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Hokland P. Revisiting the most often used item in the haematological tool box-The extent of haemodilution in bone marrow aspirates. Br J Haematol 2024. [PMID: 38602310 DOI: 10.1111/bjh.19474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/05/2024] [Indexed: 04/12/2024]
Abstract
In this issue, a nationwide retrospective Japanese study finds that, in a second opinion setting, one-third of bone marrow aspirates from patients suspected of myelodysplastic syndromes are heavily haemodiluted. Moreover, in four-fifths of such cases, the failure to obtain the correct material for diagnosis went undetected by the referring institution. These data are intriguing, but given their special set-up, caution should be exerted in transposing them to other countries. Commentary on: Ogata et al. Prevalence of massively diluted bone marrow cell samples aspirated from patients with myelodysplastic syndromes (MDS) or suspected MDS: A retrospective analysis of nationwide samples in Japan. Br J Haematol 2024 (Online ahead of print). doi: 10.1111/bjh.19447.
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Affiliation(s)
- Peter Hokland
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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2
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Iqbal U, Lee LTJ, Rahmanti AR, Celi LA, Li YCJ. Can large language models provide secondary reliable opinion on treatment options for dermatological diseases? J Am Med Inform Assoc 2024:ocae067. [PMID: 38578616 DOI: 10.1093/jamia/ocae067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/26/2024] [Accepted: 03/27/2024] [Indexed: 04/06/2024] Open
Abstract
OBJECTIVE To investigate the consistency and reliability of medication recommendations provided by ChatGPT for common dermatological conditions, highlighting the potential for ChatGPT to offer second opinions in patient treatment while also delineating possible limitations. MATERIALS AND METHODS In this mixed-methods study, we used survey questions in April 2023 for drug recommendations generated by ChatGPT with data from secondary databases, that is, Taiwan's National Health Insurance Research Database and an US medical center database, and validated by dermatologists. The methodology included preprocessing queries, executing them multiple times, and evaluating ChatGPT responses against the databases and dermatologists. The ChatGPT-generated responses were analyzed statistically in a disease-drug matrix, considering disease-medication associations (Q-value) and expert evaluation. RESULTS ChatGPT achieved a high 98.87% dermatologist approval rate for common dermatological medication recommendations. We evaluated its drug suggestions using the Q-value, showing that human expert validation agreement surpassed Q-value cutoff-based agreement. Varying cutoff values for disease-medication associations, a cutoff of 3 achieved 95.14% accurate prescriptions, 5 yielded 85.42%, and 10 resulted in 72.92%. While ChatGPT offered accurate drug advice, it occasionally included incorrect ATC codes, leading to issues like incorrect drug use and type, nonexistent codes, repeated errors, and incomplete medication codes. CONCLUSION ChatGPT provides medication recommendations as a second opinion in dermatology treatment, but its reliability and comprehensiveness need refinement for greater accuracy. In the future, integrating a medical domain-specific knowledge base for training and ongoing optimization will enhance the precision of ChatGPT's results.
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Affiliation(s)
- Usman Iqbal
- School of Population Health, Faculty of Medicine and Health, University of New South Wales (UNSW), Sydney, NSW 2052, Australia
- Department of Health, Tasmania 7000, Australia
- Global Health and Health Security Department, College of Public Health, Taipei Medical University, Taipei 110, Taiwan
| | - Leon Tsung-Ju Lee
- Graduate Institute of Clinical Medicine, Taipei Medical University, Taipei 110, Taiwan
- Department of Dermatology, Taipei Medical University Hospital, Taipei Medical University, Taipei 110, Taiwan
- Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Annisa Ristya Rahmanti
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei 110, Taiwan
- International Center for Health Information and Technology, College of Medical Science and Technology, Taipei Medical University, Taipei 110, Taiwan
- Department Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
| | - Leo Anthony Celi
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA 02139, United States
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
| | - Yu-Chuan Jack Li
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei 110, Taiwan
- International Center for Health Information and Technology, College of Medical Science and Technology, Taipei Medical University, Taipei 110, Taiwan
- Department of Dermatology, Taipei Municipal Wanfang Hospital, Taipei Medical University, Taipei 116, Taiwan
- The International Medical Informatics Association (IMIA), Genève CH-1204, Switzerland
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3
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Zhuravliov AS, Genis MY, Vasileva AS, Vasyukova OA, Tursunov II, Petropavlovsky MM, Taranenko DV, Karvetskaya VI, Kryatova AA, Lymishchenko VD, Razhbadinova NS. [The errors in intravital pathologicoanatomic diagnostic: a publications review]. Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med 2024; 32:52-60. [PMID: 38349686 DOI: 10.32687/0869-866x-2024-32-1-52-60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/02/2023] [Indexed: 02/15/2024]
Abstract
The review presents analysis of scientific publications considering medical errors in intravital pathologicoanatomic diagnostic. The examples of classification, rate of diagnostic errors and possible ways of decreasing the number of diagnostic errors in pathological anatomy are considered.
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Affiliation(s)
- A S Zhuravliov
- The Society with Limited Liability "YUNIM", 101000, Moscow, Russia,
| | - M Yu Genis
- The Society with Limited Liability "YUNIM", 101000, Moscow, Russia
| | - A S Vasileva
- The Autonomous Institution "The Republican Clinical Oncologic Dispensary" of the Minzdrav of Chuvashia, 428020, Cheboksary, Russia
| | - O A Vasyukova
- The Academician A. P. Avcyn Research Institute of Human Morphology of The Federal State Research Institution "The Academician B. V. Petrovsky Russian National Center of Surgery", 117418, Moscow, Russia
| | - I I Tursunov
- The State Budget Educational Institution of Higher Professional Education "The A. E. Evdokimov Moscow State University of Medicine and Dentistry" of Minzdrav of Russia, 127473, Moscow, Russia
| | - M M Petropavlovsky
- The Skolkovo Institute of Science and Technologies Territory of Innovation Center "Skolkovo", 121205, Moscow, Russia
| | - D V Taranenko
- The Skolkovo Institute of Science and Technologies Territory of Innovation Center "Skolkovo", 121205, Moscow, Russia
| | - V I Karvetskaya
- The Society with Limited Liability "YUNIM", 101000, Moscow, Russia
| | - A A Kryatova
- The Society with Limited Liability "YUNIM", 101000, Moscow, Russia
| | - V D Lymishchenko
- The Society with Limited Liability "YUNIM", 101000, Moscow, Russia
| | - N S Razhbadinova
- The Society with Limited Liability "YUNIM", 101000, Moscow, Russia
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4
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Wallace D. Australian Defence Force Centre for Mental Health Second Opinion Clinic - first ten years of operation. Australas Psychiatry 2023; 31:669-673. [PMID: 37501519 PMCID: PMC10566214 DOI: 10.1177/10398562231190780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
OBJECTIVES The aim is to report the operation of the Australian Defence Force Centre for Mental Health (ADFCMH) Second Opinion Clinic (SOC) after its first 10 years of operation. METHOD Demographic data and clinical data were recorded and analysed for all Australian Defence Force (ADF) personnel (n=209) seen at the clinic from 2011 to 2021. RESULTS Assessment at the clinic led to a change in diagnosis from that given at the time of referral in 40.7% (n=85) of members seen. Of the total members assessed at the SOC, 55.9% (n=117) had been on an at least one operational deployment. Mood disorders were the most common mental disorders seen among personnel at the SOC. CONCLUSIONS The ADFCMH SOC is a valuable clinical resource supporting ADF health services nationally and provides an example of an effective mental health tertiary referral service.
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Affiliation(s)
- Duncan Wallace
- ADF Centre for Mental Health, Joint Health Command, Australian Defence Force; and School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
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Maqsood A, Faheem S, Mirza D, Qayum Z, Lal A, Altamash S, Ahmed N, Heboyan A. An insight into perceptions of general pathologists about the need for oral pathology services: An observational study. SAGE Open Med 2023; 11:20503121231200758. [PMID: 37767537 PMCID: PMC10521304 DOI: 10.1177/20503121231200758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
Objective The objective of this study was to identify the degree of perception of oral pathology as a specialty among the general pathologists and the need of utilizing oral pathologists in assisting to identify oral lesions in diagnostic challenges. Methods A questionnaire-based survey was conducted among qualified general pathologists to collect the data. The survey items focused on various aspects, including the analysis of oral pathology as a specialty, the importance of employing oral pathologists for identifying oral lesions in diagnostic challenges, and the difficulties encountered in managing such lesions. The data collected was analyzed using descriptive and inferential statistics. For comparing the relationship between work experience and the referral of odontogenic cysts and tumors cases, a Chi-square test was employed. A significance level of p ⩽ 0.05 was deemed as statistically significant. Results Two hundred and fifty general pathologists responded to the questionnaire. Two hundred and thirty two (92.8%) participants showed awareness of oral pathology as a specialty. For the diagnosis of oral, jaws, and salivary glands pathologic lesions, the majority 198 (79.2%) respondents believed that oral pathologists are required for the diagnosis. Regarding the referrals of lesions to oral pathologists, 137 (54.8%), participants did not refer. In terms of training in oral pathology, all of the participants agreed that they would undertake short-term posting in oral pathology. For challenging cases, all the general pathologists believed that oral pathologists should be part of the team. Conclusion The general pathologists recognized oral pathology as a specialty and feel the need for an oral pathologist opinion in diagnosis. However, most of the general pathologists did not refer the complex cases to oral pathologists. Therefore, it is of paramount importance to encourage oral pathologists and their hiring at histopathology laboratories that are diagnosing complex head and neck cases.
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Affiliation(s)
- Afsheen Maqsood
- Department of Oral Pathology, Bahria University Dental College, Karachi, Pakistan
| | - Samra Faheem
- Department of Oral Pathology, Bahria University Dental College, Karachi, Pakistan
| | - Daud Mirza
- Department of Oral Pathology, Bahria University Dental College, Karachi, Pakistan
| | - Zahid Qayum
- Department of Oral and Maxillofacial Surgery, Khyber Girls Medical College, Hayatabad Medical Complex, Peshawar, Pakistan
| | - Abhishek Lal
- Department of Prosthodontics, Altamash Institute of Dental Medicine, Karachi, Pakistan
| | - Sara Altamash
- Department of Orthodontics, Altamash Institute of Dental Medicine, Karachi, Pakistan
| | - Naseer Ahmed
- Department of Prosthodontics, Altamash Institute of Dental Medicine, Karachi, Pakistan
| | - Artak Heboyan
- Department of Prosthodontics, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
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6
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Hillen MA, Smets EMA, M Stouthard J, de Vos FYF, Lehmann V. Cancer patients' trust as a motivator to seek a second opinion and its effects on trust. Psychol Health 2023; 38:1109-1127. [PMID: 34894900 DOI: 10.1080/08870446.2021.2011282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 10/31/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Cancer patients may seek a second opinion (SO) driven by reduced trust in their own providers. Their trust may be diminished or reinforced through the SO. This study aimed to assess (1) what proportion of patients seek SOs motivated by lacking trust and how trust changes over time; (2) whether patients' trust differs by the outcome of the SO (i.e. similar/different opinion); and (3) how communication during the SO affects trust. DESIGN A longitudinal mixed methods study including self-report assessments before (T0), immediately following (T1), and two months after the SO (T2). SO consultations (N = 62) were audio recorded, and patient-oncologist communication about the referring oncologist was coded. MAIN OUTCOME MEASURES Patient-reported motives and their trust in referring oncologists. RESULTS Reduced trust motivated 21% of patients to seek a SO. Most patients criticised their referring oncologist. Consulting oncologists generally defended their colleagues, but such affirmation was unrelated to patients' subsequent trust. Over time, trust did not change substantially. Yet, it was restored in patients motivated by impaired trust, and remained low for patients receiving a different medical outcome. CONCLUSION Patients need support to more constructively discuss their treatment relationship. Oncologists need support in providing independent SOs without harming trust relations.
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Affiliation(s)
- Marij A Hillen
- Department of Medical Psychology, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Filip Y F de Vos
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Vicky Lehmann
- Department of Medical Psychology, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Sepahpour TY, Chin K, Baker KK, Wolcott M, Margolis RL. Parental perceptions of second opinion consultations for recent onset schizophrenia. Early Interv Psychiatry 2023; 17:939-944. [PMID: 37038267 DOI: 10.1111/eip.13406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 01/03/2023] [Accepted: 03/11/2023] [Indexed: 04/12/2023]
Abstract
AIM Correct early diagnosis and intervention for schizophrenia is associated with improved outcomes. This study sought to determine the potential value of specialized consultations for individuals thought to have a recent-onset schizophrenia spectrum disorder who were not receiving specialized care. METHODS 121 consecutive one-time consultations were performed in a clinic specializing in recent-onset schizophrenia. Parents of 79 patients were questioned about the process and the value of the consultation. RESULTS Consultations were perceived by parents as both positive and helpful experiences. 85% of parents were somewhat or very happy with the consultation experience, and 86% found the consultation to be moderately or very helpful. A third of parents viewed the consultation as contributing to the long-term improvement of the patient's condition. CONCLUSIONS The findings demonstrate the potential value of consultations for individuals with possible schizophrenia spectrum disorders not receiving specialized treatment, and provide rationale for comprehensive studies investigating the widespread implementation of such consultations.
