Cancer Center Second Opinions on Breast Images May Change Interpretation, Treatment

Breast images performed outside cancer centers may be interpreted differently if reinterpreted at a cancer center.

Second opinions of breast images obtained outside of cancer centers often result in a change in interpretation and treatment, according to a study published in the American Journal of Roentgenology. Researchers from Weill Cornell Medical Center and Memorial Sloan Kettering Cancer Center, in New York City, NY, performed a review to determine whether reinterpretation of studies obtained at institutions outside a cancer center influences clinical management, specifically by revealing additional cancer and preventing unnecessary biopsy. The researchers reviewed breast imaging studies of 200 patients who underwent ultrasound and MRI at community facilities and had the images submitted for second opinions at a cancer center between January and April 2014. The cases were evaluated for concordance between the original report and the second-opinion interpretation. Second-opinion review resulting in the recommendation and performance of new biopsies was further subdivided into benign, high-risk, and malignant categories based on the histopathologic results obtained at the cancer center. The results showed  there was a change in interpretation in 55 of the 200 cases (28 percent) and overall, 26 recommendations (13 percent) led to a major change in management: • 20 new biopsies were performed, yielding 10 malignancies and four high-risk lesions; • Surgical management was changed to mastectomy for six of 10 patients with new sites of biopsy-proven malignancy; and• Eight biopsies were averted on the basis of benign interpretation of the imaging findings, and no disease was found at one-year follow-up evaluation. The researchers concluded reinterpretation of studies obtained outside a cancer center resulted in a change in interpretation in more than one-fourth of submitted studies. Cancer detection also was affected, with additional cancers found in 5 percent of patients and biopsy averted in 4 percent.