Grading and characterization of soft tissue tumors on magnetic resonance imaging: the value of an expert second opinion report

Abstract

ObjectiveTo retrospectively compare the accuracy of the initial MRI (magnetic resonance imaging) report of referring radiologists and the second opinion report.Material and methodsMRI of 155 patients presenting with a soft tissue tumor (STT) in a single large community center were referred for inclusion in the Belgian Soft Tissue Neoplasm Registry (BSTNR). The initial report and the second opinion report were made independently. Histopathology (gold standard) was obtained in 90 patients (group 1). In 65 patients, the diagnosis was made by the combination of clinical findings and/or follow-up (group 2). In group 1, the concordance in grading and tissue-specific (TS) diagnosis between the referring center (RC) and expert center (EC) was reviewed.ResultsIn group 1, MR grading yields a sensitivity of 100% and a specificity of 89% in the EC. The sensitivity was 88% and the specificity 81% in the RC. The accuracy was significantly higher in the EC (92%) compared to the RC (83%) (p = 0.039). The TS diagnosis was correct in 50% versus 38.5% of malignant tumors and in 71.8% versus 51.6% of benign tumors in the EC and RC respectively.ConclusionA second opinion report increases the accuracy in the diagnosis of STT on MRI.Main Messages• A second opinion MRI report increases the overall accuracy in the diagnosis of soft tissue tumors.• There is a good overall agreement in MR grading between the referring and expert institution.• In the expert center, there were fewer false-negative and false-positive diagnoses.• MRI performs better in the tissue-specific diagnosis of benign versus malignant STT.

Breast hibernomas: Questioning the embryological origin?

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Diagnostic triage for sarcoma: an effective model for reducing referrals to the sarcoma multidisciplinary team

“…For example, small lipomas were referred based on ultrasound scans performed by any qualified provider (AQP), despite clear NICE guidance ( Figure 5). Vanhoenacker et al 16 recently reported that a second "expert" opinion increases the accuracy in the diagnosis of STT on MRI with fewer false-positive diagnoses. This adds further evidence to having a triage service run by speciality radiologists providing "expert" opinion to manage MDT referrals, which are often from referrers inexperienced with diagnosing a STS.…”

Soft Tissue Tumors about the Shoulder

“…A second opinion report by a center with major expertise in STTs may improve the overall accuracy of grading and characterization from 83% up to 92%. 10 The role of advanced MR techniques such as diffusionweighted imaging, diffusion tensor imaging, and MR spectroscopy for tumor characterization and follow-up after treatment is still debated. 11…”

“…Because MRI of other malignant STTs is mostly nonspecific, tissue-specific diagnosis based on imaging alone is often illusive. 6,10 The main task of the radiologist, however, is to make the differential diagnosis between benign and potentially malignant lesions (►Table 4) and to refer patients with potentially malignant lesions to centers with special expertise in the diagnosis and management of STTs (►Figs. 19 and 20).…”