The Influence of Radiology Image Consultation in the Surgical Management of Breast Cancer Patients

Abstract

Background Patients referred to comprehensive cancer centers arrive with clinical data requiring review. Radiology consultation for second opinions often generates additional imaging requests, however the impact of this service on breast cancer management remains unclear. We sought to identify the incidence of additional imaging requests and the effect additional imaging has on patients’ ultimate surgical management. Methods Between November 2013 and March 2014, 153 consecutive patients with breast cancer received second opinion imaging reviews and definitive surgery at our cancer center. We identified the number of additional imaging requests, the number of fulfilled requests, the modality of additional imaging completed, the number of biopsies performed, and the number of patients whose management was altered due to additional imaging results. Results Of 153 patients the mean age was 55; 98.9 % were female; 23.5% (36) had in situ carcinoma (35 DCIS/ 1 LCIS) and 76.5% (117) had invasive carcinoma. Additional imaging was suggested for 47.7% (73/153) of patients. After multi-disciplinary consultation, 65.8% (48/73) of patients underwent additional imaging. Imaging review resulted in biopsy in 43.7% (21/48) of patients and ultimately altered preliminary treatment plans in 37.5% (18/48) of patients. (Figure 1) Changes in management included: conversion to mastectomy or to breast conservation, neoadjuvant therapy, additional wire placement, and need for contralateral breast surgery. Conclusions Our analysis of second opinion imaging consultation demonstrates the significant value this service has on breast cancer management. Overall, 11.7% (18/153) of patients who underwent breast surgery had management changes as a consequence of radiologic imaging review.

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

“…Review of the literature revealed three studies [12–14]—conducted at Rush University, University of Michigan, and Dana-Farber Brigham and Women’s Cancer Center—in which second-opinion review of breast-imaging studies similar to ours was conducted. Although our overall disagreement rate of 28% is lower than the 45–57% rate reported in those studies, our cancer detection rate of 5% was similar (2.1–5.3%).…”

“…The three previous studies were conducted over a time frame greater than the 4-month period of our study. Sixty-two percent of our study population was patients with a breast cancer diagnosis from an outside institution at the time of second-opinion review, compared with 100% of patients included in the studies by Mallory et al [14] and Newman et al [13]. Last, our study included MRI for diagnostic interpretation and for biopsy guidance.…”

Variation in Additional Breast Imaging Orders and Impact on Surgical Wait Times at a Comprehensive Cancer Center

“…Despite this practice being consistent across our center, the degree to which each surgeon relied upon or followed the radiologists’ recommendations may have varied. Although we did not examine whether additional imaging recommendations were followed, in a prior pilot study over a 5-month period, we found that 32% of patients (25/78) who had additional imaging recommended by breast imagers did not undergo these studies, suggesting that multidisciplinary input may influence ordering-practice behavior (6). …”

“…These centers frequently treat patients who initiate their diagnostic workups at other institutions, necessitating detailed reviews of outside studies, including pathology slides and imaging, before treatment decisions are made. In addition to the traditional group of oncologists (surgical, medical and radiation), pathologists and breast imagers are often included in the care team, with several studies from large cancer centers demonstrating that their second opinion reviews can alter oncologic management (1–6). …”

Radiology Consultation in the Era of Precision Oncology: A Review of Consultation Models and Services in the Tertiary Setting

“…In a similar study, fellowship trained neuroradiologists provided formal second opinions on head and neck imaging studies, resulting in changes in stage in 56% and management changes in 38%, noting 93% accuracy based on pathologic staging as gold standard (30). A recent study at our cancer center evaluated the influence of a second opinion/subspecialty consultation on the surgical management of breast cancer patients (31). They reported changes in 11.7% of patients undergoing surgery for breast cancer.…”