Cancer-center rads show the value of re-reading community breast exams

Reinterpretation of community breast studies by a specialized cancer center yielded a change in interpretation in some 28 percent of studies submitted for a second opinion during a four-month period, according to findings published online March 16 in the American Journal of Roentgenology.

What’s more, the specialists’ re-reads led to a change in clinical management in 13 percent of cases while revealing additional cancer in 5 percent and successfully averting biopsy in 4 percent.

Lead author Kristen Coffey, MD, of Weill Cornell Medicine, senior author Elizabeth Morris, MD, of Memorial Sloan Kettering Cancer Center and colleagues reviewed the cases of 200 patients who first underwent breast ultrasound and MR imaging at community facilities and then submitted their images for second opinions at the center between January and April of 2014.

The team had each case evaluated for concordance between the original report and the second-opinion interpretation. Further, the researchers subdivided the second-opinion reads that spurred new biopsies into benign, high-risk and malignant categories based on histopathologic findings.

Their key findings:

• Second-opinion review of the 200 cases showed a change in interpretation in 55 cases (28 percent; 95 percent confidence interval).
• Overall, 26 recommendations (13 percent; 95 percent CI) led to a major change in management.
• Eight biopsies were averted (4 percent; 95 percent CI) on the basis of benign interpretation of the imaging findings, and no disease was found at 1-year follow-up evaluation.

The authors also report that 20 new biopsies were performed, yielding 10 malignancies (5 percent) and four high-risk lesions (2 percent)—and surgical management was changed to mastectomy for six of 10 patients (60 percent) with new sites of biopsy-proven malignancy.

“The practice of second-opinion review influences clinical management and adds value to patient care,” the authors write in their discussion.

They point out that the 28 percent disagreement with the original community interpretations is in line with the 19 to 42 percent disagreement rates reported in studies performed in other radiology subspecialties.

“Collectively, our findings support the assertion that there is a variance in radiologic impression between general and subspecialty-trained radiologists,” Coffey et al. write.

Commenting on the 4 percent of patients who were spared from undergoing a biopsy that was initially recommended in the outside report, they write: “Reinterpretation of imaging studies spared the patient not only an unnecessary intervention but also potential anxiety and other psychologic distress. To our knowledge, this is a new finding not previously reported in the literature.

Among the limitations the authors acknowledge are the study’s small sample size and short study period.

“Our study focused on the impact of second-opinion review on patient care and clinical management and did not explore issues related to cost, which is an important area for future investigation,” they write.