Specialized Second Opinion Review of Breast MRI Impacts Management and Increases Cancer Detection

The aim of our study is to determine MRI review discrepancy frequency and the subsequent impact on patient management for patients pursuing breast imaging second opinions.

A retrospective chart review was conducted on 1,000 consecutive patients with second opinion radiology interpretations performed by subspecialty-trained breast radiologists at a dedicated cancer center July 1 through December 31, 2016. Of these, 205 included review of outside breast MRI. Outside imaging reports were compared with second opinion reports to categorize breast MRI review discrepancies. These included relevant BI-RADS category changes or identification of additional extent of disease >4 cm. The discrepancy frequency, relevant alterations in patient management, and incremental cancer detection were measured. Statistical analyses were performed using Fisher's exact test.

Discrepant second opinion breast MRI review was seen in 36 of 205 patients (18%). Additional cancer was detected through image-guided biopsy in 3 of these 36 patients and through excision in 2 (5 of 205, 2%). Additionally, five biopsies yielded high-risk pathologic results without upstage on excision. Findings suspicious for additional extent of disease >4 cm were noted in five patients (2%) treated with mastectomies. Finally, five patients had BI-RADS category downgrades. Ultimately, completion of second opinion MRI review recommendations resulted in altered management in 10% of patients (20 of 205). The absence of prior imaging studies for comparison was associated with increased discrepancy frequency (P = .005).

Second opinion breast MRI review by subspecialized breast imaging radiologists increases cancer detection and results in clinically relevant changes in patient management.