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Affiliation(s)
- Tiana Y Sepahpour
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287, USA
| | - Kathleen Chin
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, 98195, USA
| | - Krista K Baker
- Bayview Community Psychiatry Program, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, 21224, USA
| | - Maxwell Wolcott
- Department of Psychiatry, Bayview Community Psychiatry Program, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, 21224, USA
| | - Russell L Margolis
- Department of Psychiatry and Behavioral Sciences and Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287, USA
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8
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Eccher A, Malvi D, Novelli L, Mescoli C, D'Errico A. Second Opinion in the Italian Organ Procurement Transplantation: The Pathologist Is In. Clin Pract 2023; 13:610-615. [PMID: 37218806 DOI: 10.3390/clinpract13030055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/18/2023] [Accepted: 04/26/2023] [Indexed: 05/24/2023] Open
Abstract
Second opinion consultation is a well-established practice in different clinical settings of diagnostic medicine. However, little is known about second opinion consultation activity in transplantation, and even less is known about it concerning donor assessment. The consultations provided by the second opinion service led to the safer and homogeneous management of donors with a history of malignancy or ongoing neoplasm by transplant centers. Indeed, two of the most important aspects are the reduction of semantic differences in cancer reporting and the standardization of procedures, which are mainly due to the different settings and logistics of different pathology services. This article aims to discuss the role and the future of the second opinion in Italy during organ procurement, highlighting the critical issues and areas for improvement.
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Affiliation(s)
- Albino Eccher
- Department of Pathology and Diagnostics and Public Health, Section of Pathology, University Hospital of Verona, 37136 Verona, Italy
- Second Opinion, National Transplant Center, 00161 Rome, Italy
| | - Deborah Malvi
- Second Opinion, National Transplant Center, 00161 Rome, Italy
- Pathology Unit, Department of Specialized, Experimental and Diagnostic Medicine, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Luca Novelli
- Second Opinion, National Transplant Center, 00161 Rome, Italy
- Institute of Histopathology and Molecular Diagnosis, Careggi University Hospital, 50134 Florence, Italy
| | - Claudia Mescoli
- Second Opinion, National Transplant Center, 00161 Rome, Italy
- Surgical Pathology and Cytopathology Unit, Department of Medicine, University and Hospital Trust of Padua, 35128 Padua, Italy
| | - Antonietta D'Errico
- Second Opinion, National Transplant Center, 00161 Rome, Italy
- Pathology Unit, Department of Specialized, Experimental and Diagnostic Medicine, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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9
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Ploug T, Holm S. The right to a second opinion on Artificial Intelligence diagnosis-Remedying the inadequacy of a risk-based regulation. Bioethics 2023; 37:303-311. [PMID: 36434807 DOI: 10.1111/bioe.13124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 10/13/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Abstract
In this paper, we argue that patients who are subjects of Artificial Intelligence (AI)-supported diagnosis and treatment planning should have a right to a second opinion, but also that this right should not necessarily be construed as a right to a physician opinion. The right to a second opinion could potentially be satisfied by another independent AI system. Our considerations on the right to second opinion are embedded in the wider debate on different approaches to the regulation of AI, and we conclude the article by providing a number of reasons for preferring a rights-based approach over a risk-based approach.
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Affiliation(s)
- Thomas Ploug
- Centre of Applied Ethics and Philosophy of Science, Department of Communication and Psychology, Aalborg University, Copenhagen, Denmark
| | - Søren Holm
- Centre for Social Ethics and Policy, School of Law, University of Manchester, Manchester, UK
- Centre for Medical Ethics, University of Oslo, Oslo, Norway
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Lipitz-Snyderman A, Chimonas S, Mailankody S, Kim M, Silva N, Kriplani A, Saltz LB, Sihag S, Tan CR, Widmar M, Zauderer M, Weingart S, Perchick W, Roman BR. Clinical value of second opinions in oncology: A retrospective review of changes in diagnosis and treatment recommendations. Cancer Med 2023; 12:8063-8072. [PMID: 36737878 PMCID: PMC10134380 DOI: 10.1002/cam4.5598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 12/08/2022] [Accepted: 12/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Data on the clinical value of second opinions in oncology are limited. We examined diagnostic and treatment changes resulting from second opinions and the expected impact on morbidity and prognosis. METHODS This retrospective cohort study included patients presenting in 2018 to a high-volume cancer center for second opinions about newly diagnosed colorectal, head and neck, lung, and myeloma cancers or abnormal results. Two sub-specialty physicians from each cancer type reviewed 30 medical records (120 total) using a process and detailed data collection guide meant to mitigate institutional bias. The primary outcome measure was the rate of treatment changes that were "clinically meaningful", i.e., expected to impact morbidity and/or prognosis. Among those with treatment changes, another outcome measure was the rate of clinically meaningful diagnostic changes that led to treatment change. RESULTS Of 120 cases, forty-two had clinically meaningful changes in treatment with positive expected outcomes (7 colorectal, 17 head and neck, 11 lung, 7 myeloma; 23-57%). Two patients had negative expected outcomes from having sought a second opinion, with worse short-term morbidity and unchanged long-term morbidity and prognosis. All those with positive expected outcomes had improved expected morbidity (short- and/or long-term); 11 (0-23%) also had improved expected prognosis. Nine involved a shift from treatment to observation; 21 involved eliminating or reducing the extent of surgery, compared to 6 adding surgery or increasing its extent. Of the 42 with treatment changes, 13 were due to clinically meaningful diagnostic changes (1 colorectal, 5 head and neck, 3 lung, 4 myeloma; 3%-17%) . CONCLUSIONS Second-opinion consultations sometimes add clinical value by improving expected prognoses; more often, they offer treatment de-escalations, with corresponding reductions in expected short- and/or long-term morbidity. Future research could identify subgroups of patients most likely to benefit from second opinions.
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Affiliation(s)
- Allison Lipitz-Snyderman
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Susan Chimonas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sham Mailankody
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Michelle Kim
- Strategy and Innovation, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nicholas Silva
- Strategy and Innovation, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Anuja Kriplani
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Leonard B Saltz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Smita Sihag
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Carlyn Rose Tan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Maria Widmar
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Marjorie Zauderer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Saul Weingart
- Rhode Island Hospital and Hasbro Children's Hospital, Providence, Rhode Island, USA
| | - Wendy Perchick
- Strategy and Innovation, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Benjamin R Roman
- Strategy and Innovation, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Calle C, Zhong E, Hanna MG, Ventura K, Friedlander MA, Morrow M, Cody H, Brogi E. Changes in the Diagnoses of Breast Core Needle Biopsies on Second Review at a Tertiary Care Center: Implications for Surgical Management. Am J Surg Pathol 2023; 47:172-182. [PMID: 36638314 PMCID: PMC10464622 DOI: 10.1097/pas.0000000000002002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Core needle biopsy (CNB) of breast lesions is routine for diagnosis and treatment planning. Despite refinement of diagnostic criteria, the diagnosis of breast lesions on CNB can be challenging. At many centers, including ours, confirmation of diagnoses rendered in other laboratories is required before treatment planning. We identified CNBs first diagnosed elsewhere that were reviewed in our department over the course of 1 year because the patients sought care at our center and in which a change in diagnosis had been recorded. The outside and in-house CNB diagnoses were then classified based on Breast WHO Fifth Edition diagnostic categories. The impact of the change in diagnosis was estimated based on the subsequent surgical management. Findings in follow-up surgical excisions (EXCs) were used for validation. In 2018, 4950 outside cases with CNB were reviewed at our center. A total of 403 CNBs diagnoses were discrepant. Of these, 147 had a change in the WHO diagnostic category: 80 (54%) CNBs had a more severe diagnosis and 44 (30%) a less severe diagnosis. In 23 (16%) CNBs, the change of diagnostic category had no impact on management. Intraductal proliferations (n=54), microinvasive carcinoma (n=18), and papillary lesions (n=35) were the most disputed diagnoses. The in-house CNB diagnosis was confirmed in most cases with available excisions. Following CNB reclassification, 22/147 (15%) lesions were not excised. A change affecting the surgical management at our center occurred in 2.5% of all CNBs. Our results support routine review of outside breast CNB as a clinically significant practice before definitive treatment.
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Affiliation(s)
- Catarina Calle
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, New York, 10065 USA
- Faculdade de Ciencias da Saude da Universidade da Beira Interior, Covilha, Portugal
| | - Elaine Zhong
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, New York, 10065 USA
| | - Matthew G. Hanna
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, New York, 10065 USA
| | - Katia Ventura
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, New York, 10065 USA
| | - Maria A. Friedlander
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, New York, 10065 USA
| | - Monica Morrow
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Hiram Cody
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Edi Brogi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, New York, 10065 USA
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12
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Taraz Jamshidi S, Gharib M, Etemadi M, Jarahi L, Hosseini S, Ariamanesh M, Dehghani M. Pathology Reports: Discrepancy Patterns of Second Opinions in a Referral Cancer Center. Cancer Invest 2023; 41:1-8. [PMID: 36601856 DOI: 10.1080/07357907.2022.2162072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 06/08/2022] [Accepted: 12/20/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To evaluate the diagnostic mismatch (discrepancy) of pathology reports in consulted specimens referred for second opinion. MATERIALS AND METHODS This cross-sectional study was conducted at a major cancer center, Omid Hospital. In this study, 350 primary pathology reports and 350 reviewed pathology reports were extracted from the archives of Omid Hospital from 2011 to 2020 and assessed in terms of the extent of discrepancy, by two pathologists and one oncologist. The required data for each sample were entered into a checklist and then statistically analyzed. Cases with the same diagnosis on both reports were assigned to the matched group and the rest were assigned to the minor or major mismatch (discrepancy) group. Minor mismatches included changes in diagnosis that did not lead to changes in treatment (may lead to changes in prognosis or provide additional information to the oncologist) and major mismatches included changes in diagnosis leading to changes in treatment or remedies. RESULTS Two hundred seven cases (59.1%) out of three hundred fifty cases had concordant results between the diagnosis of the first pathologist and the reviewing pathologist. In one hundred forty-three cases (40.9%) mismatch (discrepancy) was observed, including eighty- two cases (23.4%) with minor mismatches (discrepancy) and sixty-one cases (17.4%) with major mismatches (discrepancy). In the major mismatch group, fifteen cases (4.3%) changed from malignant to benign, eighteen cases (5.1%) changed from benign to malignant, two cases (0.6%) changed from one stage to another stage of Disease and twenty-six cases (7.4%) had changes in the type of malignancy. In this study, it was found that there was no significant relationship between anatomical areas of sampling and diagnostic mismatch (p = 0.254). The study also found that the rate of diagnostic mismatch in specimens obtained by resection or excisional biopsy was greater than that of small biopsies (eighty cases (22.8%) and sixty-two cases (17.7%, respectively)). There was no significant relationship in this regard (p = 0.077). CONCLUSION Compared to most similar studies, the present study reported the highest discrepancy between the diagnosis of the first pathologist and the reviewing pathologist (40.9%).
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Affiliation(s)
- Shirin Taraz Jamshidi
- Department of Pathology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoumeh Gharib
- Department of Pathology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Etemadi
- Department of Pathology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Lida Jarahi
- Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sare Hosseini
- Cancer Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mona Ariamanesh
- Department of Pathology, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Mansoureh Dehghani
- Radiation Oncologist, Mashhad University of Medical Sciences, Mashhad, Iran
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Sylwestrzak T, Debniak J, Wydra D, Jastrzebski T. The analysis of the therapeutic decisions in a patient with gigantic ovarian leiomyoma. Ginekol Pol 2023:VM/OJS/J/92343. [PMID: 36597752 DOI: 10.5603/gp.a2022.0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/01/2022] [Accepted: 11/20/2022] [Indexed: 01/05/2023] Open
Abstract
Complicated or unusual cases appear in clinical practice. It's important to know how to react when we face clinical difficulty. The more unusual the case, the longer or more demanding the decision-making process is. In this case we present a patient with a gigantic ovarian tumor whose diagnosis was overturned, and the choice of the surgical procedure changed, which makes this case a very educative example of why we should consult our patients, whenever we may encounter doubts or difficulties in a therapeutic process.
