Perceived Misinterpretation Rates in Oncologic ¹⁸F-FDG PET/CT Studies: A Survey of Referring Physicians

Abstract

Because only pathologic examination can confirm the presence or absence of malignant disease in cancer patients, a certain rate of misinterpretation in any kind of imaging study is inevitable. For the accuracy of interpretation to be improved, determination of the nature, causes, and magnitude of this problem is needed. This study was designed to collect pertinent information from physicians referring patients for oncologic 18F-FDG PET/CT. Methods A total of 662 referring physicians completed an 11-question survey focused on their experience with the interpretation of oncologic 18F-FDG PET/CT studies. The participants were oncologists (36.1%; n = 239), hematologists (14.5%; n = 96), radiation oncologists (7.4%; n = 49), surgeons (33.8%; n = 224), and other physicians (8.2%; n = 54). Questions were aimed at determining the frequency, nature, and causes of scan misinterpretations as well as potential solutions to reduce the frequency of misinterpretations. Results Perceived misinterpretation rates ranged from 5% to 20%, according to most (59.3%) of the participants; 20.8% of respondents reported rates of less than 5%. Overinterpretation rather than underinterpretation was more frequently encountered (68.9% vs. 8.7%, respectively). Limited availability of a patient’s history and limited experience of interpreters were the major contributors to this phenomenon, according to 46.8% and 26.7% of the participants, respectively. The actions most commonly suggested to reduce misinterpretation rates (multiple suggestions were possible) were the institution of multidisciplinary meetings (59.8%), the provision of adequate history when ordering an examination (37.4%), and a discussion with imaging specialists when receiving the results of the examination (38.4%). Conclusion Overinterpretation rather than underinterpretation of oncologic 18F-FDG PET/CT studies prevails in clinical practice, according to referring physicians. Closer collaboration of imaging specialists with referring physicians through more multidisciplinary meetings, improved communication, and targeted training of interpreting physicians are actions suggested to reduce the rates of misinterpretation of oncologic 18F-FDG PET/CT studies.

Diagnostic errors in clinical FDG-PET/CT

“…Overinterpretation rather than underinterpretation was more frequently encountered according to the referring physicians (68.9% vs. 8.7%, respectively) [7]. Limited availability of a patient's history and limited experience of interpreters were the major contributors to this phenomenon, according to 46.8% and 26.7% of the participants in this survey, respectively [7]. Provision of adequate history when ordering an examination and multidisciplinary meetings may indeed reduce diagnostic errors.…”

“…Nuclear medicine physicians and radiologists should be conscious of this potential pitfall when reading FDG-PET/CT, and adjust their workflow or mindset accordingly. Interestingly, in a previous survey study among 663 referring physicians on their experience with the interpretation of oncological FDG-PET/CT studies, perceived misinterpretation rates ranged from 5% to 20%, according to 59.3% of the participants [7]. Overinterpretation rather than underinterpretation was more frequently encountered according to the referring physicians (68.9% vs. 8.7%, respectively) [7].…”

“…Interestingly, in a previous survey study among 663 referring physicians on their experience with the interpretation of oncological FDG-PET/CT studies, perceived misinterpretation rates ranged from 5% to 20%, according to 59.3% of the participants [7]. Overinterpretation rather than underinterpretation was more frequently encountered according to the referring physicians (68.9% vs. 8.7%, respectively) [7]. Limited availability of a patient's history and limited experience of interpreters were the major contributors to this phenomenon, according to 46.8% and 26.7% of the participants in this survey, respectively [7].…”

Misinterpretation of 18F-FDG Studies in Oncology

“…Misinterpretation of 18 F-FDG Studies in Oncology TO THE EDITOR: The survey finding by Karantanis et al (1) of perceived greater "overinterpretation" than "underintepretation" of 18 F-FDG PET/CT studies in oncology on the part of referring physicians is supported by data from a prior report in The Journal of Nuclear Medicine by Biggi et al (2). This work showed a better failure-free survival (FFS) rate in patients with Hodgkin disease and positive interim PET scans interpreted locally than in patients judged to have positive scans by a central reading group.…”

“…DOI: 10.2967/jnumed.114. 153064 The Impact of Image Reconstruction Bias on PET/ CT 90 Y Dosimetry After Radioembolization TO THE EDITOR: We read with great interest the paper entitled "The Impact of Image Reconstruction Bias on PET/CT 90 Y Dosimetry After Radioembolization" (1). In this paper, Tapp et al showed that commercial software that truncates the negative pixels (resulting from random-coincidence correction) can display a significant positive bias in 90 Y PET imaging.…”