Breast Imaging Second Opinions Impact Surgical Management

Area of Science:

• Radiology
• Oncology
• Breast Surgery

Background:

• Breast surgeons frequently provide second opinions for abnormal breast imaging findings.
• Interpretation of outside imaging by dedicated breast imagers is crucial for clinical management.
• This study assesses the concordance and utility of outside imaging interpretations from various healthcare settings.

Purpose of the Study:

• To evaluate the conformity of breast imaging interpretations from outside institutions (tertiary and community) with those at a central medical center.
• To determine the clinical utility of second opinions for breast imaging in guiding patient management and resource allocation.

Main Methods:

• Retrospective chart review of breast patients submitting outside imaging from 2011-2013 at Rush University Medical Center.
• Evaluation of radiologic diagnosis and management plan concordance between outside institutions and RUMC.

Main Results:

• Distinct variance in radiologic impression occurred in 47.4% of cases.
• Recommended management plans changed for 53.5% of patients, including additional imaging or biopsy.
• Overall surgical management changed in 27.1% of cases, with six previously unrecognized malignancies detected.
• 83.7% of patients opted to continue treatment at RUMC after the second opinion.

Conclusions:

• Second opinion reviews of outside breast imaging significantly alter definitive management in over 25% of cases.
• The practice identified six new malignancies, underscoring its diagnostic value.
• Continuing the practice of second opinions and outside exam interpretation is recommended despite resource implications.