Second Opinion Assessment in Diagnostic Mammography at a Breast Cancer Centre.

The aim of this retrospective study was to evaluate the importance of second opinion assessment for diagnostic mammography and sonography in a breast cancer centre. We analysed a total of 374 diagnostic mammographies and sonographies. All patients had previously undergone mammography and sonography examination in different external clinics, and the findings had been classified according to the BI-RADS system. All patients underwent additional sonography investigation in the outpatient department of our university clinic with additional mammography where necessary. The final diagnosis (histological clarification in 316 cases, follow-up in 58 cases) was compared with the BI-RADS classification made by the external clinics and by the university clinic, and the correlation between their findings and the final diagnosis was analysed. The final diagnosis yielded 146 benign lesions and 228 cancers. In 74 % of cases (277/374), the BI-RADS classification of the first assessment corresponded to that of the second assessment. 26/55 lesions (47 %) were upgraded at the second assessment from BI-RADS 3 to BI-RADS 4, and 71/186 findings (38 %) were downgraded at the second assessment from BI-RADS 4 to BI-RADS 3. The correlation between the initial diagnosis made in the external facilities and the final diagnosis was low (kappa: 0.263), but the correlation between the second opinion assessment and the final diagnosis was significantly (p < 0.001) higher (kappa: 0.765). The second assessment increased the sensitivity from 91 % (208/228) to 99 % (225/228) and the specificity from 32 % (46/146) to 74 % (108/146). 20 additional malignant lesions were only detected at the second assessment; however the second assessment also resulted in 3 additional false-negative findings. Surgical biopsy was prevented in 49 women after the second assessment. An independent second diagnostic evaluation can significantly improve the correlation between BI-RADS classification and the final diagnosis, resulting in a benefit for the patient.