Specialized Second Opinion Interpretations of Breast Imaging: Impact on Additional Workup and Management

• Published in: Clinical breast cancer 2018-10, Vol.18 (5), p.e1031-e1036
• Main Authors: Weinfurtner, R. Jared, Niell, Bethany, Mekhail, Yasmin, Aguila, Emily, Kamat, Leena
• Format: Article
• Language: English
• Subjects: Breast cancer; Breast imaging; Imaging discrepancy; Second opinion
• ISSN: 1526-8209; 1938-0666
• DOI: 10.1016/j.clbc.2018.03.009

This study examines the impact of second opinion breast imaging on clinical management. The study evaluated 504 second opinion breast imaging interpretations, the largest study of its kind to date. Second opinion breast imaging interpretation yielded additional cancer detection in 8% of patients and altered surgical management in 13%. Women with breast imaging often seek second opinions at tertiary care centers. Our study measures the frequency of discrepancy between initial and second opinion breast imaging recommendations and evaluates the impact on patient management. A retrospective chart review was conducted on 504 consecutive patients with second opinion breast radiology interpretations performed by 6 sub-specialized breast radiologists at a dedicated cancer center from January 1, 2014 through September 1, 2014. Outside imaging reports were compared with second opinion reports to categorize discrepancies. Interpretations were considered discrepant in cases with Breast Imaging Reporting and Data System (BI-RADS) category changes, recommendation for additional imaging, or identification of previously undiagnosed additional extent of disease greater than 5 cm. The frequencies of discrepancy, alterations in surgical management, and incremental cancer detection were measured. Statistical analysis of associated factors was performed with the Fisher exact test, with a P-value < .05 considered significant. Second opinion evaluation discrepancies were seen in 287 (57%) patients and resulted in percutaneous image-guided biopsies in 92 (18%). Forty-five additional sites of cancer were biopsy-detected in 41 (8%) patients, including 20 breast malignancies and 25 axillary metastases. Another 9 biopsies yielded high-risk pathology. Second opinion interpretations altered surgical management in 66 (13%) patients. Factors associated with increased discrepancy frequency were cancer diagnosis at presentation (P = .004), dense breasts (P = .005), and the absence of prior studies for comparison (P = .007). Although additional imaging and resources are required, second opinion radiology review by subspecialized breast radiologists increases cancer detection and results in clinically relevant changes in patient management.