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Clinical Importance of Reinterpretation of Body CT Scans Obtained Elsewhere in Patients Referred for Care at a Tertiary Cancer Center

¹ Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021.

PURPOSE: To determine the frequency and clinical importance of discordance between the initial interpretation of computed tomographic (CT) scans of the body and subsequent interpretations in patients with biopsy-proved cancer.

MATERIALS AND METHODS: The initial and reinterpretation reports for 213 CT scans of the body submitted for official review were compared independently by two radiologists. Sixty-nine sets of reports were excluded because the reviewing radiologists and the outside radiologists had prior CT scans from differing dates to use for comparison. One set of reports was excluded because of lack of clinical follow-up.

RESULTS: The interpretations were graded as "agree" in 90 patients (63%), "major disagreement" in 24 patients (17%), and "minor disagreement" in 29 patients (20%). A theoretic change in treatment could have occurred in nine of 53 cases of disagreement (17%). An actual change in treatment occurred in five of 53 cases of disagreement (9%).

CONCLUSION: Discordant interpretations were frequent (53 of 143 cases [37%]), were often major (24 of 143 cases [17%]), and resulted in actual treatment changes in five of all 143 cases (3%). Reinterpretation of body CT scans can have a substantial effect on the clinical care of individual patients with proved malignancy.

Index terms: Computed tomography (CT), clinical effectiveness • Diagnostic radiology, observer performance • Images, interpretation • Radiology and radiologists, outcomes studies

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