Clinical impact of routine second‑opinion reading of [¹⁸F]FDG‑PET/CT in newly diagnosed invasive bladder cancer: A multicentre study in a centralised referral network
8 affiliations
- 1Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- 2Department of Urology, Leiden University Medical Centre, Leiden, The Netherlands
- 3Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam, The Netherlands
- 4Department of Radiation Oncology, Netherlands Cancer Institute, Hospital, Amsterdam, The Netherlands
- 5Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- 6Department of Radiology and Nuclear Medicine, UMC Utrecht, Utrecht, The Netherlands
- 7Department of Nuclear Medicine, Leiden University Medical Centre, Leiden, The Netherlands
- 8Department of Urology, Caritas St Josef Medical Centre, University of Regensburg, Regensburg, Germany
Abstract
Purpose: [¹⁸F]FDG‑PET/CT is increasingly used to stage invasive bladder cancer (IBC), resulting in growing demand at tertiary centres for time‑intensive second‑opinion reading of externally acquired scans. However, the incremental clinical value of routine reinterpretation is unclear. We evaluated the clinical impact of second‑opinion [¹⁸F]FDG‑PET/CT reading in a centralised referral network in the Netherlands.
Methods: In this multicentre retrospective diagnostic cohort study, consecutive patients with histologically confirmed high-grade IBC who underwent externally acquired [¹⁸F]FDG‑PET/CT followed by expert second‑opinion reading at two tertiary centres were evaluated. Initial staging reports were compared with second-opinion staging assessments. Clinically meaningful discrepancies were defined as changes in nodal status (cN0 vs. cN+) or distant metastatic status (cM0 vs. cM1 or cM1a vs. cM1b). Treatment recommendation changes directly attributable to second-opinion reading were recorded.
Results: Six hundred patients were included. Agreement between initial and second‑opinion reading was high for both nodal and metastatic staging (κ = 0.89 and κ = 0.87, respectively). Clinically meaningful discrepancies occurred in 33 patients (5.5%), resulting in revised treatment recommendations in 22 patients (3.7%). Suspected nodal disease on the initial report was associated with higher odds of discrepancy at second-opinion reading (OR 2.1, 95% CI 1.0–4.4).
Conclusion: In this multicentre cohort, routine second‑opinion reading of externally acquired [¹⁸F]FDG‑PET/CT for IBC yielded limited incremental clinical impact within a centralised referral network in the Netherlands. These findings suggest that a more selective approach to second-opinion reading, particularly for patients with suspected nodal disease on the initial report, may warrant further evaluation.
Related
- A Parsimonious Machine Learning Model for Predicting Invasive Coronary Angiography Referral After Coronary Computed Tomography Angiography: Development and Multicentre External Validation
- Clinical profiles, referral patterns and low vision aid prescribing across four rehabilitation centres in Ghana: protocol for a multicentre retrospective record review
- Improving Access to Clinical Guidelines Through a Centralised Digital Platform in an NHS Setting: A Quality Improvement Study
- Population-specific molecular features and clinical significance of urinary tumor DNA mutations in Chinese patients with newly diagnosed non-muscle-invasive bladder cancer.
- Hyperuricaemia risk and its association with kidney failure and mortality in newly diagnosed type 2 diabetes with preserved renal function: a multicentre machine learning study.
BibTeX
@article{lijnen2026clinical,
title = {{Clinical impact of routine second‑opinion reading of [¹⁸F]FDG‑PET/CT in newly diagnosed invasive bladder cancer: A multicentre study in a centralised referral network}},
author = {Renee A. G. Lijnen and Misha L. Vierling and Joanneke B. Ringia and Kees Hendricksen and Gijs H. KleinJan and Arnoud W. Postema and Wouter V. Vogel and Thierry N. Boellaard and Arthur J. A. T. Braat and Linda Heijmen and Bas W. G. van Rhijn and Laura S. Mertens},
journal = {European Journal of Nuclear Medicine and Molecular Imaging},
year = {2026},
month = aug,
doi = {10.1007/s00259-026-08145-1},
url = {https://doi.org/10.1007/s00259-026-08145-1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Clinical impact of routine second‑opinion reading of [¹⁸F]FDG‑PET/CT in newly diagnosed invasive bladder cancer: A multicentre study in a centralised referral network
AU - Renee A. G. Lijnen
AU - Misha L. Vierling
AU - Joanneke B. Ringia
AU - Kees Hendricksen
AU - Gijs H. KleinJan
AU - Arnoud W. Postema
AU - Wouter V. Vogel
AU - Thierry N. Boellaard
AU - Arthur J. A. T. Braat
AU - Linda Heijmen
AU - Bas W. G. van Rhijn
AU - Laura S. Mertens
PY - 2026
DA - 2026/08/25
JO - European Journal of Nuclear Medicine and Molecular Imaging
DO - 10.1007/s00259-026-08145-1
UR - https://doi.org/10.1007/s00259-026-08145-1
AB - Purpose: [¹⁸F]FDG‑PET/CT is increasingly used to stage invasive bladder cancer (IBC), resulting in growing demand at tertiary centres for time‑intensive second‑opinion reading of externally acquired scans. However, the incremental clinical value of routine reinterpretation is unclear. We evaluated the clinical impact of second‑opinion [¹⁸F]FDG‑PET/CT reading in a centralised referral network in the Netherlands. Methods: In this multicentre retrospective diagnostic cohort study, consecutive patients with histologically confirmed high-grade IBC who underwent externally acquired [¹⁸F]FDG‑PET/CT followed by expert second‑opinion reading at two tertiary centres were evaluated. Initial staging reports were compared with second-opinion staging assessments. Clinically meaningful discrepancies were defined as changes in nodal status (cN0 vs. cN+) or distant metastatic status (cM0 vs. cM1 or cM1a vs. cM1b). Treatment recommendation changes directly attributable to second-opinion reading were recorded. Results: Six hundred patients were included. Agreement between initial and second‑opinion reading was high for both nodal and metastatic staging (κ = 0.89 and κ = 0.87, respectively). Clinically meaningful discrepancies occurred in 33 patients (5.5%), resulting in revised treatment recommendations in 22 patients (3.7%). Suspected nodal disease on the initial report was associated with higher odds of discrepancy at second-opinion reading (OR 2.1, 95% CI 1.0–4.4). Conclusion: In this multicentre cohort, routine second‑opinion reading of externally acquired [¹⁸F]FDG‑PET/CT for IBC yielded limited incremental clinical impact within a centralised referral network in the Netherlands. These findings suggest that a more selective approach to second-opinion reading, particularly for patients with suspected nodal disease on the initial report, may warrant further evaluation.
SN - 1619-7070
SN - 1619-7089
ER -