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Affiliation(s)
- Tomasz Sylwestrzak
- Clinic of Obstetrics and Gynecology, Gynecological Oncology, Gynecological Endocrinology, University Clinical Center in Gdansk, Poland, Poland.
| | - Jaroslaw Debniak
- Clinic of Obstetrics and Gynecology, Gynecological Oncology, Gynecological Endocrinology, University Clinical Center in Gdansk, Poland, Poland
| | - Dariusz Wydra
- Clinic of Obstetrics and Gynecology, Gynecological Oncology, Gynecological Endocrinology, University Clinical Center in Gdansk, Poland, Poland
| | - Tomasz Jastrzebski
- Clinic of Obstetrics and Gynecology, Gynecological Oncology, Gynecological Endocrinology, University Clinical Center in Gdansk, Poland, Poland
- Surgical Oncology Department, University Clinical Center in Gdansk, Poland
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May S, Bruch D, Muehlensiepen F, Ignatyev Y, Neugebauer E, Ronckers C, von Peter S. Physicians' Perspectives on the Implementation of the Second Opinion Directive in Germany-An Exploratory Sequential Mixed-Methods Study. Int J Environ Res Public Health 2022; 19:ijerph19127426. [PMID: 35742675 PMCID: PMC9224158 DOI: 10.3390/ijerph19127426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 02/01/2023]
Abstract
A new Second Opinion Directive (SOD) was introduced in Germany in December 2018 for hysterectomy, tonsillotomy, and tonsillectomy to support shared decision making and to avoid unnecessary surgeries. Owing to its recent implementation, evidence and insights regarding outcomes and challenges encountered with the SOD are lacking, notably from the physicians' perspective. To assess this, we undertook an exploratory sequential mixed-methods design with an initial qualitative phase followed by a quantitative evaluation. A qualitative analysis of 22 interviews with specialists in gynecology and otorhinolaryngology was followed by a statistical analysis of a survey of 136 physicians in those disciplines. The specialists expressed a generally positive opinion of the new SOD, emphasizing the aspects of patient orientation, support in decision making, and patient safety. However, they also highlighted the following structural problems regarding the SOD implementation: In addition to an increased organisational effort, the specialists criticised the SOD with regard to its implementation in rural regions with a low availability of specialists for referral. Barriers that impede the implementation of the current directive, such as the adaptation of the qualifying requirements for authorized second opinion physicians, as well as the inclusion of relevant indications, need focused consideration to obtain better alignment with everyday practice.
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Affiliation(s)
- Susann May
- Center for Health Services Research, Brandenburg Medical School (Theodor Fontane), 15562 Rüdersdorf, Germany; (D.B.); (F.M.); (Y.I.); (E.N.)
- Brandenburg Medical School (Theodor Fontane), 16816 Neuruppin, Germany; (C.R.); (S.v.P.)
- Correspondence: ; Tel.: +49-3391-39-145-91
| | - Dunja Bruch
- Center for Health Services Research, Brandenburg Medical School (Theodor Fontane), 15562 Rüdersdorf, Germany; (D.B.); (F.M.); (Y.I.); (E.N.)
- Brandenburg Medical School (Theodor Fontane), 16816 Neuruppin, Germany; (C.R.); (S.v.P.)
- Faculty for Health Sciences Brandenburg, Brandenburg Medical School (Theodor Fontane), 16816 Neuruppin, Germany
| | - Felix Muehlensiepen
- Center for Health Services Research, Brandenburg Medical School (Theodor Fontane), 15562 Rüdersdorf, Germany; (D.B.); (F.M.); (Y.I.); (E.N.)
- Brandenburg Medical School (Theodor Fontane), 16816 Neuruppin, Germany; (C.R.); (S.v.P.)
- Faculty for Health Sciences Brandenburg, Brandenburg Medical School (Theodor Fontane), 16816 Neuruppin, Germany
| | - Yuriy Ignatyev
- Center for Health Services Research, Brandenburg Medical School (Theodor Fontane), 15562 Rüdersdorf, Germany; (D.B.); (F.M.); (Y.I.); (E.N.)
| | - Edmund Neugebauer
- Center for Health Services Research, Brandenburg Medical School (Theodor Fontane), 15562 Rüdersdorf, Germany; (D.B.); (F.M.); (Y.I.); (E.N.)
| | - Cecile Ronckers
- Brandenburg Medical School (Theodor Fontane), 16816 Neuruppin, Germany; (C.R.); (S.v.P.)
- Department of Health Services Research, Carl Von Ossietzky Universität Oldenburg, 26129 Oldenburg, Germany
| | - Sebastian von Peter
- Brandenburg Medical School (Theodor Fontane), 16816 Neuruppin, Germany; (C.R.); (S.v.P.)
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Chao S, Lotfi J, Lin B, Shaw J, Jhandi S, Mahoney M, Singh B, Nguyen L, Halawi H, Geng LN. Diagnostic journeys: characterization of patients and diagnostic outcomes from an academic second opinion clinic. Diagnosis (Berl) 2022; 9:340-347. [PMID: 35596123 DOI: 10.1515/dx-2022-0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/19/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Diagnostic programs and second opinion clinics have grown and evolved in the recent years to help patients with rare, puzzling, and complex conditions who often suffer prolonged diagnostic journeys, but there is a paucity of literature on the clinical characteristics of these patients and the efficacy of these diagnostic programs. This study aims to characterize the diagnostic journey, case features, and diagnostic outcomes of patients referred to a team-based second opinion clinic at Stanford. METHODS Retrospective chart review was performed for 237 patients evaluated for diagnostic second opinion in the Stanford Consultative Medicine Clinic over a 5 year period. Descriptive case features and diagnostic outcomes were assessed, and correlation between the two was analyzed. RESULTS Sixty-three percent of our patients were women. 49% of patients had a potential precipitating event within about a month prior to the start of their illness, such as medication change, infection, or medical procedure. A single clear diagnosis was determined in 33% of cases, whereas the remaining cases were assessed to have multifactorial contributors/diagnoses (20%) or remained unclear despite extensive evaluation (47%). Shorter duration of illness, fewer prior specialties seen, and single chief symptom were associated with higher likelihood of achieving a single clear diagnosis. CONCLUSIONS A single-site academic consultative service can offer additional diagnostic insights for about half of all patients evaluated for puzzling conditions. Better understanding of the clinical patterns and patient experiences gained from this study helps inform strategies to shorten their diagnostic odysseys.
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Dontchos BN, Dodelzon K, Dogan BE, Sonnenblick EB, Destounis S, Yang R, Dialani V, Perera V, Grimm LJ. Variations and Challenges to Performing Outside Study Interpretations in Breast Imaging: A National Survey of the Society of Breast Imaging Membership. J Breast Imaging 2022; 4:153-160. [PMID: 38422430 DOI: 10.1093/jbi/wbab101] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Second-opinion interpretations of outside facility breast imaging provide value-added care but are operationally challenging for breast radiologists. Our objective was to survey members of the Society of Breast Imaging (SBI) to assess practice patterns and perceived barriers to performing outside study interpretations (OSIs). METHODS An anonymous survey was developed by the Patient Care and Delivery Committee of the SBI and distributed via e-mail to SBI radiologist members. Survey questions included practice demographics and OSI volumes, billing practices, clinical scenarios, and imaging modalities, logistics, and barriers. Responses were aggregated and comparisons were made by univariate analysis using likelihood ratio tests, t-tests, and Spearman's rank correlation tests as appropriate. Ordinal or nominal logistic modeling and linear regression modeling was also performed. RESULTS There were 371 responses (response rate of 13%). Most respondents practice at an affiliated specialty breast care center (306/371, 83%) and said their practice performed OSIs (256/371, 69%). Academic practices reported the highest OSI volumes (median 75 per month) and were most likely to indicate increases in OSI volumes over time (100/144, 69%). The most common indication for OSI was second opinion for a biopsy recommendation (245/256, 96%). Most practices provide a final BI-RADS assessment (183/261, 70%). The most cited barrier to performing OSIs was physician time constraints (252/369, 68%). CONCLUSION Breast imaging OSI practice patterns are variable among SBI members with notable differences by practice setting and multiple barriers identified. More unified guidelines and recommendations may be needed for radiologists to better perform this valuable task.
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Affiliation(s)
- Brian N Dontchos
- Massachusetts General Hospital, Department of Radiology, Boston, MA, USA
| | - Katerina Dodelzon
- Weill Cornell at New York-Presbyterian, Department of Radiology, New York, NY, USA
| | - Basak E Dogan
- The University of Texas Southwestern Medical Center, Department of Radiology, Dallas, TX, USA
| | - Emily B Sonnenblick
- Icahn School of Medicine at Mount Sinai, Department of Diagnostic, Molecular, and Interventional Radiology, New York, NY, USA
| | | | - Roger Yang
- Rutgers Robert Wood Johnson Medical School, Department of Radiology, New Brunswick, NJ, USA
| | - Vandana Dialani
- Beth Israel Deaconess Medical Center, Department of Radiology, Boston, MA, USA
| | - Vidushani Perera
- McGaw Medical Center of Northwestern University, Department of Radiology, Chicago, IL,USA
| | - Lars J Grimm
- Duke University Medical Center, Department of Radiology, Durham, NC, USA
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Tuite CM, Boros MC, Ruth K. Value of Second-Opinion Interpretation of Outside-Facility Breast Imaging Studies to a Radiology Department and Cancer Center. J Am Coll Radiol 2022:S1546-1440(22)00117-X. [PMID: 35216943 DOI: 10.1016/j.jacr.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/22/2021] [Accepted: 12/27/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this study was to estimate the physician work effort for formal written breast radiology second-opinion reports of imaging performed at outside facilities, to compare this effort with a per-report credit system, and to estimate the downstream value of subsequent services provided by the radiology department and institution at a National Comprehensive Cancer Network-designated comprehensive cancer center. METHODS A retrospective review was conducted of consecutive reports for "outside film review" from July 1, 2015, to June 30, 2018. The number and types of breast imaging studies reinterpreted for each individual patient request were tabulated for requests for a 3-month sample from each year. Physician effort was estimated on the basis of the primary interpretation CMS fee schedule for work relative value units (wRVUs) for the study-specific Current Procedural Terminology (CPT) code and study type. This effort was compared with the interpreting radiologist credit of 0.44 wRVUs per report. Subsequent imaging and evaluation and management encounters generated by these second-opinion patient requests were tracked through June 30, 2019. RESULTS For the 3-year period reviewed, 2,513 unique patient requests were identified, averaging 837 per fiscal year. For January to March of 2016, 2017, and 2018, 645 unique patient reports were identified. For these reports, 2,216 studies were reinterpreted, with an estimated physician effort of 2,660 wRVUs compared with 284 wRVUs on the basis of per-report credit. The range of annualized wRVUs for all outside studies interpreted and credited per specific CPT code was 3,135 to 3,804 (mean, 3,547). However, the institutional relative value unit credit received for fiscal years 2015, 2016, and 2017, on the basis of the number of patient requests, was only 385, 375, and 345 wRVUs, respectively. CONCLUSIONS This study demonstrates the substantial work effort necessary to provide formal second-opinion interpretations for breast imaging studies at a National Comprehensive Cancer Network cancer center. The authors believe that these data support billing for the study-specific CPT code and crediting the radiologist with the full wRVUs for each study reinterpreted.
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Siedow M, Eisner M, Yaney A, Washington I, Zynger D, Martin D, Mo X, Diconstanzo D, Diaz DA. Impact of prostate biopsy secondary pathology review on radiotherapy management. Prostate 2022; 82:210-215. [PMID: 34698410 DOI: 10.1002/pros.24260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/05/2021] [Accepted: 10/15/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND The Gleason scoring system is the most widely used method to assess prostate adenocarcinoma pathology however interobserver variability is significant. Gleason score, PSA level, and clinical stage comprise the NCCN risk stratification that guides treatment decision making. Given the importance of an accurate Gleason score and wide interobserver variability, referral centers routinely review outside pathology at the time of consultation. We sought to address the impact a secondary pathology review had on radiation therapy treatment recommendations in men with prostate cancer at our institution. METHODS We retrospectively collected patient data on 342 patients seen at our institution from January 2012 to December 2018. Clinicopathologic data were used to subdivide patients into risk groups and available treatment options per NCCN criteria. Cases reviewed by our genitourinary pathologist (GUP) were compared with reports from outside pathologists. Inter-rater reliability between pathologists was assessed with weighted Cohen's kappa statistic and agreement of treatment options was determined by McNemar's exact tests. RESULTS GUP scored more cores positive in 16.47% of cases on secondary review. Primary Gleason score was changed in 12.28% of patients and secondary score in 26.02% of cases. Total Gleason score was different in 29.24% of cases, 19.01% were downgraded and 10.23% upgraded. The weighted kappa statistic was 0.759 (95% confidence interval [CI]: 0.711, 0.807). 18.77% of patients were assigned to a different NCCN risk group following secondary review. The weighted kappa statistic comparing NCCN risk stratification was 0.802 (95% CI: 0.754, 0.850). Secondary review influenced radiation therapy recommendations pertaining to brachytherapy boost and androgen deprivation therapy in men with high risk disease (χ2 = 5.33, p = 0.0386; χ2 = 8.05, p = 0.0072, respectively). Kappa statistic was found to be highest when GUP assessed high-risk disease versus all other categories (κ = 0.823, 95% CI: 0.750, 0.895). CONCLUSIONS We found nearly one in five men (18.7%) was assigned a different NCCN risk group and thus offered potentially different treatment options after a secondary pathology review at our institution. Given the inherent nature of prostate cancer and lung disease-specific survival associated with modern therapies, our study demonstrates the importance of a secondary pathology review and its potential impact on radiation therapy recommendations.
