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

• Published in: Annals of surgical oncology Vol. 22; no. 10; pp. 3383 - 3388
• Main Authors: Mallory, Melissa Anne, Losk, Katya, Lin, Nancy U., Sagara, Yasuaki, Birdwell, Robyn L., Cutone, Linda, Camuso, Kristen, Bunnell, Craig, Aydogan, Fatih, Golshan, Mehra
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.10.2015; Springer Nature B.V
• Subjects: Breast Neoplasms - diagnostic imaging; Breast Neoplasms - surgery; Breast Oncology; Disease Management; Female; Follow-Up Studies; Humans; Image Interpretation, Computer-Assisted; Mammography - methods; Mastectomy; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Staging; Oncology; Prognosis; Radiology; Referral and Consultation; Surgery; Surgical Oncology; Additional Imaging; National Comprehensive Cancer Network; Comprehensive Cancer Center; Breast Cancer Management; Breast Conserve Therapy
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-015-4663-4

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. Fig. 1 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.