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The Influence of Radiology Image Consultation in the Surgical Management of Breast Cancer Patients

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Patients referred to comprehensive cancer centers arrive with clinical data requiring review. Radiology consultation for second opinions often generates additional imaging requests; however, the impact of this service on breast cancer management remains unclear. We sought to identify the incidence of additional imaging requests and the effect additional imaging has on patients’ ultimate surgical management.

Methods

Between November 2013 and March 2014, 153 consecutive patients with breast cancer received second opinion imaging reviews and definitive surgery at our cancer center. We identified the number of additional imaging requests, the number of fulfilled requests, the modality of additional imaging completed, the number of biopsies performed, and the number of patients whose management was altered due to additional imaging results.

Results

Of 153 patients, the mean age was 55 years; 98.9 % were female; 23.5 % (36) had in situ carcinoma (35 DCIS/1 LCIS), and 76.5 % (117) had invasive carcinoma. Additional imaging was suggested for 47.7 % (73/153) of patients. After multidisciplinary consultation, 65.8 % (48/73) of patients underwent additional imaging. Imaging review resulted in biopsy in 43.7 % (21/48) of patients and ultimately altered preliminary treatment plans in 37.5 % (18/48) of patients (Fig. 1). Changes in management included: conversion to mastectomy or breast conservation, neoadjuvant therapy, additional wire placement, and need for contralateral breast surgery.

Impact of second-opinion imaging reviews on the management of breast cancer patients

Conclusions

Our analysis of second opinion imaging consultation demonstrates the significant value that this service has on breast cancer management. Overall, 11.7 % (18/153) of patients who underwent breast surgery had management changes as a consequence of radiologic imaging review.

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References

  1. DeSantis C, Lin CC, Mariotto AB, et al. Cancer treatment and survivorship statistics, 2014. CA. 2014;64(4):252–71.

    PubMed  Google Scholar 

  2. Institute of Medicine, Committee on Quality of Health Care in America. Improving the 21st-century health care system-six aims for improvement. In: Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press; 2001. p. 53–4.

    Google Scholar 

  3. Golshan M, Losk K, Kadish S, et al. Understanding process-of-care delays in surgical treatment of breast cancer at a comprehensive cancer center. Breast Cancer Res Treat. 2014;148(1):125–33.

    Article  PubMed  Google Scholar 

  4. Taylor C, Shwebridge A, Harris J, Green JS. Benefits of multidisciplinary teamwork in the management of breast cancer. Breast Cancer Targets Ther. 2013;5:79–85.

    Article  Google Scholar 

  5. Golshan M, Greenberg CC. Commentary on “Changes in surgical management resulting from case review at a breast cancer multidisciplinary tumor board.” Am J Hematol Oncol. 2007;6(7)13–4.

    Google Scholar 

  6. Geller BM, Nelson HD, Carney PA, et al. Second opinion in breast pathology: policy, practice, and perception. J Clin Pathol. 2014;67:1–6.

    Article  Google Scholar 

  7. Staradub VL, Messenger KA, Hao N, et al. Changes in breast cancer therapy because of pathology second opinions. Ann Surg Oncol. 2002;9:982–7.

    Article  PubMed  Google Scholar 

  8. Chang JH, Vines E, Bertsch H, et al. The Impact of a multidisciplinary breast cancer center on recommendations for patient management. Cancer. 2001;91(7):1231–7.

    Article  CAS  PubMed  Google Scholar 

  9. Newman EA; Guest AB, Helvie MA, et al. Changes in surgical management resulting from case review at a breast cancer multidsciplinary tumor board. Cancer. 2006;207(10):2346–51.

    Article  Google Scholar 

  10. Spivey TL, Carlson K, Janssen I, et al. Breast imaging second opinions impact surgical management. Ann Surg Oncol. 2015. doi: 10.1245/s10434-014-4205-5.

    PubMed  Google Scholar 

  11. Beam CA, Layde PM, Sullivan DC. Variability in the interpretation of screening mammograms by US radiologists. Arch Intern Med. 1996;156(2):209–13.

    Article  CAS  PubMed  Google Scholar 

  12. Jackson SL, Taplin SH, Sickles EA. Variability of interpreteive accuracy among diagnostic mammography facilities. J Natl Cancer Inst. 2009;101:814–27.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Sickles EA, Wolverton DE, Dee KE. Performance parameteres for screenign and disgnostic mammography: specialist and general radiologists. Radiology. 2002;224:861–9.

    Article  PubMed  Google Scholar 

  14. Elmore JG, Wells CK, Lee CH, et al. Variability in radiologists’ interpretations of mammograms. N Engl J Med. 1994;331:1493–9.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgement

This study was funded in part by the NIH Grant R25CA089017 and by the National Comprehensive Cancer Network (NCCN) Opportunities for Improvement grant.

Disclosures

The authors have no conflict of interests to declare.

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Authors and Affiliations

  1. Department of Surgery, Dana Farber/Brigham and Women’s Cancer Center, Boston, MA, USA

    Melissa Anne Mallory MD, Yasuaki Sagara MD, Linda Cutone, Fatih Aydogan MD & Mehra Golshan MD, FACS

  2. Department of Quality and Patient Safety, Dana-Farber Cancer Institute, Boston, MA, USA

    Katya Losk MPH & Kristen Camuso MPH

  3. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA

    Nancy U. Lin MD & Craig Bunnell MD, MPH, MBA

  4. Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA

    Robyn L. Birdwell MD

Authors
  1. Melissa Anne Mallory MD
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  2. Katya Losk MPH
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  3. Nancy U. Lin MD
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  4. Yasuaki Sagara MD
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  5. Robyn L. Birdwell MD
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  6. Linda Cutone
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  7. Kristen Camuso MPH
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  8. Craig Bunnell MD, MPH, MBA
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  9. Fatih Aydogan MD
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  10. Mehra Golshan MD, FACS
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Corresponding author

Correspondence to Mehra Golshan MD, FACS.

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Mallory, M.A., Losk, K., Lin, N.U. et al. The Influence of Radiology Image Consultation in the Surgical Management of Breast Cancer Patients. Ann Surg Oncol 22, 3383–3388 (2015). https://doi.org/10.1245/s10434-015-4663-4

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  • DOI: https://doi.org/10.1245/s10434-015-4663-4

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