title: Effect of referring physician specialty and practice type on referral for image-guided breast biopsy.
abstract: OBJECTIVE
  To determine whether referring physician specialty and practice type affect the likelihood of referral for image-guided breast biopsy.
  
  
  METHODS
  We reviewed the records of every patient who received a Breast Imaging Reporting and Data System (BI-RADS) category 4 or 5 examination (mammography, ultrasound, or both) performed during the year 2000 at both our community- and hospital-based practices. We recorded the referring physician specialty and office location (academic medical center vs. community), breast-imaging facility location (hospital vs. community), patient age, patient insurance status, BI-RADS category, and palpability of the lesion. Multiple logistic regression analysis was performed to examine the relationship of these factors to the biopsy type (surgical vs. image-guided).
  
  
  RESULTS
  Of the 831 patients with a BI-RADS Category 4 or 5 report, 734 underwent follow-up surgical or image-guided needle biopsy. Multiple logistic regression analysis demonstrated that referral by a nonsurgeon or by a physician at the academic medical center was associated with a higher likelihood of the patient's being referred for image-guided biopsy. Patients referred by surgeons and community physicians were more likely to undergo surgical biopsy. BI-RADS Category 5 examinations and palpable lesions were also associated with a higher probability of undergoing surgical biopsy. Patient age, insurance status, and breast-imaging facility location were not related to biopsy type.
  
  
  CONCLUSIONS
  In our practice, patients referred for breast imaging by nonsurgeons and academic physicians were more likely to be referred for image-guided biopsy, whereas patients referred by surgeons and community physicians were more likely to undergo surgical biopsy.
authors.affiliation: Brown Medical School, Providence, Rhode Island 02806, USA. elazarus@lifespan.org
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lazarus
authors.forename: Martha B
authors.initials: MB
authors.lastname: Mainiero
authors.forename: Ilana F
authors.initials: IF
authors.lastname: Gareen
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000379:methods / Q000706:statistics & numerical data*; D001943:Breast Neoplasms / Q000175:diagnosis / Q000473:pathology*; D016001:Confidence Intervals; D003952:Diagnostic Imaging / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data; D008511:Medicine; D008875:Middle Aged; D009367:Neoplasm Staging; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data / Q000639:trends*; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013038:Specialization; D016217:Ultrasonography, Mammary / Q000706:statistics & numerical data