The Preoperative Assessment of Hepatic Tumours: Evaluation of UK Regional Multidisciplinary Team Performance

Introduction. In the UK, patients where liver resection is contemplated are discussed at hepatobiliary multidisciplinary team (MDT) meetings. The aim was to assess MDT performance by identification of patients where radiological and pathological diagnoses differed. Materials and Methods. A retrospective review of a prospectively maintained database of all cases undergoing liver resection from March 2006 to January 2012 was performed. The presumed diagnosis as a result of radiological investigation and MDT discussion is recorded at the time of surgery. Imaging was reviewed by specialist gastrointestinal radiologists, and resultswereagreedonby consensus. Results. Four hundred and thirty-eight patients were studied. There was a significant increase in the use of preoperative imaging modalities ( ) but no change in the rate of discrepant diagnosis over time. Forty-two individuals were identified whose final histological diagnosis was different to that following MDT discussion (9.6%). These included 30% of patients diagnosed preoperatively with hepatocellular carcinoma and 25% with cholangiocarcinoma of a major duct. Discussion. MDT assessment of patients preoperatively is accurate in terms of diagnosis. The highest rate of discrepancies occurred in patients with focal lesions without chronic liver disease or primary cancer, where hepatocellular carcinoma was overdiagnosed and peripheral cholangiocarcinoma underdiagnosed, where particular care should be taken. Additional care should be taken in these groups and preoperative multimodality imaging considered. 1. Introduction Cancer care in the UK has undergone a major change in recent years with the centralisation of care in a network of cancer centres [1]. This has led to the establishment of regional hepatopancreaticobiliary (HPB) units where patients in whom liver resection is contemplated are discussed at a multidisciplinary team (MDT) meeting in the presence of radiologists, oncologists, surgeons, and physicians. This is intended to provide greater clinical input into the diagnosis of the wide spectrum of disease processes for which liver resection is appropriate [2]. During the same period increasing awareness of the complimentary role of different imaging modalities in diagnosing liver disease [3–5] has led to many patients having multiple investigations prior to surgery. Although the accuracy of single imaging modalities including ultrasound [3, 6, 7], computerised tomography (CT) [3, 7, 8], magnetic resonance imaging (MRI) [3, 7, 9], and positron emission tomography (PET) [3, 8] scans in assessing