Optimizing diagnostic pathways through digital multidisciplinary team management of patients with cancer of unknown primary: a retrospective analysis

Objectives Diagnostic pathways for cancer of unknown primary (CUP) are often underdeveloped. At our tertiary referral centre for CUP, we recently introduced a new diagnostic workflow that includes digital discussion of CUP patients by a dedicated multidisciplinary team (MDT), centralized second opinion reviews, and an MDT-guided approach to further diagnostic steps. This study retrospectively assesses the outcomes of this optimized workflow on efficiency, diagnostic yield, and healthcare professional satisfaction. Methods We retrospectively compared outcomes for 39 patients from period A (May 2021-April 2022) to 41 patients from period B (Dec 2022-Nov 2023) following workflow optimization. Outcomes included time-to-diagnosis, diagnostic yield, impact of second opinion imaging reviews, and satisfaction levels among involved MDT members. Results After workflow implementation, median time to diagnosis/treatment decreased from 36 to 28days (P=.07). Second opinion imaging reviews led to the detection of new tumour lesions in 10% of cases. A primary tumour diagnosis was established 49% patients from period A versus 61% from period B (P=.37). Satisfaction among MDT members notably improved, especially regarding interdisciplinary communication and workflow efficiency. Conclusion Our optimized CUP workflow with digital MDT-discussions and routine second opinion reviews of imaging data, improved diagnostic efficiency and satisfaction among physicians. These results highlight the value of a multidisciplinary, patient-centred approach focused on effective patient management in CUP. Advances in knowledge Integrating digital MDT discussions and centralized second-opinion reviews in CUP care improves diagnostic efficiency and may enhance primary tumour detection rates. Radiologists and other diagnosticians play a key role in this multidisciplinary approach.