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Expert radiological review of skeletal surveys identifies additional abnormalities in 23% of cases: further evidence for the value of myeloma multi‐disciplinary teams in the accurate staging and treatment of myeloma patients

Myeloma multi-disciplinary teams (MDTs) have recently been introduced as a compulsory part of the National Institute of Clinical Excellence guidelines for haemato-oncology (National Institute of Clinical Excellence, 2003). The staging and treatment of myeloma patients requires information from the clinical picture, bone marrow biopsy and also from radiological imaging. All patients, therefore, undergo a skeletal survey with plain X rays as part of their work up. Asymptomatic myeloma patients are simply observed whilst patients with symptomatic disease receive chemotherapy treatment with possible radiotherapy to localised bone lesions. A previous study (Lecouvet et al, 1999) reported that the skeletal survey was the determinant factor in the staging of 34% of the study population. In view of the importance of radiological findings, the Improving Outcomes Guidance (National Institute of Clinical Excellence, 2003) recommend that Myeloma MDTs should include at least one designated radiologist who liaises with radiologists at other sites and is fully and regularly involved in MDT discussions. As part of the Mid-Trent Cancer Network, we established a Myeloma MDT in September 2001. All new cases of myeloma diagnosed within the network (population 2 million, served by five hospitals including a British Society for Haematology Level 4 Centre) are discussed by specialist haemato-oncologists and transplant physicians at these monthly MDT meetings. Histological review of bone marrow biopsies is performed by a specialist haemato-pathologist and all skeletal surveys are reviewed by a specialist musculoskeletal radiologist at the MDT meeting. This ensures that the correct diagnosis has been made and establishes a treatment plan, including recommendations for radiotherapy, orthopaedic interventions, the need for further magnetic resonance imaging and the suitability for high-dose therapy. A retrospective audit was carried out on all patients whose skeletal surveys were reviewed at the MDT between March 2003 and December 2004. This comprised 83 patients aged between 25 and 92 years, of whom 50 were male and 33 were female. As these meetings are held monthly, the majority of skeletal surveys had been previously reported by other radiologists ahead of the meetings. When the findings of the expert radiological review were compared with the original skeletal survey reports, it was observed that there were discordant results in 19 (23%) of patients. The number of positive reports increased from 28 (34%) to 36 (43%), indicating that the presence of lytic lesions had been missed in eight patients. Furthermore, MDT review of other cases revealed additional areas of either definite or