Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Role of Dedicated Subspecialized Radiologists in Multidisciplinary Team Discussions on Lower Gastrointestinal Tract Cancers

  • Sun Kyung Jeon (Department of Radiology, Seoul National University Hospital) ;
  • Se Hyung Kim (Department of Radiology, Seoul National University Hospital) ;
  • Cheong-il Shin (Department of Radiology, Seoul National University Hospital) ;
  • Jeongin Yoo (Department of Radiology, Seoul National University Hospital) ;
  • Kyu Joo Park (Department of Surgery, Seoul National University Hospital) ;
  • Seung-Bum Ryoo (Department of Surgery, Seoul National University Hospital) ;
  • Ji Won Park (Department of Surgery, Seoul National University Hospital) ;
  • Tae-You Kim (Department of Internal Medicine, Seoul National University Hospital) ;
  • Sae-Won Han (Department of Internal Medicine, Seoul National University Hospital) ;
  • Dae-Won Lee (Department of Internal Medicine, Seoul National University Hospital) ;
  • Eui Kyu Chie (Department of Radiation Oncology, Seoul National University Hospital) ;
  • Hyun-Cheol Kang (Department of Radiation Oncology, Seoul National University Hospital)
  • Received : 2021.08.26
  • Accepted : 2022.03.03
  • Published : 2022.07.01
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Abstract

Objective: To determine the impact of dedicated subspecialized radiologists in multidisciplinary team (MDT) discussions on the management of lower gastrointestinal (GI) tract malignancies. Materials and Methods: We retrospectively analyzed the data of 244 patients (mean age ± standard deviation, 61.7 ± 11.9 years) referred to MDT discussions 249 times (i.e., 249 cases, as five patients were discussed twice for different issues) for lower GI tract malignancy including colorectal cancer, small bowel cancer, GI stromal tumor, and GI neuroendocrine tumor between April 2018 and June 2021 in a prospective database. Before the MDT discussions, dedicated GI radiologists reviewed all imaging studies again besides routine clinical reading. The referring clinician's initial diagnosis, initial treatment plan, change in radiologic interpretation compared with the initial radiology report, and the MDT's consensus recommendations for treatment were collected and compared. Factors associated with changes in treatment plans and the implementation of MDT decisions were analyzed. Results: Of the 249 cases, radiologic interpretation was changed in 73 cases (29.3%) after a review by dedicated GI radiologists, with 78.1% (57/73) resulting in changes in the treatment plan. The treatment plan was changed in 92 cases (36.9%), and the rate of change in the treatment plan was significantly higher in cases with changes in radiologic interpretation than in those without (78.1% [57/73] vs. 19.9% [35/176], p < 0.001). Follow-up records of patients showed that 91.2% (227/249) of MDT recommendations for treatment were implemented. Multiple logistic regression analysis revealed that the nonsurgical approach (vs. surgical approach) decided through MDT discussion was a significant factor for patients being managed differently than the MDT recommendations (odds ratio, 4.48; p = 0.017). Conclusion: MDT discussion involving additional review of radiology examinations by dedicated GI radiologists resulted in a change in the treatment plan in 36.9% of cases. Changes in treatment plans were significantly associated with changes in radiologic interpretation.

Keywords

Acknowledgement

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (NRF-2021R1F1A1046393).

