title: Breast Imaging Second Opinions Impact Surgical Management.
abstract: BACKGROUND
  Breast surgeons often see women for second opinions for abnormalities found on breast imaging. For second opinions, these images are submitted for review and interpretation by dedicated breast imagers. This study evaluated the conformity of results among interpretation of imaging submitted from outside hospitals both from tertiary care centers, as well as community programs, in an attempt to evaluate the utility of this practice for the sake of clinical management and resource utilization.
  
  
  METHODS
  A retrospective chart review was conducted on all breast patients that submitted outside imaging films for the years 2011 to 2013 at Rush University Medical Center (RUMC). The radiologic diagnosis and each patient's proposed management plan was collected and evaluated for concordance between the outside institutions and RUMC.
  
  
  RESULTS
  A total of 380 patients who presented for second opinions with an interpretation of outside exams were evaluated. In 47.4 % [95 % confidence interval (CI) 42.4-52.4] of cases there was distinct variance in radiologic impression. For 53.5 % (95 % CI 48.4-58.5) of patients, there was a change in recommended management plan, which included recommendations for either additional imaging or need for additional biopsy. In total, this changed the overall surgical management in 27.1 % (95 % CI 22.8-31.9) of cases. In six patients, the reinterpretation of outside imaging detected new malignancies not previously identified. Overall, 83.7 % (95 % CI 79.7-87.1) of patients who submitted imaging from outside institutions chose to complete the remainder of their treatment at RUMC.
  
  
  CONCLUSIONS
  The practice of second opinion review changed overall definitive management at our specialty center in more than one in four cases. In addition, the review identified six previously unrecognized malignancies. Given this data, the practice of second opinions and interpretation of outside exams should continue despite the additional resources required.
authors.affiliation: Department of General Surgery, Rush University Medical Center, Chicago, IL, USA, tara_spivey@rush.edu.
authors.forename: Tara Lynn
authors.initials: TL
authors.lastname: Spivey
authors.forename: Kjirsten Ayn
authors.initials: KA
authors.lastname: Carlson
authors.forename: Imke
authors.initials: I
authors.lastname: Janssen
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Witt
authors.forename: Peter
authors.initials: P
authors.lastname: Jokich
authors.forename: Andrea
authors.initials: A
authors.lastname: Madrigrano
mesh_terms: D001706:Biopsy; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D003657:Decision Making; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D009367:Neoplasm Staging; D011379:Prognosis; D012017:Referral and Consultation; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods