title: Changes in surgical management resulting from case review at a breast cancer multidisciplinary tumor board.
abstract: BACKGROUND
  The treatment of breast cancer requires a multidisciplinary approach, and patients are often referred to a multidisciplinary cancer clinic. The purpose of the current study was to evaluate the impact of this approach on the surgical management of breast cancer.
  
  
  METHODS
  The medical records of 149 consecutive patients referred to a multidisciplinary breast cancer clinic over a 1-year period with a diagnosis of breast cancer were reviewed retrospectively for alterations in radiologic, pathologic, surgical, and medical interpretations and the effect that these alterations had on recommendations for surgical management.
  
  
  RESULTS
  A review of the imaging studies resulted in changes in interpretations in 67 of the 149 patients studied (45%). This resulted in a change in surgical management in 11% of patients. Review of the pathology resulted in changes in the interpretation for 43 of the 149 patients (29%). Thirteen patients (9%) had surgical management changes made solely as a result of pathologic reinterpretation. In 51 patients (34%), a change in surgical management was recommended after discussion with the surgeons, medical oncologists, and radiation oncologists that was not based on reinterpretation of the radiologic or pathologic findings. Overall, a second evaluation of patients referred to a multidisciplinary tumor board led to changes in the recommendations for surgical management in 77 of 149 of those patients studied (52%).
  
  
  CONCLUSIONS
  The changes in management stemmed from differences in mammographic interpretation, pathologic interpretation, and evaluation by medical and radiation oncologists and surgical breast specialists. Multidisciplinary review can provide patients with useful additional information when making difficult treatment decisions.
authors.affiliation: Department of Surgery, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan 48109, USA.
authors.forename: Erika A
authors.initials: EA
authors.lastname: Newman
authors.forename: Amy B
authors.initials: AB
authors.lastname: Guest
authors.forename: Mark A
authors.initials: MA
authors.lastname: Helvie
authors.forename: Marilyn A
authors.initials: MA
authors.lastname: Roubidoux
authors.forename: Alfred E
authors.initials: AE
authors.lastname: Chang
authors.forename: Celina G
authors.initials: CG
authors.lastname: Kleer
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Diehl
authors.forename: Vincent M
authors.initials: VM
authors.lastname: Cimmino
authors.forename: Lori
authors.initials: L
authors.lastname: Pierce
authors.forename: Daniel
authors.initials: D
authors.lastname: Hayes
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Newman
authors.forename: Michael S
authors.initials: MS
authors.lastname: Sabel
mesh_terms: D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D006287:Health Planning Guidelines; D006801:Humans; D033183:Interdisciplinary Communication; D009936:Organizational Innovation; D011859:Radiography; D012189:Retrospective Studies; D013044:Specialty Boards / Q000458:organization & administration*