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Open Access Open Badges Original research article

Impact of neuroradiologist second opinion on staging and management of head and neck cancer

John T Lysack1234*, Monica Hoy2, Mark E Hudon1, Steven C Nakoneshny3, Shamir P Chandarana23, T Wayne Matthews23 and Joseph C Dort23

Author Affiliations

1 Division of Neuroradiology, University of Calgary, Calgary, Alberta, Canada

2 Division of Otolaryngology-Head and Neck Surgery, University of Calgary, Calgary, Alberta, Canada

3 The Ohlson Research Initiative, University of Calgary, Calgary, Alberta, Canada

4 Department of Diagnostic Imaging, Foothills Medical Centre, 1403-29 Street NW, Calgary, AB T2N 2T9, Canada

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Journal of Otolaryngology - Head and Neck Surgery 2013, 42:39  doi:10.1186/1916-0216-42-39

Published: 5 June 2013



Patients with head and neck cancer frequently present to academic tertiary referral centers with imaging studies that have been performed and interpreted elsewhere. At our institution, these outside head and neck imaging studies undergo formal second opinion reporting by a fellowship-trained academic neuroradiologist with expertise in head and neck imaging. The purpose of this study was to determine the impact of this practice on cancer staging and patient management.


Our institutional review board approved the retrospective review of randomized original and second opinion reports for 94 consecutive cases of biopsy proven or clinically suspected head and neck cancer in calendar year 2010. Discrepancy rates for staging and recommended patient management were calculated and, for the 32% (30/94) of cases that subsequently went to surgery, the accuracies of the reports were determined relative to the pathologic staging gold standard.


Following neuroradiologist second opinion review, the cancer stage changed in 56% (53/94) of cases and the recommended management changed in 38% (36/94) of patients with head and neck cancer. When compared to the pathologic staging gold standard, the second opinion was correct 93% (28/30) of the time.


In a majority of patients with head and neck cancer, neuroradiologist second opinion review of their outside imaging studies resulted in an accurate change in their cancer stage and this frequently led to a change in their management plan.

Second opinion; Radiology; Cancer staging; Head and neck cancer; Quality improvement