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Affiliation(s)
- Michael Siedow
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mariah Eisner
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Alexander Yaney
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Iman Washington
- Department of Radiation Oncology, Moffit Cancer Center, Tampa, Florida, USA
| | - Debra Zynger
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Douglas Martin
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Xiaokui Mo
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Dominic Diconstanzo
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Dayssy Alexandra Diaz
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Minamitani M, Mukai T, Ogita M, Yamashita H, Katano A, Nakagawa K. Relationship between Consulting for Second Medical Opinions, Radiotherapy, and Satisfaction with Therapy, Analyzed by Structural Equation Modeling: A Web-Based Survey. Asian Pac J Cancer Prev 2021; 22:2889-2896. [PMID: 34582658 PMCID: PMC8850878 DOI: 10.31557/apjcp.2021.22.9.2889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The radiotherapy utilization rate in Japan is lower than that in other developed countries. This study identified factors associated with the low rate, by conducting an online survey of Japanese cancer survivors. METHODS We reviewed the web survey results of Japanese cancer patients. The survey examined the process of choosing treatments and the actual treatment received. We included respondents whose most engaged-in treatment was either radiotherapy or surgery, dividing them into two groups. We used the chi-square test to compare the patients in the both groups for their impression of the therapy, decision-making approach, and decision to seek second medical opinions (SMOs). To assess the relationship between seeking SMOs, being most engaged in radiotherapy, and feeling satisfied, we used the structural equation modeling (SEM) approach. RESULTS We included 139 patients in the radiotherapy group and 681 patients in the surgery group. Compared with patients in the surgery group, more patients in the radiotherapy group sought SMOs (19% vs. 28%), shared opinions with their doctor (27% vs. 42%), and were satisfied with their treatment (69% vs. 78%). SEM analysis showed that seeking SMOs contributed to radiotherapy being the most-engaged-in therapy (β = 0.23; P < 0.01), and the treatment contributed to the satisfaction (β = 0.15; P < 0.01). CONCLUSION Patients who underwent radiotherapy felt more satisfied with the treatment than patients who underwent surgery. Perceptions about radiotherapy and SMOs may be a reason for the low utilization of radiotherapy in Japan.
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Affiliation(s)
| | - Tomoya Mukai
- Graduate Schools for Law and Politics, MA, the University of Tokyo, Tokyo, Japan
| | - Mami Ogita
- Department of Radiology, MD, the University of Tokyo Hospital, Tokyo, Japan
| | - Hideomi Yamashita
- Department of Radiology, MD, PhD, the University of Tokyo Hospital, Tokyo, Japan
| | - Atsuto Katano
- Department of Radiology, MD, PhD, the University of Tokyo Hospital, Tokyo, Japan
| | - Keiichi Nakagawa
- Department of Comprehensive radiation oncology, MD, PhD, the University of Tokyo, Tokyo, Japan
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Laliberté SM, Poirier VJ, Pinard CJ, Hocker SE, Foster RA. A retrospective comparison of first and second opinion histopathology with patient outcomes in veterinary oncology cases (2011-2019). Vet Comp Oncol 2021; 20:198-206. [PMID: 34399003 DOI: 10.1111/vco.12762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/13/2021] [Indexed: 11/29/2022]
Abstract
Mandatory second opinion histopathology is common practice in human surgical pathology. It is intended to confirm the original diagnosis or identify clinically significant discrepancies, which could alter the course of disease, cost of treatment, patient management or prognosis. This retrospective analysis aimed to evaluate agreement between first and second opinion histopathology cases, examine their correlation with natural history of disease and investigate the rationale for pursuing this test. Medical records from 2011 to 2019 were reviewed, identifying 109 cases where second opinion histopathology was sought. Reasons for seeking second opinion and clinical disease course were also reviewed to determine whether case progression favoured first or second opinion findings in cases of diagnostic disagreement. Diagnostic disagreement was found in 49.5% of cases. Complete diagnostic disagreement (a change in degree of malignancy or tumour type) occurred in 15.6% cases and partial disagreement (a change in tumour subtype, grade, margins and mitotic count) occurred in 33.9%. Major disagreement (a change in diagnosis resulting in alteration of treatment recommendations) occurred in 38.5% of cases. The most common reasons for seeking second opinion were an atypical/poorly differentiated tumour (31.2%; 34/109) or a discordant clinical picture (24.8%; 27/109). Among cases with any form of disagreement, natural history of disease favoured second opinion findings in 33.3%. The first opinion was favoured over the second in a single case. These findings reinforce previous literature supporting a role for second opinion histopathology in optimizing therapy and predicting outcomes in veterinary oncology, particularly in cases where diagnosis is in question based on the overall clinical picture.
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Affiliation(s)
- Sarah M Laliberté
- Mona Campbell Animal Cancer Center, Ontario Veterinary College, University of Guelph, Guelph, Canada
| | - Valerie J Poirier
- Mona Campbell Animal Cancer Center, Ontario Veterinary College, University of Guelph, Guelph, Canada
| | - Christopher J Pinard
- Mona Campbell Animal Cancer Center, Ontario Veterinary College, University of Guelph, Guelph, Canada
| | - Samuel E Hocker
- Mona Campbell Animal Cancer Center, Ontario Veterinary College, University of Guelph, Guelph, Canada.,Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USA
| | - Robert A Foster
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, Canada
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Farooq A, Abdelkader A, Javakhishivili N, Moreno GA, Kuderer P, Polley M, Hunt B, Giorgadze TA, Jorns JM. Assessing the value of second opinion pathology review. Int J Qual Health Care 2021; 33:6153784. [PMID: 33644816 DOI: 10.1093/intqhc/mzab032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/09/2021] [Accepted: 02/26/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Second opinion review of pathology cases can identify diagnostic errors that impact patient care. OBJECTIVE We sought out to determine discrepancy rates and clinical impact of review of pathology cases to reassess our policy of review on all second opinion cases. METHODS All second opinion pathology cases over 1 year (2018) were retrospectively reviewed for discrepancy, multiple pathologist review and clinicopathologic features via chart and slide review. Cases were categorized as no significant discordance, major discordance without management change and major discordance with management change. RESULTS Among 4239 second opinion cases, 3.7% (156/4239) had major discordance with no change in management and 1% (42/4239) had major discordance with change in management. Discordance was significantly associated with multiple pathologist review at our institution (P < 0.001). Highest rates of discordance were observed for thyroid fine needle aspiration (15.3%, 26/170), tissue biopsy of bone/soft tissue (9.6%), endocrine (8.8%), genitourinary (6.7%), gynecologic (6.2%), hematopathology (4%), gastrointestinal/liver (3.7%) and thoracic (3%) sites. CONCLUSIONS Our study showed a 1% major discordance rate with resulting significant change in clinical management, spread across nearly all subspecialties. Thus, we support recommendations for review of relevant outside pathology material for all patients for which review has the potential to illicit management change such as instituting a major medical or surgical therapy.
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Affiliation(s)
- Ayesha Farooq
- Department of Pathology, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Lab Building, Lower Level, Room L69, Milwaukee, WI 53226, USA
| | - Amrou Abdelkader
- SC/ACL Laboratories, Great Lakes Pathologists, 8901 W Lincoln Avenue, West Allis, WI 53227, USA
| | | | - Gustavo A Moreno
- Department of Pathology, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Lab Building, Lower Level, Room L69, Milwaukee, WI 53226, USA
| | - Pilar Kuderer
- Department of Pathology, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Lab Building, Lower Level, Room L69, Milwaukee, WI 53226, USA
| | - Marisa Polley
- Department of Pathology, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Lab Building, Lower Level, Room L69, Milwaukee, WI 53226, USA
| | - Bryan Hunt
- Department of Pathology, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Lab Building, Lower Level, Room L69, Milwaukee, WI 53226, USA
| | - Tamar A Giorgadze
- Department of Pathology, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Lab Building, Lower Level, Room L69, Milwaukee, WI 53226, USA
| | - Julie M Jorns
- Department of Pathology, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Lab Building, Lower Level, Room L69, Milwaukee, WI 53226, USA
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van Someren JL, Lehmann V, Stouthard JM, Stiggelbout AM, Smets EMA, Hillen MA. Oncologists' Communication About Uncertain Information in Second Opinion Consultations: A Focused Qualitative Analysis. Front Psychol 2021; 12:635422. [PMID: 34135806 PMCID: PMC8201772 DOI: 10.3389/fpsyg.2021.635422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/30/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Uncertainty is omnipresent in cancer care, including the ambiguity of diagnostic tests, efficacy and side effects of treatments, and/or patients' long-term prognosis. During second opinion consultations, uncertainty may be particularly tangible: doubts and uncertainty may drive patients to seek more information and request a second opinion, whereas the second opinion in turn may also affect patients' level of uncertainty. Providers are tasked to clearly discuss all of these uncertainties with patients who may feel overwhelmed by it. The aim of this study was to explore how oncologists communicate about uncertainty during second opinion consultations in medical oncology. Methods: We performed a secondary qualitative analysis of audio-recorded consultations collected in a prospective study among cancer patients (N = 69) who sought a second opinion in medical oncology. We purposively selected 12 audio-recorded second opinion consultations. Any communication about uncertainty by the oncologist was double coded by two researchers and an inductive analytic approach was chosen to allow for novel insights to arise. Results: Seven approaches in which oncologists conveyed or addressed uncertainty were identified: (1) specifying the degree of uncertainty, (2) explaining reasons of uncertainty, (3) providing personalized estimates of uncertainty to patients, (4) downplaying or magnifying uncertainty, (5) reducing or counterbalancing uncertainty, and (6) providing support to facilitate patients in coping with uncertainty. Moreover, oncologists varied in their (7) choice of words/language to convey uncertainty (i.e., "I" vs. "we"; level of explicitness). Discussion: This study identified various approaches of how oncologists communicated uncertain issues during second opinion consultations. These different approaches could affect patients' perception of uncertainty, emotions provoked by it, and possibly even patients' behavior. For example, by minimizing uncertainty, oncologists may (un)consciously steer patients toward specific medical decisions). Future research is needed to examine how these different ways of communicating about uncertainty affect patients. This could also facilitate a discussion about the desirability of certain communication strategies. Eventually, practical and evidence-based guidance needs to be developed for clinicians to optimally inform patients about uncertain issues and support patients in dealing with these.
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Affiliation(s)
- Jamie L van Someren
- Department of Medical Psychology, Amsterdam Public Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Vicky Lehmann
- Department of Medical Psychology, Amsterdam Public Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | | | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam Public Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Marij A Hillen
- Department of Medical Psychology, Amsterdam Public Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
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Ihrler S, Agaimy A, Guntinas-Lichius O, Haas CJ, Mollenhauer M, Sandison A, Greber L. Why is the histomorphological diagnosis of tumours of minor salivary glands much more difficult? Histopathology 2021; 79:779-790. [PMID: 34042205 DOI: 10.1111/his.14421] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/05/2021] [Accepted: 05/24/2021] [Indexed: 12/26/2022]
Abstract
AIMS There is a widespread perception among clinicians and pathologists that the histomorphological assessment of minor salivary gland (MinSG) tumours is more difficult and hampered by more misdiagnoses than that of major salivary gland tumours. This is based on a vague, subjective clinical impression, lacking scientific proof. The aim of the present study was to identify and statistically verify potential reasons that could explain this difference. METHODS AND RESULTS We identified 14 putative clinical, pathological and combined clinicopathological reasons that, altogether, could explain the phenomenon of the perceived greater diagnostic difficulty associated with MinSG tumours. We performed a comprehensive literature search and a statistical comparison of data from a large personal consultation series (biased for difficult cases) with cumulated data from straightforward, unselected (non-consultation) series from the literature. By performing this comparison, we identified, with statistical significance, a comprehensive series of reasons, as well as of consequences, of the greater difficulty in diagnosing MinSG tumours. CONCLUSIONS Among the 14 criteria, high frequencies of initial incisional biopsies and of a low-grade category in malignant tumours emerged as the two most important reasons for enhanced diagnostic difficulty. Very rare entities, unusual locations, shortcomings in clinicopathological communication, and pecularities of the special anatomical location of the hard palate, such as tumour necrosis, mucosal ulceration, pseudoinvasion, and the peculiar phenomenon of 'tumoral-mucosal fusion', contribute to further diagnostic difficulties. The awareness of these shortcomings and pitfalls enables us to provide a series of recommendations for clinicians and pathologists that might aid in assessment and reduce the rate of misdiagnosis of MinSG tumours.
