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Objectives <p>To evaluate the completeness and discordance of outside rectal MRI initial staging reports compared to second-opinion reviews, and to assess the potential clinical impact of major discordance on treatment decisions in patients with rectal adenocarcinoma.</p> Materials and methods <p>A retrospective analysis of outside rectal MRI reviews submitted for second-opinion interpretation by subspecialized radiologists from June 2014–March 2020 was conducted. Outside and second review reports were compared side-by-side; cases with discordance (and those with major discordance, i.e., may alter treatment, particularly) were identified. Two colorectal surgeons, blinded to report origins, reviewed cases with major discordance to evaluate their theoretical impact on patient management and rated their confidence level of the reports on a five-point Likert scale (1=lowest confidence).</p> Results <p>In 461 patients (median age, 57 years [IQR: 49–67]; 274 male), compared to outside reviews, second reviews demonstrated improved report completeness across tumor characteristics, local extent, and nodal/metastatic disease clinical staging categories. The largest reporting gaps were in tumor morphology (66.4%, 306/461 vs. 98.7%, 455/461) and extramural venous invasion (29.1%, 134/461 vs. 93.9%, 433/461). Overall, 53.8% (248/461) of cases showed discordance, with 56.5% (140/248) classified as major. In this subset, second reviews led to fewer cases with insufficient information, e.g., 18.6% (26/140) to 7.1% (10/140) for Surgeon 1, and changes in surgical planning in 38.1–46.3% (43/113 to 44/95) of patients. Surgeons rated reports from second reviews with higher confidence scores (median, 4 vs. 2–3, <i>p</i> &lt; 0.001).</p> Conclusions <p>Second-opinion reviews may impact patient care and improve surgeons’ confidence for treatment planning.</p> Key Points <p><Emphasis Type="BoldItalic">Question</Emphasis> <i>Do subspecialist radiologist second-opinion reviews improve rectal MRI report completeness and affect treatment decisions in rectal adenocarcinoma staging?</i></p> <p><Emphasis Type="BoldItalic">Findings</Emphasis> <i>While outside reviews often under-reported key imaging findings, second reviews improved report completeness, which led to increased confidence by our surgeons in treatment planning.</i></p> <p><Emphasis Type="BoldItalic">Clinical relevance</Emphasis> <i>These findings underscore the value of expert interpretation and highlight the need for optimized MRI protocols and broader adoption of structured reporting in rectal cancer staging.</i></p> Graphical Abstract <p></p>

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Added value and clinical impact of second-opinion subspecialist radiologist interpretations of baseline rectal MRI in patients with rectal cancer

  • 期刊论文

  • 发表日期：

    2025年11月14日

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  • Jennifer S. Golia Pernicka,
  • Tae-Hyung Kim,
  • Stephanie Nougaret,
  • David D. B. Bates,
  • Maria El Homsi,
  • J. Louis Fuqua III,
  • Natalie Gangai,
  • Natally Horvat,
  • Emmanouil Pappou,
  • Viktoriya Paroder,
  • Maria Widmar,
  • Iva Petkovska,
  • Marc J. Gollub

摘要

Objectives

To evaluate the completeness and discordance of outside rectal MRI initial staging reports compared to second-opinion reviews, and to assess the potential clinical impact of major discordance on treatment decisions in patients with rectal adenocarcinoma.

Materials and methods

A retrospective analysis of outside rectal MRI reviews submitted for second-opinion interpretation by subspecialized radiologists from June 2014–March 2020 was conducted. Outside and second review reports were compared side-by-side; cases with discordance (and those with major discordance, i.e., may alter treatment, particularly) were identified. Two colorectal surgeons, blinded to report origins, reviewed cases with major discordance to evaluate their theoretical impact on patient management and rated their confidence level of the reports on a five-point Likert scale (1=lowest confidence).

Results

In 461 patients (median age, 57 years [IQR: 49–67]; 274 male), compared to outside reviews, second reviews demonstrated improved report completeness across tumor characteristics, local extent, and nodal/metastatic disease clinical staging categories. The largest reporting gaps were in tumor morphology (66.4%, 306/461 vs. 98.7%, 455/461) and extramural venous invasion (29.1%, 134/461 vs. 93.9%, 433/461). Overall, 53.8% (248/461) of cases showed discordance, with 56.5% (140/248) classified as major. In this subset, second reviews led to fewer cases with insufficient information, e.g., 18.6% (26/140) to 7.1% (10/140) for Surgeon 1, and changes in surgical planning in 38.1–46.3% (43/113 to 44/95) of patients. Surgeons rated reports from second reviews with higher confidence scores (median, 4 vs. 2–3, p < 0.001).

Conclusions

Second-opinion reviews may impact patient care and improve surgeons’ confidence for treatment planning.

Key Points

Question Do subspecialist radiologist second-opinion reviews improve rectal MRI report completeness and affect treatment decisions in rectal adenocarcinoma staging?

Findings While outside reviews often under-reported key imaging findings, second reviews improved report completeness, which led to increased confidence by our surgeons in treatment planning.

Clinical relevance These findings underscore the value of expert interpretation and highlight the need for optimized MRI protocols and broader adoption of structured reporting in rectal cancer staging.

Graphical Abstract