References

  1. El Saghir NS, Charara RN, Kreidieh FY, Eaton V, Litvin K, Farhat RA, et al. Global practice and efficiency of multidisciplinary tumor boards: results of an American Society of Clinical Oncology international survey. J Glob Oncol 2015;1:57-64 
  2. Ringborg U, Pierotti M, Storme G, Tursz T; European Economic Interest Grouping. Managing cancer in the EU: the Organisation of European Cancer Institutes (OECI). Eur J Cancer 2008;44:772-773 
  3. Wright FC, De Vito C, Langer B, Hunter A; Expert Panel on Multidisciplinary Cancer Conference Standards. Multidisciplinary cancer conferences: a systematic review and development of practice standards. Eur J Cancer 2007;43:1002-1010 
  4. Munro A, Brown M, Niblock P, Steele R, Carey F. Do multidisciplinary team (MDT) processes influence survival in patients with colorectal cancer? A population-based experience. BMC Cancer 2015;15:686 
  5. Ryan J, Faragher I. Not all patients need to be discussed in a colorectal cancer MDT meeting. Colorectal Dis 2014;16:520-526 
  6. Chinai N, Bintcliffe F, Armstrong EM, Teape J, Jones BM, Hosie KB. Does every patient need to be discussed at a multidisciplinary team meeting? Clin Radiol 2013;68:780-784 
  7. Taylor C, Munro AJ, Glynne-Jones R, Griffith C, Trevatt P, Richards M, et al. Multidisciplinary team working in cancer: what is the evidence? BMJ 2010;340:c951 
  8. Santoso JT, Schwertner B, Coleman RL, Hannigan EV. Tumor board in gynecologic oncology. Int J Gynecol Cancer 2004;14:206-209 
  9. Kozak VN, Khorana AA, Amarnath S, Glass KE, Kalady MF. Multidisciplinary clinics for colorectal cancer care reduces treatment time. Clin Colorectal Cancer 2017;16:366-371 
  10. Nikolovski Z, Watters DAK, Stupart D, Guest GD. Colorectal multidisciplinary meetings: how do they affect the timeliness of treatment? ANZ J Surg 2017;87:E112-E115 
  11. Wille-Jorgensen P, Sparre P, Glenthoj A, Holck S, Norgaard Petersen L, Harling H, et al. Result of the implementation of multidisciplinary teams in rectal cancer. Colorectal Dis 2013;15:410-413 
  12. Obias VJ, Reynolds HL Jr. Multidisciplinary teams in the management of rectal cancer. Clin Colon Rectal Surg 2007;20:143-147 
  13. Royal College of Radiologists. Cancer multidisciplinary team meetings-standards for clinical radiologists. London: Royal College of Radiologists, 2014 
  14. Jung SM, Hong YS, Kim TW, Park JH, Kim JH, Park SH, et al. Impact of a multidisciplinary team approach for managing advanced and recurrent colorectal cancer. World J Surg 2018;42:2227-2233 
  15. Eakins C, Ellis WD, Pruthi S, Johnson DP, Hernanz-Schulman M, Yu C, et al. Second opinion interpretations by specialty radiologists at a pediatric hospital: rate of disagreement and clinical implications. AJR Am J Roentgenol 2012;199:916-920 
  16. Lu MT, Tellis WM, Avrin DE. Providing formal reports for outside imaging and the rate of repeat imaging. AJR Am J Roentgenol 2014;203:107-110 
  17. Bell ME, Patel MD. The degree of abdominal imaging (AI) subspecialization of the reviewing radiologist significantly impacts the number of clinically relevant and incidental discrepancies identified during peer review of emergency after-hours body CT studies. Abdom Imaging 2014;39:1114-1118 
  18. Pillay B, Wootten AC, Crowe H, Corcoran N, Tran B, Bowden P, et al. The impact of multidisciplinary team meetings on patient assessment, management and outcomes in oncology settings: a systematic review of the literature. Cancer Treat Rev 2016;42:56-72 
  19. De Ieso PB, Coward JI, Letsa I, Schick U, Nandhabalan M, Frentzas S, et al. A study of the decision outcomes and financial costs of multidisciplinary team meetings (MDMs) in oncology. Br J Cancer 2013;109:2295-2300 
  20. van Hagen P, Spaander MC, van der Gaast A, van Rij CM, Tilanus HW, van Lanschot JJ, et al. Impact of a multidisciplinary tumour board meeting for upper-GI malignancies on clinical decision making: a prospective cohort study. Int J Clin Oncol 2013;18:214-219 
  21. Wood JJ, Metcalfe C, Paes A, Sylvester P, Durdey P, Thomas MG, et al. An evaluation of treatment decisions at a colorectal cancer multi-disciplinary team. Colorectal Dis 2008;10:769-772