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Affiliation(s)
- Stephan Ihrler
- DERMPATH Muenchen, Munich, Germany.,Institute of Pathology, Ludwig-Maximilians-University, Munich, Germany
| | - Abbas Agaimy
- Pathological Institute, Friedrich-Alexander University, Erlangen, Germany
| | | | | | | | - Ann Sandison
- Department of Head and Neck/Oral Pathology, Guy's and St Thomas' NHS Trust, London, UK
| | - Lukas Greber
- Dental School, Ludwig-Maximilians-University, Munich, Germany
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Abstract
PURPOSE Clubfoot is the most common congenital foot deformity in children. Caregivers often seek medical information on the internet. The aim of the study was to characterize how social media is used by caregivers to access medical information. METHODS A search was performed on Facebook, Twitter and YouTube platforms. Information was quantitatively assessed. Comments were qualitatively assessed, and the Kruskal-Wallis test was used to study thematic comment distribution. RESULTS In total, 58 Facebook groups and pages, 109 YouTube accounts and ten Twitter accounts related to clubfoot were discovered from 2007 to 2019. Facebook groups and pages had a collective 56 123 members and 80 544 total likes, respectively. YouTube had a collective 3 280 454 views, with 54 969 total comments throughout the accounts. Comment themes most commonly included sharing information and advice (38.7%), appreciation and success stories (12.8%), emotional support (12.7%) and social media as a second opinion (11.9%). Facebook groups contained a significantly higher number of comments related to 'social media as a second opinion' compared with Facebook pages (p = 0.001), Twitter (p = 0.016) and YouTube (p < 0.0001) while YouTube contained a significantly lower number of comments related to 'sharing information' compared with Facebook groups, pages and Twitter (p < 0.0001). CONCLUSION Social media continues to be a growing tool for information sharing and the findings of this study highlight the importance placed by caregivers on the advice of their peers. The online presence of caregivers may represent an opportunity for orthopaedic surgeons to communicate with patients and help them make informed decisions. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Gabriel Hanna
- Department of Orthopaedic Surgery, New Jersey Medical School, Newark, USA,Correspondence should be sent to Gabriel Hanna, New Jersey Medical School, 140 Bergen Street, Newark, NJ 07103, USA. E-mail:
| | - Brian D. Batko
- Department of Orthopaedic Surgery, New Jersey Medical School, Newark, USA
| | - James Potter
- Department of Orthopaedic Surgery, New Jersey Medical School, Newark, USA
| | - Joseph Ippolito
- Department of Orthopaedic Surgery, New Jersey Medical School, Newark, USA
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Lohman ME, Grekin RC, North JP, Neuhaus IM. Impact of second-opinion dermatopathology reviews on surgical management of malignant neoplasms. J Am Acad Dermatol 2021; 84:1385-1392. [PMID: 33333152 DOI: 10.1016/j.jaad.2020.12.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/30/2020] [Accepted: 12/08/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Second-opinion review is linked to error reduction and treatment changes in anatomic pathology. OBJECTIVE We sought to establish the rate of diagnostic discrepancy identified by second-opinion dermatopathologic review and the effect on surgical treatment. METHODS Cases referred for treatment of a malignant neoplasm diagnosed by an outside pathologist were reviewed. The external and internal second-opinion dermatopathologic reports were compared. Discordance in diagnosis, subtype, and treatment change owing to second-opinion review was recorded. The referring pathologist's level of dermatopathologic training was also documented. RESULTS A total of 358 cases were included. Dermatopathologic second-opinion diagnosis was discordant with the outside diagnosis in 37 of 358 cases (10.3%). In 32 of 358 cases (8.9%), second-opinion review resulted in a change in treatment, with 28 of 32 (87.5%) of these changes resulting in cancelled surgery. Dermatologists without dermatopathologic fellowship training had the highest rate of discordant diagnoses compared with pathologists and dermatopathologists. LIMITATIONS This was a retrospective study at a tertiary care facility. CONCLUSION Second-opinion dermatopathologic review is associated with identification of discordant diagnoses and a substantial influence on treatment, with both cancellation of surgery and augmented management. Secondary pathologic review should be considered in high-volume surgical practices.
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Affiliation(s)
- Mary E Lohman
- Department of Dermatology, University of California-San Francisco, San Francisco, California
| | - Roy C Grekin
- Department of Dermatology, University of California-San Francisco, San Francisco, California
| | - Jeffrey P North
- Department of Dermatology, University of California-San Francisco, San Francisco, California
| | - Isaac M Neuhaus
- Department of Dermatology, University of California-San Francisco, San Francisco, California.
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Mao A, Meng Y, Wang Q, Du E, Dong P, Yan X, Wang K, Yang Y, Hu G, Qiu W. Outcome Assessment for a Telemedicine-Based Second Opinion Program for Midwest China. Inquiry 2020; 57:46958020968788. [PMID: 33179553 PMCID: PMC7673049 DOI: 10.1177/0046958020968788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Through an examination of the records of a telemedicine-based second opinion program in county-level hospitals in central and western China, the impact of this service on the diagnosis and treatment of cancer-related diseases was analyzed and evaluated. In this study, all 135 cancer-related cases were included in the analysis. The basic characteristics of the patients were described, the opinions of the original and second diagnosis and treatment were compared, the rate of consistency between them was calculated, the therapeutic regimens were analyzed and the differences between groups were tested. In 94.07% of the cases, the reason for the doctor's request for second opinion service was to assist in the formulation of therapeutic regimen. 64.44% of cases were confirmed with the diagnosis and 17.78% therapeutic regimen by the second opinion service. 126 cases obtained improved therapeutic regimens, and there were statistically significant differences in treatment methods in the diagnosis changed group. Comparing with other international SO studies, the diagnostic consistency rate obtained in this study was lower but not the lowest. The therapeutic consistency rate was quite low, due to the high proportion of original therapeutic regimens missing. This telemedicine-based second opinion program has brought beneficial improvements to the diagnosis and treatment of cancer-related diseases in county-level hospitals in central and western China.
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Affiliation(s)
- Ayan Mao
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yueli Meng
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qing Wang
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Enhuan Du
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Pei Dong
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaoling Yan
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Kun Wang
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yujie Yang
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Guangyu Hu
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wuqi Qiu
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Freiburg L, Bhole S, Liko Hazizi E, Friedewald SM. Breast Imaging Second Opinion Consultation: A Single Institution's Process of Improvement and Reform. J Breast Imaging 2020; 2:232-239. [PMID: 38424985 DOI: 10.1093/jbi/wbaa022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To review a single institution's second opinion breast imaging process, data tracking, and metrics before and after implementing quality improvement changes and the effect on report turnaround time. METHODS This Institutional Review Board approved retrospective quality improvement project was performed at a tertiary-care academic medical center and included patients 18 years or older who submitted their outside facility imaging for reinterpretation (any combination of mammography, breast ultrasonography, and/or magnetic resonance imaging performed within the last six months) with finalized second opinion reports between June 1, 2016, and July 17, 2017. Significant intradepartmental changes were implemented March 2017 with the goal to improve second opinion report turnaround time. Key metrics from 399 studies were analyzed before and after implemented changes. Two-sided Fisher's exact test was used to assess the significance of results. RESULTS After department interventions, the percentage of outside reports available at the time of surgical consultation improved from 82% (213/259) to 91% (127/140), an 11% improvement (P < 0.05). The average number of days from initial second opinion consultation to the availability of final report improved from 10.2 days to 9 days, a 12% improvement. Prior to the changes, the number of days it took a radiologist to complete a report varied from 1 to 4 days, but afterwards was consistently 1 day or less. CONCLUSION Implementation of second opinion intradepartmental changes demonstrated a significant improvement in report turnaround time and the number of finalized reports available at the time of surgical consultation. An efficient second opinion process is crucial to a breast imaging center, as it ultimately expedites patient surgical and oncological care.
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Affiliation(s)
- Luke Freiburg
- Loyola University, Department of Radiology, Maywood, IL
| | - Sonya Bhole
- Northwestern Memorial Hospital, Prentice Women's Hospital, Chicago, IL
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Filev PD, Little BP, Duong PAT. Second-Opinion Reads in Interstitial Lung Disease Imaging: Added Value of Subspecialty Interpretation. J Am Coll Radiol 2020; 17:786-790. [PMID: 31930981 DOI: 10.1016/j.jacr.2019.12.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 12/17/2019] [Accepted: 12/17/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to determine how often a second-opinion interpretation of interstitial lung disease (ILD) by an academic cardiothoracic radiologist is discordant with the initial interpretation by a nonacademic radiologists and how often the clinical diagnosis determined by multidisciplinary consensus agrees with the initial and second-opinion interpretations. METHODS This retrospective study included 364 consecutive second-opinion CT examination reports of imaging from nonacademic radiology practices from July 2014 to May 2016. The second-opinion interpretations, provided by seven fellowship-trained cardiothoracic radiologists, were compared with the initial interpretations and the clinical diagnoses determined by multidisciplinary consensus. RESULTS Two hundred ninety-six consecutive reports met the inclusion criteria, and two hundred had findings of ILD. The initial interpretations lacked specific diagnoses in 41% of reports, but the second-opinion reports lacked specific diagnoses in only 7%. When a diagnosis was provided, the second-opinion diagnosis disagreed with the initial interpretation in 25% of cases. The clinical-consensus diagnosis was concordant with that of the academic radiologists 85% of the time but concordant with the initial interpretation only 44% of the time. The academic radiologists' diagnostic sensitivity was higher than that of the initial radiologists for the four most common diagnoses: usual interstitial pneumonitis (0.91 versus 0.4), sarcoidosis (0.94 versus 0.60), hypersensitivity pneumonitis (0.79 versus 0.17), and nonspecific interstitial pneumonitis (0.72 versus 0.14). CONCLUSIONS Academic cardiothoracic radiologists were more likely to provide specific diagnoses for ILD, and these diagnoses were more likely to be concordant with the multidisciplinary consensus.
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Affiliation(s)
- Peter D Filev
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Brent P Little
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Phuong-Anh T Duong
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah.
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29
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Maruyama Y, Sadahira T, Araki M, Mitsui Y, Wada K, Rodrigo AGH, Munetomo K, Kobayashi Y, Watanabe M, Yanai H, Watanabe T, Nasu Y. Factors predicting pathological upgrading after prostatectomy in patients with Gleason grade group 1 prostate cancer based on opinion-matched biopsy specimens. Mol Clin Oncol 2020; 12:384-389. [PMID: 32190323 DOI: 10.3892/mco.2020.1996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 12/11/2019] [Indexed: 11/06/2022] Open
Abstract
The present study investigated the concordance between Gleason scores assigned to prostate biopsy specimens by outside pathologists and a urological pathology expert, and determined the risk of upgrading between opinion-matched Gleason grade group (GGG) 1 biopsy specimens and radical prostatectomy specimens. Between January 2012 and May 2018, 733 patients underwent robot-assisted radical prostatectomy. Patients whose original biopsy specimens from outside hospitals were reviewed by a urological pathology expert Okayama University Hospital were included. Patients who had received neoadjuvant hormonal therapy were excluded. Logistic regression analysis was used to identify predictors of upgrading among GGG 1 diagnoses. A total of 403 patients were included in the present study. Agreement in GGG between initial and second-opinion diagnoses was present in 256 cases (63.5%). Although opinion-matched cases improved concordance between biopsy and prostatectomy specimen GGG compared with single-opinion cases (initial, 35.2%; second-opinion, 36.5%; matched, 41.4%), 71% (56/79) of cases classified as GGG 1 were upgraded after prostatectomy. Multivariate analysis revealed that prostate-specific antigen density and Prostate Imaging Reporting and Data System version 2 score were significant predictors of upgrading (odds ratio, 1.10; P=0.01; and odds ratio, 1.88; P=0.03, respectively). In conclusion, the GGG concordance rate between needle-core biopsy and radical prostatectomy specimens was higher in opinion-matched cases; however, 71% of opinion-matched GGG1 cases were upgraded after robot-assisted radical prostatectomy. Urologists should propose treatment strategies or further biopsy rather than active surveillance for patients with GGG1 and a high PSAD and/or PI-RADS score.
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Affiliation(s)
- Yuki Maruyama
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Takuya Sadahira
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Motoo Araki
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Yosuke Mitsui
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Koichiro Wada
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Acosta Gonzalez Herik Rodrigo
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Kazuaki Munetomo
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Yasuyuki Kobayashi
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Masami Watanabe
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Hiroyuki Yanai
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Toyohiko Watanabe
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Yasutomo Nasu
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
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Halaska C, Sachs P, Sanfilippo K, Lin CT. Patient Attitudes About Viewing Their Radiology Images Online: Preintervention Survey. J Med Internet Res 2019; 21:e12595. [PMID: 31322124 PMCID: PMC6670277 DOI: 10.2196/12595] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 05/12/2019] [Accepted: 06/18/2019] [Indexed: 01/17/2023] Open
Abstract
Background Although patient data is available through electronic portals, little information exists about the benefits and/or challenges of providing patients with online access to their radiology images. Objective The aims of this quality improvement project were to understand patient attitudes toward being able to view their radiology images online and determine how information should be presented to ensure the images are helpful to the patients, rather than causing confusion and anxiety. Methods An online survey of consumers was conducted to evaluate attitudes toward online access to personal radiological images. Results A total of 105 responses were received from 686 community members (15.3%). Of 105 consumers, 94 (89.5%) reported a desire to have access to the radiology images within their online patient portal; 86.7% (91/105) believed it would help them better understand their medical conditions and 81.0% (85/105) said this would help them feel more in control of their care. Most respondents (74/105, 70.5%) said it would help them feel reassured that their doctor was doing the right thing, and 63.8% (67/105) said it would increase their level of trust in their doctor. Among surveyed patients, 78.1% (82/105) valued viewing their radiology images online, while 92.4% (97/105) valued their online radiology reports. Most patients (69/105, 65.7%) wished to discuss their results with their ordering clinician, 29.5% (31/105) wished to discuss with their interpreting radiologist, and 3.8% (4/105) wished to share their images on social media. The biggest potential concern among 23.8% (25/105) was that the images would be confusing. Conclusions A large majority of surveyed patients desired the ability to view their radiology images online and anticipated many benefits and few risks. Health care organizations with electronic health records and online patient portals should consider augmenting their existing portals with this highly desired feature. To avoid the biggest patient concern, radiology reports should accompany images. Patients wanted to discuss their results with their ordering physician and their interpreting radiologist. Some even would like to share results on social media. Further research on the actual experience with such a tool will be needed.
