Second opinion interpretation of breast ultrasound images-Is it worth another look?

Horvat, João V.; D’Alessio, Donna; Bernard‐Davila, Blanca; Martinez, Danny F.; Morris, Elizabeth A.

doi:10.1016/j.clinimag.2018.06.012

Cited by 6 publications

(8 citation statements)

References 23 publications

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“…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%

“…In their study, 33% of patients with second-look ultrasound resulting from discrepant review resulted in additional biopsies being performed or averted, which is similar to the 35% observed in our study. They also demonstrated a PPV3 of 25% for the added biopsies, slightly lower than the PPV3 of 36% in the breast and 31% in the axilla demonstrated in our study [ 10 ].…”

Section: Discussioncontrasting

confidence: 88%

“…While prior studies have demonstrated the added value of second opinion imaging interpretations in regard to additional cancer detection and relevant changes in management, there are limited data on the specific impact of breast ultrasound second opinion imaging review on the management of breast cancer patients [ 1 – 3 , 5 , 10 ]. In this study, second opinion review of outside ultrasound imaging resulted in discrepant findings in 27% of patients, leading to the detection of additional cancer in 10 patients (2.5%) and changes in clinical management in 12%.…”

Section: Discussionmentioning

confidence: 99%

“…There are, however, scant data on the specific impact of breast and axillary ultrasound second opinion imaging review. In a recent study of 209 patients with second opinion breast ultrasound review, clinical management was altered in 33%, with additional cancer detected in 5% of patients [ 10 ]. The purpose of our study was to determine breast ultrasound review discrepancy frequency and the subsequent utility and impact on patient management in a large cohort of patients pursuing breast imaging second opinion.…”

Section: Introductionmentioning

confidence: 99%

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

2022

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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%.

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Section: Discussionsupporting

confidence: 89%

Section: Discussioncontrasting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

2022

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“…These screenshots are static and isolated, which may lead to uncertain or unobjective assessment in characterizing the BI-RADS stage of lesions. 4 An SOUS is low cost and may benefit the majority of these patients if predictive factors that correlate with malignancy and benignancy can be identified. An SOUS is defined as re-evaluation of a lesion(s) via ultrasound within 2 weeks, with total independence from the first examination and evaluation by a different radiologist.…”

Section: Introductionmentioning

confidence: 99%

Application of a second opinion ultrasound in Breast Imaging Reporting and Data System 4A cases: can immediate biopsy be avoided?

et al. 2021

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Objective The probability of malignancy in women who are diagnosed with a Breast Imaging Reporting and Data System (BI-RADS) 4A score is low. Application of a second opinion ultrasound (SOUS), which is low in cost and minimally invasive, may lower the biopsy rate for patients who fall into this category. This study aimed to apply SOUS to patients with a BI-RADS score of 4A and predict the pathological results of a biopsy. Methods One hundred seventy-eight patients were analyzed. Univariate and multivariate analyses were performed to screen for predictive factors that are associated with malignancy. Categorical alteration of downgraded, unchanged, or upgraded was made after SOUS results. Changes in category were compared with biopsies to determine their predictive value of benignancy or malignancy. Results Independent factors associated with malignancy were age (>50 years), tumor size (≥20 mm), margin (not circumscribed), orientation (not parallel), and peripheral location, and an upgraded categorical alteration from SOUS. Downgraded categorical alterations were associated with benignancy. Conclusions In BI-RADS 4A cases, a biopsy is recommended when independent factors are associated with malignancy. A downgraded result from an SOUS examination is a protective factor, supporting the likelihood of benignancy in these patients.

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Clinical value of second opinions in oncology: A retrospective review of changes in diagnosis and treatment recommendations

et al. 2023

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Background Data on the clinical value of second opinions in oncology are limited. We examined diagnostic and treatment changes resulting from second opinions and the expected impact on morbidity and prognosis. Methods This retrospective cohort study included patients presenting in 2018 to a high‐volume cancer center for second opinions about newly diagnosed colorectal, head and neck, lung, and myeloma cancers or abnormal results. Two sub‐specialty physicians from each cancer type reviewed 30 medical records (120 total) using a process and detailed data collection guide meant to mitigate institutional bias. The primary outcome measure was the rate of treatment changes that were “clinically meaningful”, i.e., expected to impact morbidity and/or prognosis. Among those with treatment changes, another outcome measure was the rate of clinically meaningful diagnostic changes that led to treatment change. Results Of 120 cases, forty‐two had clinically meaningful changes in treatment with positive expected outcomes (7 colorectal, 17 head and neck, 11 lung, 7 myeloma; 23–57%). Two patients had negative expected outcomes from having sought a second opinion, with worse short‐term morbidity and unchanged long‐term morbidity and prognosis. All those with positive expected outcomes had improved expected morbidity (short‐ and/or long‐term); 11 (0–23%) also had improved expected prognosis. Nine involved a shift from treatment to observation; 21 involved eliminating or reducing the extent of surgery, compared to 6 adding surgery or increasing its extent. Of the 42 with treatment changes, 13 were due to clinically meaningful diagnostic changes (1 colorectal, 5 head and neck, 3 lung, 4 myeloma; 3%–17%) . Conclusions Second‐opinion consultations sometimes add clinical value by improving expected prognoses; more often, they offer treatment de‐escalations, with corresponding reductions in expected short‐ and/or long‐term morbidity. Future research could identify subgroups of patients most likely to benefit from second opinions.

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Second opinion interpretation of breast ultrasound images-Is it worth another look?

Abstract: RTUR was found to be an important tool in the management of patients at our comprehensive cancer center. Although additional false-positive lesions may be detected on RTUR, a great number of patients will benefit from RTUR in finding additional cancers or avoiding unnecessary biopsies.

Cited by 6 publications

References 23 publications

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

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

Application of a second opinion ultrasound in Breast Imaging Reporting and Data System 4A cases: can immediate biopsy be avoided?

Clinical value of second opinions in oncology: A retrospective review of changes in diagnosis and treatment recommendations

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