Hepatopancreaticobiliary imaging second-opinion consultations: Is there value in the second reading?

Anup S. Shetty, Ashmit Mittal, Amber Salter, Vamsi R. Narra, Kathryn J. Fowler

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


OBJECTIVE. Tertiary care practices increasingly provide second-opinion consultations on reports from outside practices or institutions. This practice of providing a second opinion has been studied in a variety of subspecialties; however, its potential effect on the management of hepatopancreaticobiliary (HPB) disease is not known. The purpose of this study was to assess the rate of significant discrepancies between the initial report and the consultation report, the source of discrepancies, and the frequency of repeat imaging recommendations. MATERIALS AND METHODS. Retrospective chart review was performed for 480 consecutive CT and MRI consultation reports interpreted between January 2014 and December 2015 for patients with HPB diseases whose initial CT and MRI reports were generated at outside facilities. The initial report and the consultation report were independently reviewed and compared by two abdominal radiologists. Discrepancies between the initial report and the consultation report were divided into minor and major differences in the detection or interpretation of abnormalities. Clinical importance was defined as a change in a finding or interpretation that directly impacted management of the patient. RESULTS. A major discrepancy between the reports was identified in 27–28% of cases split evenly between detection and interpretation of abnormalities. Interreader agreement for categorization was moderate (weighted kappa value, 0.49). In consensus review, the rate of a major discrepancy occurring increased to 32%. Common sources of discrepancy were interpretation of findings as malignant versus benign (49% of cases) and accuracy of staging (15% of cases). Imaging limitations were described in 16% of cases, commonly as a result of an insufficient protocol or poor image quality. CONCLUSION. Discrepancies in interpretation resulting in direct implications for clinical management are seen in almost one-third of HPB consultation cases. Second-opinion imaging consultation in the tertiary care setting can frequently impact management.

Original languageEnglish (US)
Pages (from-to)1264-1272
Number of pages9
JournalAmerican Journal of Roentgenology
Issue number6
StatePublished - Dec 2018
Externally publishedYes


  • Consultation
  • Discrepancy
  • Hepatopancreaticobiliary
  • Radiology
  • Second opinion

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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