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Affiliation(s)
| | - Peter Sachs
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, United States
| | | | - Chen-Tan Lin
- University of Colorado School of Medicine, Aurora, CO, United States
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Sood N, Jimenez DE, Pham TB, Cordrey K, Awadalla N, Milanaik R. Paging Dr. Google: The Effect of Online Health Information on Trust in Pediatricians' Diagnoses. Clin Pediatr (Phila) 2019; 58:889-896. [PMID: 31043059 DOI: 10.1177/0009922819845163] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study investigates how parental trust in physician diagnoses and likelihood of seeking a second opinion (SO) are affected by Internet sources. In an anonymous survey, 1374 parents of minors viewed a vignette describing their child's symptoms followed by Internet results that either supported or contradicted the pediatrician's diagnosis (Dx). A control group did not view any Internet results. After learning the Dx, participants rated trust in the Dx and likelihood of seeking a SO on a 7-point Likert-type scale. Participants who viewed contradicting results were less likely to trust the Dx ( P < .001) and more likely to seek a SO than the control ( P < .001). Participants who viewed supporting results were more likely to trust the Dx ( P < .001) and less likely to seek a SO than the control ( P < .001). Physicians must be aware of the influence the Internet may have on patients' trust.
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Affiliation(s)
- Nikita Sood
- 1 Steven and Alexandra Cohen Children's Medical Center of New York, Lake Success, NY, USA
| | - David E Jimenez
- 1 Steven and Alexandra Cohen Children's Medical Center of New York, Lake Success, NY, USA
| | - Tammy B Pham
- 1 Steven and Alexandra Cohen Children's Medical Center of New York, Lake Success, NY, USA
| | - Kyla Cordrey
- 1 Steven and Alexandra Cohen Children's Medical Center of New York, Lake Success, NY, USA
| | - Nicol Awadalla
- 1 Steven and Alexandra Cohen Children's Medical Center of New York, Lake Success, NY, USA
| | - Ruth Milanaik
- 1 Steven and Alexandra Cohen Children's Medical Center of New York, Lake Success, NY, USA
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32
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Minig L, Bosch JM, Illueca C, Zorrero C, Cárdenas-Rebollo JM, Cruz J, Romero I. Relevance of minor discrepancies at second pathology review in gynaecological cancer. Ecancermedicalscience 2019; 13:929. [PMID: 31281426 PMCID: PMC6592709 DOI: 10.3332/ecancer.2019.929] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Indexed: 11/11/2022] Open
Abstract
Aim To determine the incidence of discrepancy rate between the initial pathology diagnosis and referral diagnosis in women with gynaecological cancer. Methods A retrospective observational study was performed including all consecutive patients with gynaecological cancer referred and who underwent pathologic review between January 2013 and May 2017. Discrepancies were minor when future treatment was not altered or major when the treatment was modified. Results A total of 259 patients were included. The original diagnosis was ovarian cancer (n = 126, 48.6%), endometrial cancer (n = 84, 32.4%), cervical cancer (n = 43, 16.6%) and vulvar cancer (n = 6, 2.3%). Eighteen women (6.9%) had major discrepancies and 69 patients (26.6%) had minor discrepancies. The main reason for the minor discrepancy was tumour grade or histology subtype. Regarding ovarian cancer, 13 out of 16 patients had minor discrepancies at histology subtype among serous, endometrioid, mucinous or undifferentiated tumours. The main issue for the minor discrepancy in patients with cervical cancer was among different subtype of cervical adenocarcinoma. Minor discrepancies due to tumour grade were also observed in 14, 19, 8 and 3 patients with endometrial, ovarian, cervical and vulvar cancer, respectively. Conclusions A second pathology review also adds valid information in those cases with minor discrepancies leading to a difference in patients´ counselling regarding follow-up and prognosis.
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Affiliation(s)
- Lucas Minig
- Gynecology Department, CEU Cardenal Herrera University, 46115 Valencia, Spain.,https://orcid.org/0000-0001-7648-5604
| | - José Manuel Bosch
- Gynecology Department, Instituto Valenciano de Oncología (IVO), 46009 Valencia, Spain
| | - Carmen Illueca
- Pathology Department, Instituto Valenciano de Oncología (IVO), 46009 Valencia, Spain
| | - Cristina Zorrero
- Gynecology Department, Instituto Valenciano de Oncología (IVO), 46009 Valencia, Spain
| | | | - Julia Cruz
- Pathology Department, Instituto Valenciano de Oncología (IVO), 46009 Valencia, Spain
| | - Ignacio Romero
- Medical Oncology Department, Instituto Valenciano de Oncología (IVO), 46009 Valencia, Spain
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Weinfurtner RJ, Mooney B, Forbus J. Specialized Second Opinion Review of Breast MRI Impacts Management and Increases Cancer Detection. J Am Coll Radiol 2019; 16:922-927. [PMID: 30833163 DOI: 10.1016/j.jacr.2019.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/04/2019] [Accepted: 01/05/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The aim of our study is to determine MRI review discrepancy frequency and the subsequent impact on patient management for patients pursuing breast imaging second opinions. METHODS A retrospective chart review was conducted on 1,000 consecutive patients with second opinion radiology interpretations performed by subspecialty-trained breast radiologists at a dedicated cancer center July 1 through December 31, 2016. Of these, 205 included review of outside breast MRI. Outside imaging reports were compared with second opinion reports to categorize breast MRI review discrepancies. These included relevant BI-RADS category changes or identification of additional extent of disease >4 cm. The discrepancy frequency, relevant alterations in patient management, and incremental cancer detection were measured. Statistical analyses were performed using Fisher's exact test. RESULTS Discrepant second opinion breast MRI review was seen in 36 of 205 patients (18%). Additional cancer was detected through image-guided biopsy in 3 of these 36 patients and through excision in 2 (5 of 205, 2%). Additionally, five biopsies yielded high-risk pathologic results without upstage on excision. Findings suspicious for additional extent of disease >4 cm were noted in five patients (2%) treated with mastectomies. Finally, five patients had BI-RADS category downgrades. Ultimately, completion of second opinion MRI review recommendations resulted in altered management in 10% of patients (20 of 205). The absence of prior imaging studies for comparison was associated with increased discrepancy frequency (P = .005). CONCLUSION Second opinion breast MRI review by subspecialized breast imaging radiologists increases cancer detection and results in clinically relevant changes in patient management.
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Whorms DS, Giess CS, Golshan M, Freedman RA, Bunnell CA, Alper EC, Losk K, Khorasani R. Clinical Impact of Second Opinion Radiology Consultation for Patients With Breast Cancer. J Am Coll Radiol 2018; 16:814-823. [PMID: 30579707 DOI: 10.1016/j.jacr.2018.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/06/2018] [Accepted: 10/14/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To assess the incidence and clinical significance of discrepancy in subspecialty interpretation of outside breast imaging examinations for newly diagnosed breast cancer patients presenting to a tertiary cancer center. MATERIALS AND METHODS This Institutional Review Board-approved retrospective study included patients presenting from July 2016 to March 2017 to a National Cancer Institute-designated comprehensive cancer center for second opinion after breast cancer diagnosis. Outside and second opinion radiology reports of 252 randomly selected patients were compared by two subspecialty breast radiologists to consensus. A peer review score was assigned, modeled after ACR's RADPEERTM peer review metric: 1-agree; 2-minor discrepancy (unlikely clinically significant); 3-moderate discrepancy (may be clinically significant); 4-major discrepancy (likely clinically significant). Among cases with clinically significant discrepancies, rates of clinical management change (management alterations including change in follow-up, neoadjuvant therapy use, and surgical management as a direct result of image review), and detection of additional malignancy were assessed through electronic medical record review. RESULTS A significant difference in interpretation (scores = 3 or 4) was seen in 41 of 252 cases (16%, 95% confidence interval [CI], 11.7%-20.8%). The difference led to additional workup in 38 of 252 cases (15%, 95% CI 10.6%-19.5%) and change in clinical management in 18 of 252 cases (7.1%, 95% CI 4.0%-10.2%), including 15 of 252 with change in surgical management (6.0%, 95% CI, 3.0%-8.9%). An additional malignancy or larger area of disease was identified in 11 of 252 cases (4.4%, 95% CI, 1.8%-6.9%). CONCLUSION Discrepancy between outside and second-opinion breast imaging subspecialists frequently results in additional workup for breast cancer patients, changes in treatment plan, and identification of new malignancies.
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Affiliation(s)
- Debra S Whorms
- Center for Evidence-Based Imaging and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Catherine S Giess
- Center for Evidence-Based Imaging and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Mehra Golshan
- Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Rachel A Freedman
- Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Craig A Bunnell
- Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Emily C Alper
- Center for Evidence-Based Imaging and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Katya Losk
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ramin Khorasani
- Center for Evidence-Based Imaging and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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Strosberg C, Gibbs J, Braswell D, Leslie RR, Messina J, Centeno BA, Coppola D. Second Opinion Reviews for Cancer Diagnoses in Anatomic Pathology: A Comprehensive Cancer Center's Experience. Anticancer Res 2018; 38:2989-2994. [PMID: 29715129 DOI: 10.21873/anticanres.12551] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 02/23/2018] [Accepted: 03/08/2018] [Indexed: 11/10/2022]
Abstract
AIM The objective of this study was to define the rates of discrepancy between outside pathological diagnoses and secondary reviews. MATERIALS AND METHODS We assessed the rates of discordance between outside diagnoses and secondary reviews, categorizing by organ site and minor or major (affecting patient care) discordances. RESULTS A total of 9,289 consecutive surgical pathology (SP) and cytopathology (CP) cases reviewed in 2015 were identified. For 8,191 outside SP cases reviewed, the overall discordance rate (DR) was 14.2% (2.2% major, 12.0% minor). Specifically, neuropathology had the highest DR (10.9%), cutaneous and breast the lowest (1.1% each). Among 1,098 CP cases, the total DR was 13.7% (3.0% major, 10.7% minor). The majority of CP cases (1,066) were non-gynecological and had a total DR of 13.4% (2.7% major, 10.7% minor). CONCLUSION While major DR was low, certain subspecialties had high DRs. This project can help identify areas where focused education could help improve pathological diagnostic accuracy for cancer.
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Affiliation(s)
- Carolina Strosberg
- Department of Chemical Biology Molecular Medicine, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, U.S.A.,Department of Pathology and Cell Biology, University of South Florida, Tampa, FL, U.S.A
| | - Julie Gibbs
- Department of Chemical Biology Molecular Medicine, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, U.S.A.,Department of Pathology and Cell Biology, University of South Florida, Tampa, FL, U.S.A
| | - Diana Braswell
- Department of Chemical Biology Molecular Medicine, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, U.S.A.,Department of Pathology and Cell Biology, University of South Florida, Tampa, FL, U.S.A
| | - Ronni R Leslie
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, U.S.A
| | - Jane Messina
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, U.S.A.,Department of Oncological Sciences, University of South Florida, Tampa, FL, U.S.A
| | - Barbara A Centeno
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, U.S.A.,Department of Oncological Sciences, University of South Florida, Tampa, FL, U.S.A
| | - Domenico Coppola
- Department of Chemical Biology Molecular Medicine, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, U.S.A. .,Department of Anatomic Pathology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, U.S.A.,Department of Oncological Sciences, University of South Florida, Tampa, FL, U.S.A.,Department of Tumor Biology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, U.S.A
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Weyerstraß J, Prediger B, Neugebauer E, Pieper D. [First results of a German second opinion program show high patient satisfaction and large discrepancies between initial therapy recommendations and second opinion]. Z Evid Fortbild Qual Gesundhwes 2018; 133:46-50. [PMID: 29482914 DOI: 10.1016/j.zefq.2018.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 11/21/2017] [Accepted: 01/30/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Although legally anchored, there are no empirical results from German second opinion programs. In this study, various aspects within a population of a second opinion program are examined. METHODS In this study patients were analyzed who sought a second opinion in the period from August 2011 to December 2016. Differences in patient characteristics, differentiated by agreement of first and second opinion, were analyzed using multivariate logistic regression. Patients' satisfaction and quality of life were examined one, three and six months after obtaining the second opinion. RESULTS In total, 1,414 patients sought a second opinion. Most frequently, second opinions were sought on knee (38.7 %), back (26.8 %), hip (11.7 %), and shoulder (10.2 %) complaints. Except for the indication (p=0.035), no patient characteristic had influence on the conformation of the second opinion. Approximately two out of three initial recommendations were not confirmed by the specialists. 89 % of the patients were satisfied or very satisfied with the second opinion and the service offered. CONCLUSIONS The second opinion offers patients the opportunity to seek an additional independent medical opinion and thus provides support for decision making. Further research is needed to examine the reasons for the high discrepancies between the first and second opinions.
