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.
Keywords: breast cancer; multimodality; second-opinion readings; second-opinion reinterpretation; subspecialization.