General practitioners' perspectives on targeted breast ultrasound as primary diagnostic test in women with focal breast complaints: An interview study

The high diagnostic accuracy of ultrasound opens possibilities to shift towards an initial ultrasound approach for the evaluation of focal breast complaints in women, with only additional DBT in case of unclear or suspicious ultrasound findings. As general practitioners (GPs) are important stakeholders in the diagnostic pathway, this study focuses on GPs perspective on ultrasound as primary diagnostic imaging test, as well as the GP referral process.

Sixteen Dutch GPs were interviewed on the referral process and their perceived barriers and facilitators of initial ultrasound diagnostics in women presenting with focal breast complaints. Interview data were transcribed verbatim and analyzed thematically.

Thematic analysis identified themes related to 1) the routine breast consult (consult characteristics, referral decision, referral rationale and diagnostic imaging decision) and 2) considerations of an ultrasound-only approach. Regarding the latter, the theme diagnostic workflow emphasizes GPs concerns regarding long waiting times for ultrasound. Professional communication describes communicational barriers on patient-radiologist and radiologist-GP level. In the theme doctor-patient relationship shared decision-making was highlighted, while concerns existed on the lack of patient return to the GP after result disclosure at the hospital. Effectiveness of imaging is associated with GPs' acceptance of the diagnostic performance of ultrasound as stand-alone modality. Personal expertise and workload is related to consequences of an initial ultrasound approach on GPs workload and professional tasks. Regarding the patient benefit-harm trade-off, various patient (dis)advantages were highlighted. Decentralization of diagnostic evaluation was considered a potential practical implication of ultrasound as primary diagnostic test.

Participants seemed to welcome ultrasound-only diagnostics for the evaluation of women's focal breast complaints, emphasizing multiple benefits for both the patients and GPs. They, however, also addressed various challenges that should be taken into consideration when actually practicing an initial ultrasound approach.