title: Second-Opinion Review of Breast Imaging at a Cancer Center: Is It Worthwhile?
abstract: OBJECTIVE
  Second-opinion review of breast imaging studies can be a time-consuming and labor-intensive process. The purpose of this investigation was to determine whether reinterpretation of studies obtained at institutions outside a cancer center influences clinical management, specifically by revealing additional cancer and preventing unnecessary biopsy.
  
  
  METHODS
  A review was conducted of breast imaging studies of 200 patients who underwent ultrasound and MRI at community facilities and had the images submitted for second opinions at a cancer center between January and April 2014. Each case was evaluated for concordance between the original report and the second-opinion interpretation. Second-opinion review resulting in the recommendation and performance of new biopsies was further subdivided into benign, high-risk, and malignant categories based on the histopathologic results obtained at the cancer center.
  
  
  RESULTS
  Second-opinion review of the 200 cases showed a change in interpretation in 55 cases (28%; 95% CI, 21-34%). Overall, 26 recommendations (13%; 95% CI, 9-18%) led to a major change in management. Twenty new biopsies were performed, yielding 10 malignancies (5%; 95% CI, 2-9%) and four high-risk lesions (2%; 95% CI, 1-5%). Surgical management was changed to mastectomy for 6 of 10 patients (60%) with new sites of biopsy-proven malignancy. Eight biopsies were averted (4%; 95% CI, 2-8%) on the basis of benign interpretation of the imaging findings, and no disease was found at 1-year follow-up evaluation.
  
  
  CONCLUSIONS
  Reinterpretation of studies obtained outside a cancer center resulted in a change in interpretation in more than one-fourth of submitted studies. Additional cancer was detected in 5% of patients, and biopsy was averted for 4%. The practice of second-opinion review influences clinical management and adds value to patient care.
authors.affiliation: 1 Department of Radiology, Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Kristen
authors.initials: K
authors.lastname: Coffey
authors.affiliation: 1 Department of Radiology, Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Donna
authors.initials: D
authors.lastname: D'Alessio
authors.affiliation: 1 Department of Radiology, Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Delia M
authors.initials: DM
authors.lastname: Keating
authors.affiliation: 1 Department of Radiology, Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Morris
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000473:pathology; D002173:Cancer Care Facilities / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D015588:Observer Variation; D015995:Prevalence; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary / Q000706:statistics & numerical data*; D014600:Utilization Review
keywords: breast cancer; multimodality; second-opinion readings; second-opinion reinterpretation; subspecialization