Second-Opinion Review of Breast Imaging at a Cancer Center: Is It Worthwhile?

Abstract

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.

The Value of a Second Opinion for Breast Cancer Patients Referred to a National Cancer Institute (NCI)-Designated Cancer Center with a Multidisciplinary Breast Tumor Board

“…In the reported literature, the rate of changes in diagnosis ranges from 0 to 13% depending on the cancer and the institution. 4 , 6 – 8 Three of these four studies occurred in states with multiple tertiary care centers, including Pennsylvania, Massachusetts, Michigan, and Maryland. Compared with these studies, our study found that 23% of the patients had additional cancers diagnosed based on radiologic evaluation by MTB alone.…”

“…A recent study reviewed 200 cases, finding new cancers detected in 5% of patients. 8 Additionally, in 4% of the cases, they reported avoidance of biopsies deemed unnecessary. Findings have shown MTBs to be efficacious in identifying additional cancers and also preventing unnecessary harm.…”

“…Studies specifically addressing MTBs’ evaluation of second opinions also have resulted in changes in diagnoses and patient management. 8 …”

Improving Cancer Diagnosis and Care: Patient Access to Oncologic Imaging Expertise

“…However, training opportunities are often lacking when new methods and technologies are introduced into the clinic. 7,8 The increasingly complex process of cancer diagnosis raises the risk for diagnostic errors in three major categories: test selection and execution, image interpretation, and communication, both among physicians and with patients and their families. 1 Delays or failures in diagnosing cancer represent approximately 30% of all diagnostic-related malpractice claims.…”

“…radiologists specializing in cancer imaging, with secondopinion reports indicating the need for changes in patient management in as many as 13% to 53.5% of cases. [7][8][9][10][11][12][13][14][15][16][17][18][19] Second-opinion review can prevent unnecessary biopsies while improving cancer detection, as was shown by a recent study that included 147 patients who self-referred for second-opinion readings of breast images. 20 On secondary review, 24 (25%) of 96 lesions originally reported as suspicious were downgraded to benign or probably benign, preventing biopsy in 21 patients, all of whom remained disease free on follow-up imaging.…”