Impact of Second-Opinion Interpretation of Breast Imaging Studies in Patients Not Currently Diagnosed With Breast Cancer

Sen, Lauren Q. Chang; Mayo, Ray Cody; Lesslie, Michele D.; Yang, Wei Tse; Leung, Jessica W.T.

doi:10.1016/j.jacr.2018.03.055

Cited by 10 publications

(4 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The 27% discrepancy frequency in our study is similar to that for previous studies of second opinion breast imaging review which ranges from 18 to 57% [ 1 – 8 , 10 ]. A previous study focusing specifically on MRI discrepancy frequency demonstrated a lower frequency (18%) than breast imaging review overall.…”

Section: Discussionsupporting

confidence: 89%

“…After receiving institutional review board approval with waiver of informed consent, a retrospective chart review was performed on a database of 1000 consecutive patients presenting for second opinion breast imaging review to a single National Comprehensive Cancer Network (NCCN) designated cancer center from July 1, 2016, through April 30, 2017. Review of prior second opinion breast imaging studies demonstrated sample sizes ranging 149-380 [1,2,[4][5][6][7][8]11]. erefore, 400 consecutive patients from this database that included mammogram and ultrasound review, without MRI review, were included (Figure 1).…”

Section: Methodsmentioning

confidence: 99%

“…With increasing frequency, patients present to these institutions with radiologic and pathologic examinations performed elsewhere leading to request for second opinion review of those studies [1]. Second opinion interpretation of imaging by subspecialized radiologists has been previously shown to improve diagnostic ability and alter patient management [2][3][4][5][6][7][8]. In particular, breast fellowship-trained radiologists demonstrate increased cancer detection compared to their general counterparts [8].…”

Section: Introductionmentioning

confidence: 99%

“…Second opinion interpretation of imaging by subspecialized radiologists has been previously shown to improve diagnostic ability and alter patient management [2][3][4][5][6][7][8]. In particular, breast fellowship-trained radiologists demonstrate increased cancer detection compared to their general counterparts [8].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Repeat Breast Ultrasound Demonstrates Utility with Added Cancer Detection in Patients following Breast Imaging Second Opinion Recommendations

2022

View full text Add to dashboard Cite

Purpose. Second opinion consultation for patients with suspicious findings on breast imaging and patients with known breast cancer is not uncommon. We sought to determine the frequency of second opinion breast and axillary ultrasound imaging review and the subsequent impact on clinical management. Materials and Methods. An IRB-approved retrospective chart review was conducted on 400 consecutive patients with second opinion radiology interpretations performed by subspecialized breast radiologists at a designated cancer center, including mammogram and ultrasound review. The outside institution imaging reports were compared with second opinion reports to categorize ultrasound review discrepancies which were defined as any BI-RADS category change. The discrepancy frequency, relevant alterations in patient management, and added cancer detection were measured. Results. The second opinion imaging review resulted in discrepant findings in 108/400 patients (27%). Patients with heterogeneously or extremely dense breasts had higher discrepancy frequency (36% discrepancy, 68/187) than those with almost entirely fatty or scattered fibroglandular breast tissue (19% discrepancy, 40/213) with P = 0.0001. Discrepancies resulted in the following changes in impression/recommendations: 70 repeat ultrasounds for better characterization of a breast lesion, 11 repeat ultrasounds of a negative region, 20 repeat ultrasounds for benign axillary lymph nodes, 5 downgrades from probably benign to benign, and 2 upgrades from benign to suspicious. Repeat ultrasounds of the axilla in 19 patients resulted in 13 biopsy recommendations, and 4 were metastatic (PPV3 31%). In the breast, repeat ultrasounds in 81 patients resulted in 14 upgrades to suspicious. Of these, 5 yielded malignancy. In addition, one patient was upgraded from benign to suspicious based on the outside image, with pathology revealing malignancy (breast PPV3 40%). Breast lesion BI-RADS category downgrades in 27 patients resulted in 10 avoided biopsies. Ultimately, second opinion ultrasound review resulted in altered management in 12% of patients (47/400). This included discovery of additional breast malignancies in 6 patients, metastatic lymph nodes in 4 patients, excisional biopsy for atypia in 1 patient, 4 patients proceeding to mastectomy, 10 patients who avoided biopsies, and 22 patients who avoided follow-up of benign findings. Conclusions. In this study, subspecialized second opinion ultrasound review had an impact on preventing unnecessary procedures and follow-up exams in 8% of patients while detecting additional cancer in 2.5%.

show abstract

Section: Discussionsupporting

confidence: 89%