Impact of Imaging Review and Multidisciplinary Discussion During Hepatobiliary Tumor Board: A Prospective Study.

Abstract

This study aimed to quantify the value of imaging second review and multidisciplinary discussion of cases presented at the hepatobiliary tumor board (HTB) at a comprehensive cancer center. Cases referred to HTB for review and discussion during approximately 20 months were prospectively collected and characterized according to referral information, revisions to imaging findings, original management plan (before HTB), and final management plan (after HTB). Accuracy of original imaging interpretations versus revisions was determined, mostly by follow-up imaging. For 50 (34.2 %) of 147 patients, hepatobiliary group radiologists (HBRs) performed revisions of original imaging interpretations. In consequence of imaging revision, the management plan was changed for 19 (12.9 %) patients. Revision rates were higher for reports initially read by abdominal radiologists (ARs) than for reports read by HBRs (41.5 % vs 20.8 %; p = 0.011). Imaging reads related to cholangiocarcinoma and colorectal liver metastases (CLM) cases were the most frequently revised (12.2 % vs 8.2 % of all cases brought to conference). Management changes related to revisions occurred most frequently in CLM cases (58.3 %). Imaging revisions improved accuracy by 27.9 %. In 38.8 % of all cases, HBT discussion changed management. The most common reason for the change was interventional radiology or radiation oncology input (28.1 %). The vast majority of the time (95.1 %) questions brought to HTB by clinicians could be answered using available imaging. Imaging review by hepatobiliary radiologists and multidisciplinary discussion at HTB increases diagnostic accuracy of reads and results in management change for more than one third of patients.