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Merabi Z, Boulos F, Santiago T, Jenkins J, Abboud M, Muwakkit S, Tarek N, Zaatari G, Jeha S, El-Solh H, Saab R. Pediatric cancer pathology review from a single institution: Neuropathology expert opinion is essential for accurate diagnosis of pediatric brain tumors. Pediatr Blood Cancer 2018; 65. [PMID: 28675683 DOI: 10.1002/pbc.26709] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/08/2017] [Accepted: 06/08/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES Second pathology review has been reported to improve accuracy in oncologic diagnoses, including pediatric malignancies. We assessed the impact of second review on the diagnosis of pediatric malignancies at a tertiary care referral center in Beirut, Lebanon. METHODS Pathology reports of patients treated at the Children's Cancer Institute in Lebanon were retrospectively reviewed for the period 2008-2016 and compared with same samples' diagnoses at St. Jude Children's Research Hospital. Diagnostic disagreements were divided into major, minor, and none based on their effect on diagnosis and/or patient management. RESULTS Second review was requested for 171 cases, accounting for 19% of all cases during that period. Second opinion was mostly requested for brain tumors (62% of all brain tumor cases) and neuroblastoma for NMYC testing (65% of all neuroblastoma), while hematologic malignancies had the fewest referrals (3% of all hematologic cases). Major disagreements in second review occurred in 20 cases (12% of total), and minor disagreements in 21 cases (12% of total). The largest proportion of major disagreements (71%) occurred in pediatric brain tumors, and novel molecular tests contributed to the diagnosis in 55% of these cases. CONCLUSIONS The availability of a specialized pediatric neuropathologist and a basic panel of relevant molecular testing are essential for appropriate diagnosis of pediatric brain tumors. Centers that do not have the available infrastructure in place can benefit greatly from second review referrals for this challenging subset of tumors.
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Affiliation(s)
- Zeina Merabi
- Department of Pediatric and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fouad Boulos
- Department of Pediatric and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Jesse Jenkins
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Miguel Abboud
- Department of Pediatric and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Samar Muwakkit
- Department of Pediatric and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nidale Tarek
- Department of Pediatric and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ghazi Zaatari
- Department of Pediatric and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sima Jeha
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Hassan El-Solh
- Department of Pediatric and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Raya Saab
- Department of Pediatric and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Sawan P, Rebeiz K, Schoder H, Batlevi C, Moskowitz A, Ulaner GA, Dunphy M, Mannelli L. Specialized second-opinion radiology review of PET/CT examinations for patients with diffuse large B-cell lymphoma impacts patient care and management. Medicine (Baltimore) 2017; 96:e9411. [PMID: 29390562 PMCID: PMC5758264 DOI: 10.1097/md.0000000000009411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To identify discrepancies in fludeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) reports generated by general radiologists and subspecialized oncological radiologists for patients with diffuse large B-cell lymphoma (DLBCL), and to assess if such discrepancies impact patient management.Two radiologists retrospectively reviewed 72 PET/CT scans of patients with DLBCL referred to our institutions between 2009 and 2011, and recorded the discrepancies between the outside and second-opinion reports regarding multiple preset criteria using kappa statistic (Κ), including the disease stage. A multidisciplinary staging that considered all patient clinical data, pathology, and follow up radiological scans, was considered as standard of reference. A hemato-oncologist, blinded to the reports' origin, subjectively graded the quality and structure of these reports for each patient to determine if clinical stage and disease activity could be derived accurately from these reports.Agreement was not, or slightly, achieved between the reports regarding the binary and multilevel criteria (Κ < 0-0.2 and weighted Κ = 0.082, respectively). Second-opinion reviews of PET/CT scans were concordant with the multidisciplinary staging in 78% of cases with an almost perfect agreement (Κ = 0.860). A change in staging was demonstrated in 36% of cases. In addition, 68% of second-opinion reports were assigned the highest grades on quality (grades 4 and 5) by the hemato-oncologist, compared with 15% of outside reports, with no noted agreement (weighted Κ = -0.007).Second-opinion review of PET/CT scans by sub-specialized oncological radiologists increases accuracy of initial staging, posttreatment evaluation and also the clinical relevance of the radiology reports.
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Affiliation(s)
- Peter Sawan
- Department of Radiology
- Department of Molecular Imaging and Therapy
| | | | | | - Connie Batlevi
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, York Avenue, New York, NY
| | - Alison Moskowitz
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, York Avenue, New York, NY
| | | | | | - Lorenzo Mannelli
- Department of Radiology
- Department of Molecular Imaging and Therapy
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Bellevicine C, Migliatico I, Vigliar E, Serra N, Troncone G. Intra-institutional second opinion diagnosis can reduce unnecessary surgery for indeterminate thyroid FNA: A preliminary report on 34 cases. Cytopathology 2017; 28:254-258. [PMID: 28470780 DOI: 10.1111/cyt.12431] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2017] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Indeterminate diagnoses are rendered on 15%-30% of thyroid fine-needle aspirates (FNA). Thus, a second diagnostic opinion given by an outside expert pathologist is a common practice that facilitates a more appropriate clinical management. Conversely, the role of an intra-institutional second opinion diagnosis (iSOD), which is usually informally performed in-house, has not been well established. METHODS To assess the contribution of iSOD, a retrospective series of 34 thyroid FNA diagnosed as follicular neoplasm/suspicious follicular neoplasm (FN/SFN) with matched histological follow-up and a malignancy rate of 17.6% was selected and independently reviewed by two cytopathologists (CYT1 and 2). Cases with discrepant diagnoses were referred to a third in-house senior cytopathologist for the iSOD. The malignancy rates (MR) obtained after single independent reviews and iSOD were compared. RESULTS MR obtained after CYT1 and CYT2 re-screening was similar (14.28% and 19.04%, respectively) and did not improve the original MR (17.64%). Conversely, after the iSOD of discrepant diagnoses, the overall malignancy rate increased up to the 27.27%, potentially sparing unnecessary surgical procedures. CONCLUSIONS Intra-institutional second opinion practice for "indeterminate" thyroid FNA avoids unnecessary surgeries and maximises the detection of malignant cases diagnosed as FN/SFN.
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Affiliation(s)
- C Bellevicine
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - I Migliatico
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - E Vigliar
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - N Serra
- Institute of Radiology, Second University of Naples, Naples, Italy
| | - G Troncone
- Department of Public Health, University of Naples "Federico II", Naples, Italy
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Sarode SC, Sarode GS, Anand R, Patil S, Unadkat H. WhatsApp is an effective tool for obtaining second opinion in oral pathology practice. J Oral Pathol Med 2016; 46:513-519. [PMID: 27770472 DOI: 10.1111/jop.12515] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of this study was to find out the efficacy of WhatsApp application for obtaining second opinion on histopathological diagnosis in oral pathology practice. METHODS A total of 247 cases comprising of 34 different oral pathologies were photomicrographed using smartphone cameras through compound microscopes and sent for second opinion diagnosis (SOD) to 20 different oral pathologists using WhatsApp. RESULTS Of 4795 (97.06%) total second opinion received, correct SOD were received for 4710 (98.22%) cases. Hundred percent times correct SOD was received for lesions including adenomatoid odontogenic tumor, keratinizing cystic odontogenic tumor, odontome, and dentigerous cyst. Lesions such as myoepithelial carcinoma, osteosarcoma, fibrosarcoma, and intravascular papillary endothelial hyperplasia received less percentage of correct SOD (85.71-75.75%). Correct SOD was obtained for variants of ameloblastoma (99.01%), grading of epithelial dysplasia (87.54%), and squamous cell carcinoma (95.26%). A positive correlation was observed between correct SOD and age (P = 0.0143) and experience (P = 0.0189) of the pathologist. The time taken for giving second opinion by the pathologists ranged from 81.98 ± 32.89 to 90.72 ± 38.88 min. CONCLUSION Smartphone camera is a handy and efficient tool in capturing photomicrographs from the compound microscope. Transfer of such photomicrograph via WhatsApp is an effective and convenient approach in procuring second opinion on histopathological diagnosis of oral pathologies.
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Affiliation(s)
- Sachin C Sarode
- Department of Oral Pathology and Microbiology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, India
| | - Gargi S Sarode
- Department of Oral Pathology and Microbiology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, India
| | - Rahul Anand
- Department of Oral Pathology and Microbiology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, India
| | - Shankargouda Patil
- Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Hemant Unadkat
- National Dental Centre of Singapore, Singapore, Singapore
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Radhakrishnan A, Grande D, Mitra N, Bekelman J, Stillson C, Pollack CE. Second opinions from urologists for prostate cancer: Who gets them, why, and their link to treatment. Cancer 2016; 123:1027-1034. [PMID: 28263389 DOI: 10.1002/cncr.30412] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 09/29/2016] [Accepted: 10/03/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cancer patients are encouraged to obtain second opinions before starting treatment. Little is known about men with localized prostate cancer who seek second opinions, the reasons why, and the association with treatment and quality of care. METHODS We surveyed men who were diagnosed with localized prostate cancer in the greater Philadelphia area from 2012 to 2014. Men were asked if they obtained a second opinion from a urologist, and the reasons why. We used multivariable logistic regression models to evaluate the relationship between second opinions and definitive prostate cancer treatment and perceived quality of care. RESULTS A total of 2386 men responded to the survey (adjusted response rate, 51.1%). After applying exclusion criteria, the final analytic cohort included 2365 respondents. Of these, 40% obtained second opinions, most commonly because they wanted more information about their cancer (50.8%) and wanted to be seen by the best doctor (46.3%). Overall, obtaining second opinions was not associated with definitive treatment or perceived quality of cancer care. Men who sought second opinions because they were dissatisfied with their initial urologist were less likely to receive definitive treatment (odds ratio, 0.49; 95% confidence interval, 0.32-0.73), and men who wanted more information about treatment were less likely to report excellent quality of cancer care (odds ratio, 0.70; 95% confidence interval, 0.49-0.99) compared with men who did not receive a second opinion. CONCLUSIONS Although a large proportion of men with localized prostate cancer obtained a second opinion, the reasons for doing so were not associated with treatment choice or perceived quality of cancer care. Future study is needed to determine when second opinions contribute to increasing the value of cancer care. Cancer 2017;123:1027-34. © 2016 American Cancer Society.
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Affiliation(s)
- Archana Radhakrishnan
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland
| | - David Grande
- Division of General Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nandita Mitra
- Department of Biostatistics and Epidemiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Justin Bekelman
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christian Stillson
- Division of General Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Craig Evan Pollack
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland.,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Al-Ibraheemi A, Folpe AL. Voluntary Second Opinions in Pediatric Bone and Soft Tissue Pathology: A Retrospective Review of 1601 Cases From a Single Mesenchymal Tumor Consultation Service. Int J Surg Pathol 2016; 24:685-691. [PMID: 27363432 DOI: 10.1177/1066896916657591] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The diagnosis of bone and soft tissue tumors in children is challenging. These lesions are especially difficult for general pathologists. We reviewed our experience with pediatric mesenchymal tumors sent in consultation to our service, with the goal of identifying issues that most often prompted second-opinion referral. Roughly 16 000 cases were seen in toto, of which 1601 occurred in children. These included 491 bone cases and 1110 soft tissue cases. The cases were referred by private practices/nonacademic medical centers (85%), academic medical centers (8%), and pediatric hospitals (7%). Reasons for referral were (a) self-perceived lack of experience with pediatric mesenchymal tumors (n = 930), (b) second opinion requested by the clinician or patient (n = 132), and (c) perceived or real need for ancillary studies not available at the referring institution (n = 116). The referring pathologists suggested a diagnosis for 670 cases; of these, 476 (71%) were in essential agreement with our final diagnosis. Of the remaining, 139 (21%) were considered "minor disagreements" and 55 (8%) "major disagreements." The "major disagreement" cases could be divided into (a) malignant tumors submitted with benign diagnoses (58%), (b) benign tumors submitted with malignant diagnoses (25%), (c) nonneoplastic conditions submitted as representing neoplasms (11%), and (d) neoplasm submitted as representing nonneoplastic conditions (6%). Pediatric mesenchymal tumors comprised 10% of cases sent to our mesenchymal tumor consultation practice. The rates of diagnostic disagreement found in this study are roughly in accordance with prior studies of mandatory and voluntary second opinion in adult soft tissue tumors. Given the rarity of these tumors, expert second opinion may be of value.
