examine the relationship between lesion characteristics and histopathologic results. B R E A S T I MAG I N G O R I G I N A L A R T I C L E PURPOSEWe aimed to assess the effectiveness of magnetic resonance imaging (MRI)-guided vacuum-assisted breast biopsy (VABB), evaluate and compare the characteristics and histopathologic findings of lesions, and overview the follow-up results of benign lesions. METHODSMRI findings and histopathologic results of breast lesions biopsied by MRI-guided VABB between 2013 and 2016 were retrospectively analyzed. MRI findings closely related with malignancy were investigated in particular. Follow-up results of benign lesions were evaluated. RESULTSMRI-guided VABB was applied to 116 lesions of 112 women. Of the lesions, 75 (65%) were benign, while 41 (35%) were malignant. Segmental (94%), clustered (89%), and clustered ring (67%) nonmass-like enhancement patterns were found to be more related with malignancy. False-negative rate of MRI-guided VABB was 12%, underestimation rate was 21%. One of the 54 followed-up benign lesions had a malignant result. CONCLUSION MRI-guided VABB is a reliable method for the diagnosis of breast lesions that are positive only on MRI. Follow-up results show that cancer detection rate is low for radio-pathologically concordant lesions. Further multicenter studies with larger patient population are needed to elucidate these results.You may cite this article as: Taşkın F, Soyder A, Tanyeri A, Öztürk VS, Ünsal A. Lesion characteristics, histopathologic r...

Patient-initiated second opinions during acute hospital care

“…Second opinions are described in the literature as an important tool for preventing medical errors and for providing patients with the most effective treatment possible. 15 Therefore, both physicians and patients may benefit from second opinion consultations. However, this study demonstrated that acute care patients often show passive attitude towards seeking a second opinion during hospitalization, although some reported seeking a second opinion in the past (not during a hospitalization period).…”

“…Most studies that examined second opinions during hospitalization focused on second opinions initiated by physicians. [14][15] Studies that did examine patients' initiated second opinion were mostly among oncology patients. 9 These studies focused on reasons, motives and expectations in relation to second opinion, 1,16 and did not focus on the barriers patients are facing when seeking a second opinion.…”

Tablets for Image Review and Communication in Daily Routine of Orthopedic Surgeons—An Evaluation Study

“…Having said that it is known that a second or more opinions on medical images increases the accuracy of the diagnosis for various diseases (e.g., in neuroradiology [4], for breast cancer diagnosis [5] or for reassessment of cervical spine CTs [6]), the disparity between the number of professionals and the amount of data has become a major challenge with respect to accurate and efficient reporting. Due to the sheer number of images and the lack of adequate tools, the time for reviewing radiological images has become less-not just for diagnostic reporting, but also for surgical preparation, for example.…”

Risk factors for computed tomography interpretation discrepancy in emergently transferred patients

“…[2] Thus, it has become important for the patient's treatment plan to immediately reconfi rm the CT image of a transferred patient in the referred ED. [3] However, previous studies conducted on patients visiting EDs reported significant discrepancies of interpretations between EDs for the same CT image. [2][3][4][5] If such a discrepancy is found in the ED, the clinical process could change, and the performance of additional imaging may be required, resulting in unnecessary radiation exposure and an increased cost burden on patients.…”

“…[3] However, previous studies conducted on patients visiting EDs reported significant discrepancies of interpretations between EDs for the same CT image. [2][3][4][5] If such a discrepancy is found in the ED, the clinical process could change, and the performance of additional imaging may be required, resulting in unnecessary radiation exposure and an increased cost burden on patients. [6] Moreover, additional imaging studies may lead to prolonged ED length of stay (LOS), in turn causing ED crowding, which can adversely affect the patient's clinical results and reduce the patient's satisfaction level.…”