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Detection of recurrent pancreatic cancer: value of second-opinion interpretations of cross-sectional images by subspecialized radiologists

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Abstract

Purpose

To investigate the value of second-opinion interpretation of cross-sectional images by subspecialized radiologists to diagnose recurrent pancreatic cancer after surgery.

Methods

The IRB approved and issued a waiver of informed consent for this retrospective study. Initial and second-opinion interpretations of 69 consecutive submitted MRI or CT follow-up after pancreatic cancer resection between January 1, 2009 and December 31, 2013 were evaluated by one oncologic imaging radiologist, who was blinded to patient’s clinical details and histopathologic data. The reviewer was asked to classify each interpretation in reference of the diagnosis of PDAC recurrence. It was also recorded if the radiologic interpretation recommended additional imaging studies to confirm recurrence. The diagnosis of recurrence was determined by pathology when available, otherwise by imaging follow-up, clinical, or laboratory assessments. Cohen’s kappa statistic was used to assess agreement between initial and second-opinion interpretations. The differences between the initial and second-opinion interpretations were examined using McNemar test or Bowker’s test of symmetry.

Results

Disagreement on recurrence between the initial report and the second-opinion interpretation was observed in 32% of cases (22/69; k = 0.44). Second-opinion interpretations had a higher sensitivity and a higher specificity on recurrence compared to the initial interpretations (0.93 vs. 0.75 and 0.90 vs. 0.68, respectively), and the difference in specificity was significant (p = 0.016). Additional imaging studies were recommended more frequently in the initial interpretation (22% vs. 6%, p = 0.006).

Conclusions

Our study shows the second-opinion interpretation by subspecialized radiologists improves the detection of pancreatic cancer recurrence after surgical resection.

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Abbreviations

CT:

Computed tomography

MRI:

Magnetic resonance imaging

PDAC:

Pancreatic ductal adenocarcinoma

RAI:

Recommended additional imaging

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Acknowledgments

Funding was provided by National Institutes of Health (Grant Number P30 CA008748).

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Authors and Affiliations

  1. Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    Sandra Huicochea Castellanos, Giuseppe Corrias, Gary A. Ulaner, Mark Dunphy, Romina Grazia Giancipoli & Lorenzo Mannelli

  2. Department of Radiology, Univerisità degli Studi di Cagliari, Cagliari, Italy

    Giuseppe Corrias

  3. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Zheng Junting & Marinela Capanu

  4. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Vinod Balachandran

  5. Department of Nuclear Medicine, Sapienza University of Rome, Rome, Italy

    Romina Grazia Giancipoli

  6. IRCCS SDN, Naples, Italy

    Serena Monti

Authors
  1. Sandra Huicochea Castellanos
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  2. Giuseppe Corrias
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  3. Gary A. Ulaner
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  4. Mark Dunphy
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  5. Zheng Junting
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  6. Marinela Capanu
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  7. Vinod Balachandran
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  8. Romina Grazia Giancipoli
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  9. Serena Monti
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  10. Lorenzo Mannelli
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Corresponding author

Correspondence to Lorenzo Mannelli.

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Huicochea Castellanos, S., Corrias, G., Ulaner, G.A. et al. Detection of recurrent pancreatic cancer: value of second-opinion interpretations of cross-sectional images by subspecialized radiologists. Abdom Radiol 44, 586–592 (2019). https://doi.org/10.1007/s00261-018-1765-z

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  • DOI: https://doi.org/10.1007/s00261-018-1765-z

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