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Chalian M, Del Grande F, Thakkar RS, Jalali SF, Chhabra A, Carrino JA. Second-Opinion Subspecialty Consultations in Musculoskeletal Radiology. AJR Am J Roentgenol 2016; 206:1217-21. [PMID: 27058462 DOI: 10.2214/AJR.15.14540] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to evaluate the significance of subspecialty second-opinion consultations for CT and MRI examinations in musculoskeletal (MSK) radiology. MATERIALS AND METHODS All 3165 MSK CT and MRI examinations referred to one academic institution for second-opinion consultation during a 24-month period were reviewed by three MSK-trained radiologists. Outside and inside reports were compared by two independent MSK radiology fellows using a previously published 5-point scale. Clinically important differences (categories 4 and 5) were defined as those likely to change patient management. Statistical comparisons of rates were performed using a chi-square test with Bonferroni corrections. Interobserver reliability was reported using linear weighted kappa statistics and the percentage of agreement. RESULTS Of all second-opinion examinations, 73.5% (2326/3165) had an outside report available for comparison and inclusion in this study. There were 610 of 2326 (26.2%) examinations with clinically important differences. The rate of clinically important discrepant readings was even higher in oncologic cases (36.3%; 331/911). When the final diagnosis was determined from pathology reports performed after internal interpretation, the second-opinion consultation was noted to be correct in 82.0% (334/407) of examinations with category 4 or 5 discrepancies. There was very good agreement (κ = 0.93) in scoring the discrepancies between second-opinion consultants. CONCLUSION The subspecialty second-opinion consultation was more accurate than outside reports in 82.0% of examinations when pathologic confirmation was made. A moderate rate (26.2%) of discrepant interpretations was noted between outside and inside MSK imaging examinations, especially in tumor cases (36.3%). Most discrepancies were in interpreting rather than detecting abnormalities.
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Shin DW, Cho J, Yang HK, Kim SY, Mok HK, Lee H, Park SM, Huh JS, Ryu J, Park JH. Attitudes towards second opinion services in cancer care: a nationwide survey of oncologists in Korea. Jpn J Clin Oncol 2016; 46:441-7. [PMID: 27004900 DOI: 10.1093/jjco/hyw016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 01/26/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Second opinion is a common phenomenon in many health systems, especially in the care of patients with cancer. However, it is not clear whether second opinion seeking should be promoted or discouraged and how second opinion services and policies can be better formalized to maximize the benefits and minimize the disadvantages. METHODS A nationwide survey was conducted with a representative sample of 678 physicians involved in cancer care (75.5% participation rate) recruited in 13 cancer centres. RESULTS Most physicians involved with cancer care perceived patients' second opinion seeking as a legitimate right (96.0%) and they acknowledged the need for second opinion services under certain conditions (98.2%). Many believed that second opinions can enhance patient satisfaction (77.3%) and quality of care (74.3%), but they also had concerns about increase in healthcare and societal costs (91.3%) and concentration in a high-volume centre (90.7%). While the majority agreed with the involvement of the first opinion physicians in the second opinion services (69.5%), there were mixed opinions regarding the desirability of remote (teleconsultation) second opinion services (49.0%) and coverage by national health insurance (51.9%). CONCLUSION Physicians were generally positive to second opinion services and expected positive consequences in terms of patient satisfaction and quality of care. However, they had concerns about the consequences regarding cost and equity, and disagreements were observed regarding the way to improve second opinion services. The physicians' opinions revealed in our study will be helpful in developing clearer guidelines used to maximize the benefits of second opinion services.
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Affiliation(s)
- Dong Wook Shin
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Juhee Cho
- Department of Health, Behavior and Society & Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA Cancer Education Center, Samsung Comprehensive Cancer Center, SAHIST and School of Medicine, Sunkyungkwan University School of Medicine, Seoul
| | - Hyung Kook Yang
- Division of Cancer Policy and Management, National Cancer Control Institute, National Cancer Center, Goyang
| | - So Young Kim
- Division of Cancer Policy and Management, National Cancer Control Institute, National Cancer Center, Goyang
| | - Hyung Kyun Mok
- Division of Cancer Policy and Management, National Cancer Control Institute, National Cancer Center, Goyang
| | - Hyejin Lee
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Seon Mee Park
- Department of Gastroenterology, Chungbuk National University College of Medicine, Cheongju
| | - Jung Sik Huh
- Department of Urology, Jeju National University Hospital, Jeju National University College Medicine, Jeju
| | - Junsun Ryu
- Department of Otolaryngology-Head and Neck Surgery, Head & Neck Oncology Clinic, Center for Thyroid Cancer, Research Institute and Hospital, National Cancer Center, Goyang
| | - Jong Hyock Park
- Division of Cancer Policy and Management, National Cancer Control Institute, National Cancer Center, Goyang College of Medicine/Graduate School of Health Science Business Convergence, Chungbuk National University, Cheongju, Korea
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Patrawala S, Maley A, Greskovich C, Stuart L, Parker D, Swerlick R, Stoff B. Discordance of histopathologic parameters in cutaneous melanoma: Clinical implications. J Am Acad Dermatol 2016; 74:75-80. [PMID: 26514601 DOI: 10.1016/j.jaad.2015.09.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 08/27/2015] [Accepted: 09/06/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Histopathologic analysis remains the gold standard for the diagnosis of melanoma, however previous studies have shown a substantial rate of interobserver variability in the evaluation of melanocytic lesions. OBJECTIVE We sought to evaluate discordance in the histopathological diagnosis and microstaging parameters of melanoma and subsequent impact on clinical management. METHODS This was a retrospective review of 588 cases of cutaneous melanoma and melanoma in situ from January 2009 to December 2014 that were referred to Emory University Hospital, Atlanta, GA, for treatment. Per institutional policy, all outside melanoma biopsy specimens were reviewed internally. Outside and institutional reports were compared. RESULTS Disagreement between outside and internal reports resulted in a change in American Joint Committee on Cancer pathologic stage in 114/588 (19%) cases, resulting in a change in management based on National Comprehensive Cancer Network guidelines in 105/588 (18%) cases. LIMITATIONS Given the retrospective nature of data collection and the bias of a tertiary care referral center, cases in this study may not be representative of all melanoma diagnoses. CONCLUSION These findings confirm consistent subjectivity in the histopathologic interpretation of melanoma. This study emphasizes that a review of the primary biopsy specimen may lead to significant changes in tumor classification, resulting in meaningful changes in clinical management.
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Affiliation(s)
- Samit Patrawala
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Alexander Maley
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Caitlin Greskovich
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Lauren Stuart
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Douglas Parker
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Robert Swerlick
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Benjamin Stoff
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia.
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Löfgren J, Loft A, Barbosa de Lima VA, Østerlind K, von Benzon E, Højgaard L. Clinical importance of re-interpretation of PET/CT scanning in patients referred to a tertiary care medical centre. Clin Physiol Funct Imaging 2015. [PMID: 26211508 DOI: 10.1111/cpf.12278] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate, in a controlled prospective manner with double-blind read, whether there are differences in interpretations of PET/CT scans at our tertiary medical centre, Rigshospitalet, compared to the external hospitals. METHODS Ninety consecutive patients referred to our department who had an external F-18-FDG PET/CT scan were included. Only information that had been available at the time of the initial reading at the external hospital was available at re-interpretation. Teams with one radiologist and one nuclear medicine physician working side by side performed the re-interpretation in consensus. Two oncologists subsequently and independently compared the original reports with the re-interpretation reports. In case of 'major discordance', the oncologists assessed the respective reports validities. RESULTS The interpretations were graded as 'accordant' in 43 patients (48%), 'minor discordance' in 30 patients (33%) and 'major discordance' in 17 patients (19%). In 11 (65%) of the 17 cases graded as 'major discordance', it was possible to determine which report that was most correct. In 9 of these 11 cases (82%), the re-interpretation was most correct; in one case, the original report and in another case, both interpretations were incorrect. CONCLUSIONS Major discordant interpretations were frequent [19% (17 of 90 cases)]. In those cases where follow-up could assess the validity, the re-interpretation at Rigshospitalet was most correct in 9 of 11 cases (82%), indicating that there is a difference in expertise in interpreting PET/CT at a tertiary referral hospital compared to primary local hospitals.
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Affiliation(s)
- Johan Löfgren
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Annika Loft
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Kell Østerlind
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Eric von Benzon
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Liselotte Højgaard
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Abstract
OBJECTIVES The goal of this study was to identify second opinion consultations by physicians and to determine patient and family factors that appeared to contribute to a second opinion being sought. METHODS One hundred and fifty consecutive parents of children with cancer recently treated in our Department of Pediatric Hematology Oncology were interviewed by telephone. The questionnaire included epidemiological data, details about the disease, timing of the second opinion consultation, reasons for seeking a second opinion, and the outcome of the consultation. RESULTS Thirty-seven (24.7%) parents sought a second opinion. Advice was sought from other physicians in the hospital or at other clinics. There was a correlation to a higher socioeconomic status (P = .003) and to the number of educational years (P = .001). Most of the parents sought a second opinion because they wanted confirmation about the treatment protocol and the professional level of the hematologist oncologist/surgeon and the institution. CONCLUSIONS Second opinion consultations were not uncommon and were mainly secondary to the desire for reassurance. Pediatric oncologists should ensure that patients and their families feel comfortable requesting a second opinion consultation.
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Affiliation(s)
- Oz Mordechai
- Department of Pediatric Hematology Oncology, Rambam Health Care Campus , Haifa , Israel
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Abstract
OBJECTIVES To examine situations in which compulsory treatment was not approved by the second opinion required under New Zealand's Mental Health Act. METHODS Qualitative and quantitative analysis of 11 index cases where full approval of treatment was not given and of 33 matched controls. RESULTS The reasons for non-approval of treatment were diverse. Following non-approval, intensive consultation occurred, reflecting significant disagreement between clinicians. The process of resolution included discharge from the Act, patients consenting to treatment and alternative treatment plans. Compared with controls, index cases had significantly lower rates of being mentally well in the community over the subsequent year. CONCLUSIONS Non-approval marks a group of patients with very poor clinical outcome. Explicit processes are needed to manage non-approval of compulsory treatment plans.
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Affiliation(s)
- Jessie Lenagh-Glue
- Research Assistant, Faculty of Law, University of Otago, Dunedin, New Zealand
| | - Paul Glue
- Professor, Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - John Dawson
- Professor, Faculty of Law, University of Otago, Dunedin, New Zealand
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Abstract
Breast cancer pathology reports contain valuable information about the histologic diagnosis, prognostic factors and predictive indicators of therapeutic response. A second opinion may be requested by medical oncologists and surgeons, when a patient is referred from another institution for treatment. We report the experience with pathology second opinion in selected patients referred to the Breast Oncology Unit. 205 cases referred to the Breast Oncology Unit were selected for second opinion after clinical evaluation, between 2002 and 2012. The cases reviewed included 102 core needle biopsies, 88 surgical specimens from the breast and 18 lymphadenopathies, 14 from the axillary region. Pathology second opinion was based on a review of hematoxylin-eosin preparations, recuts of submitted paraffin blocks and written external pathology reports. Immunohistochemical studies for hormone receptors, HER2, myoepithelial cells, and other markers were performed in selected cases. A case was reclassified as showing major change when second opinion showed a potential for significant change in prognosis or treatment. Otherwise, it was considered to represent minor change or to be concordant. In 52 cases (25.4%), the pathology review showed changes. Thirty-three (16%) patients were reclassified for major changes and 19 (9.2%) as minor changes. In six patients, more than one major change was identified. The major discrepancies identified were related to the histologic classification (12 cases), the presence or absence of invasion in ductal carcinoma (15 cases), the results of hormone receptors (5 cases), and HER2 (7 cases). Major changes in histologic classification included two cases diagnosed as invasive ductal carcinoma and reclassified as benign, four cases with diagnosis of breast cancer reclassified as metastatic lung cancer, one case diagnosed as small cell carcinoma of lung metastatic in the breast, reclassified as primary carcinoma of the breast, and three cases with diagnosis of breast cancer in the axilla reclassified as primary cutaneous adnexal carcinomas (2) and metastatic melanoma (1), respectively. In two cases, the histologic type of the primary breast tumor was changed. Second opinion in breast pathology may uncover significant discrepancies that impact on patient management and prognosis. Major discrepancies are most frequently related to the assessment of the presence or absence of invasion in ductal carcinoma, the results of predictive makers of therapeutic response, and the differential diagnosis of breast cancer and nonmammary tumors in the breast, the axilla, and at distant sites.
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Affiliation(s)
- Vicente Marco
- Department of Pathology, Hospital Quiron Barcelona, Barcelona, Spain
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Abstract
Patients choose to seek a second opinion in matters related to their health for a variety of reasons, and the total cost associated with these second opinion visits is estimated to be billions of dollars annually. Understanding the reasons behind second opinion self-referrals is key to improving patient satisfaction and reducing redundancy in delivered health care. This study represents a retrospective analysis of the records from a single provider at the Massachusetts Eye and Ear Infirmary (MEEI) Comprehensive Ophthalmology Service in order to determine the various reasons that patients self-refer to an ophthalmology clinic seeking second opinions. A total of 174 patients presenting for a second opinion were identified over a one-year period. Patients presented for second opinions for two primary reasons: 60% presented in order to seek a confirmation of a diagnosis from an outside ophthalmologist (54%) or optometrist (6%), and 40% presented due to a previous adverse experience with an outside provider, such as perceived treatment failure (26%), poor bedside manner (3%), distrust of the provider (5%), and poor provider communication skills (7%). This study strives to reiterate that the reduction of adverse patient experiences through effective communication of expected treatment options and outcomes, with a realistic time course of therapy, could significantly improve patient satisfaction and reduce costly second opinion visits.
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