OBJECTIVE
Second-opinion review of breast imaging studies can be a time-consuming and labor-intensive process. The purpose of this investigation was to determine whether reinterpretation of studies obtained at institutions outside a cancer center influences clinical management, specifically by revealing additional cancer and preventing unnecessary biopsy.
MATERIALS AND METHODS
A review was conducted of breast imaging studies of 200 patients who underwent ultrasound and MRI at community facilities and had the images submitted for second opinions at a cancer center between January and April 2014. Each case was evaluated for concordance between the original report and the second-opinion interpretation. Second-opinion review resulting in the recommendation and performance of new biopsies was further subdivided into benign, high-risk, and malignant categories based on the histopathologic results obtained at the cancer center.
RESULTS
Second-opinion review of the 200 cases showed a change in interpretation in 55 cases (28%; 95% CI, 21–34%). Overall, 26 recommendations (13%; 95% CI, 9–18%) led to a major change in management. Twenty new biopsies were performed, yielding 10 malignancies (5%; 95% CI, 2–9%) and four high-risk lesions (2%; 95% CI, 1–5%). Surgical management was changed to mastectomy for 6 of 10 patients (60%) with new sites of biopsy-proven malignancy. Eight biopsies were averted (4%; 95% CI, 2–8%) on the basis of benign interpretation of the imaging findings, and no disease was found at 1-year follow-up evaluation.
CONCLUSION
Reinterpretation of studies obtained outside a cancer center resulted in a change in interpretation in more than one-fourth of submitted studies. Additional cancer was detected in 5% of patients, and biopsy was averted for 4%. The practice of second-opinion review influences clinical management and adds value to patient care.
A complete blood count showed a hemoglobin of 13.0 g per dL (reference range, 14.0 to 18.0 g per dL), hematocrit 40% (40% to 54%), red blood cell count (RBC) 4.65 × 10(9) per L (4.60 to 6.00), and platelet count 179 × 10(9) per L (150 to 450). The urinalysis results showed 3+ protein, 4+ blood, and urine RBC of greater than 100 per high power field (hpf). The urinalysis results did not indicate the presence of parasitic ova or adult parasites. Based on these results, the physician ordered cystoscopic testing, suspecting bladder cancer. Analysis of the bladder tissue showed inflammation (Image 1) and several ova that were consistent with developing Schistosoma (Image 2). Many of the ova were calcified and surrounded by severely inflamed tissue (Image 3).
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