C0520 - The Impact of Hepatobiliary Multidisciplinary Tumor Board Review on Patient Management: A Descriptive Analysis

Monday, October 24, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Nirmal Desai, MD

University of Chicago Hospital
Chicago, IL

Nirmal Desai, MD¹, Chukwunedum Aniemeka, MD¹, Anjana Pillai, MD²
¹University of Chicago Hospital, Chicago, IL; ²University of Chicago, Chicago, IL

Introduction: The importance of a multidisciplinary tumor clinic on patient outcomes has been well demonstrated, especially in the care of patients with hepatocellular carcinoma (HCC). Hepatobiliary tumor boards however have not been studied as closely and their impact is largely uncharacterized. We aimed to characterize the impact of our institution’s hepatobiliary tumor board on patient management and outcomes, specifically regarding tumor characterization and diagnosis, treatment plan and avoidance of unnecessary testing.

Methods: We conducted a single-center retrospective review of patients discussed at our institution’s Multidisciplinary Hepatobiliary Tumor Board (MDTB) during the study period of January 1^st, 2017- December 31^st, 2018.

Results: We reviewed 94 patients in total. The majority of patients presented with HCC (45%), followed by benign liver lesions (24%), bile duct/gallbladder cancers (6%), benign bile duct/gallbladder lesions (4%), colorectal liver metastasis (1%), neuroendocrine liver metastasis (1%) and the remaining were other hepatobiliary pathologies (18%). In 30% of total cases, review at MDTB led to further characterization or correction of initial diagnosis. In 12% of total cases, the diagnosis was corrected from concern for malignancy/malignant to non-malignant. In 20% of cases, an unnecessary intervention (described as imaging, procedure, or treatment) was prevented. The next step in management (described as further imaging, procedure, or biopsy) was suggested in 57% of cases. In total, 12 of the 94 patients analyzed were newly diagnosed with HCC. In these cases, 100% of the treatments recommended by the MDTB met adherence to 2018 AASLD practice guidelines. As an institution, the most frequent choice for locoregional therapy was TARE.

Discussion: Expert case review at MDTB has a significant impact on patient morbidity and management strategy of complex hepatobiliary tumors. Of the patients reviewed, 30% had further characterization or correction of initial diagnosis (of these, 39% had their diagnosis corrected from concern for malignancy to non-malignant) and 20% avoided unnecessary interventions, 53% of which were procedures. Among newly diagnosed HCC cases, clinical practice at our institution adhered to AASLD guidelines with TARE being the preferred locoregional therapy. Further ongoing research will allow for a greater understanding of MDTB impact and allow for characterization of MDTB practice changes over the years.

	2017 Cases (n=50)	2018 Cases (n=44)	Total Cases (n=94)	Percent of Total Cases
A) Further characterization or correction of initial diagnosis
i) Diagnosis corrected from concern for malignancy/malignant to non-malignant	8	3	11	11.7%
ii) Diagnosis corrected from non-malignant to malignant	1	1	2	2.1%
iii) Non-malignant tumor diagnosis further characterized	9	6	15	16.0%
Total:	18	10	28	29.8%
B) Unnecessary intervention prevented
i) Procedure	8	2	10	10.6%
ii) Treatment	1	2	3	3.2%
iii) Imaging	3	3	6	6.4%
Total:	12	7	19	20.2%
C) Next step in management suggested
i) Imaging	18	18	36	38.3%
ii) Biopsy	2	2	4	4.3%
iii) Procedure	3	11	14	14.9%
Total:	23	31	54	57.4%

Table: MDTB Outcome Measures

Disclosures:

Nirmal Desai indicated no relevant financial relationships.

Chukwunedum Aniemeka indicated no relevant financial relationships.

Anjana Pillai: AstraZeneca – Advisory Committee/Board Member. Eisai – Advisory Committee/Board Member. Exelixis – Advisory Committee/Board Member. Genentech – Advisory Committee/Board Member. Replimune – Advisory Committee/Board Member.

Nirmal Desai, MD¹, Chukwunedum Aniemeka, MD¹, Anjana Pillai, MD². C0520 - The Impact of Hepatobiliary Multidisciplinary Tumor Board Review on Patient Management: A Descriptive Analysis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.