title: Variation in Additional Breast Imaging Orders and Impact on Surgical Wait Times at a Comprehensive Cancer Center.
abstract: BACKGROUND
  In the multidisciplinary care model, breast imagers frequently provide second-opinion reviews of imaging studies performed at outside institutions. However, the need for additional imaging and timeliness of obtaining these studies has yet to be established. We sought to evaluate the frequency of additional imaging orders by breast surgeons and to evaluate the impact of this supplementary imaging on timeliness of surgery.
  
  
  METHODS
  We identified 2489 consecutive women with breast cancer who underwent first definitive surgery (FDS) at our comprehensive cancer center between 2011 and 2013. The number of breast-specific imaging studies performed for each patient between initial consultation and FDS was obtained. χ (2) tests were used to quantify the proportion of patients undergoing additional imaging by surgeon. Interval time between initial consultation and additional imaging and/or biopsy was calculated. The delay of additional imaging on time to FDS was assessed by t test.
  
  
  RESULTS
  Of 2489 patients, 615 (24.7 %) had at least one additional breast-specific imaging study performed between initial consultation and FDS, with 222 patients undergoing additional biopsies (8.9 %). The proportion of patients receiving imaging tests by breast surgeon ranged from 15 to 39 % (p < 0.0001). Patients receiving additional imaging had statistically longer wait times to FDS for BCT (21.4-28.5 days, p < 0.0001).
  
  
  CONCLUSIONS
  Substantial variability exists in the utilization of additional breast-specific imaging and in the timeliness of obtaining these tests among breast surgeons. Further research is warranted to assess the sources and impact of this variation on patient care, cost, and outcomes.
authors: Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA. mgolshan@partners.org.
authors: Mehra
authors: M
authors: Golshan
authors: Department of Quality and Patient Safety, Dana-Farber Cancer Institute, Boston, MA, USA.
authors: Katya
authors: K
authors: Losk
authors: Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
authors: Melissa A
authors: MA
authors: Mallory
authors: Department of Quality and Patient Safety, Dana-Farber Cancer Institute, Boston, MA, USA.
authors: Kristen
authors: K
authors: Camuso
authors: Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
authors: Susan
authors: S
authors: Troyan
authors: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
authors: Nancy U
authors: NU
authors: Lin
authors: Department of Quality and Patient Safety, Dana-Farber Cancer Institute, Boston, MA, USA.
authors: Sarah
authors: S
authors: Kadish
authors: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
authors: Craig A
authors: CA
authors: Bunnell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000473:pathology* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology* / Q000601:surgery; D015331:Cohort Studies; D003952:Diagnostic Imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D012017:Referral and Consultation; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D055815:Young Adult