Spivey Tara Lynn, Carlson Kjirsten Ayn, Janssen Imke, Witt Thomas R, Jokich Peter, Madrigrano Andrea
Department of General Surgery, Rush University Medical Center, Chicago, IL, USA,
Ann Surg Oncol. 2015 Jul;22(7):2359-64. doi: 10.1245/s10434-014-4205-5. Epub 2015 Jan 22.
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.
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.
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.
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.
乳腺外科医生经常会接待因乳腺影像学检查发现异常前来寻求二次诊断意见的女性患者。对于二次诊断，这些影像资料会提交给专业的乳腺影像诊断医生进行评估和解读。本研究评估了来自三级医疗中心以及社区项目的外部医院提交的影像解读结果的一致性，旨在评估这种做法在临床管理和资源利用方面的实用性。
对2011年至2013年期间在拉什大学医学中心（RUMC）提交外部影像胶片的所有乳腺患者进行回顾性病历审查。收集放射学诊断结果以及每位患者的拟行治疗方案，并评估外部机构与RUMC之间的一致性。
总共评估了380例因外部检查解读前来寻求二次诊断意见的患者。在47.4%[95%置信区间（CI）42.4 - 52.4]的病例中，放射学印象存在明显差异。在53.5%（95%CI 48.4 - 58.5）的患者中，推荐的治疗方案发生了变化，包括建议进行额外的影像学检查或需要进行额外的活检。总体而言，这在27.1%（95%CI 22.8 - 31.9）的病例中改变了整体手术管理方案。在6例患者中，对外部影像的重新解读发现了先前未识别的新恶性肿瘤。总体而言，83.7%（95%CI 79.7 - 87.1）提交外部机构影像的患者选择在RUMC完成其余治疗。
二次诊断审查的做法在我们的专科中心改变了超过四分之一病例的整体最终管理方案。此外，审查发现了6例先前未被识别的恶性肿瘤。鉴于这些数据，尽管需要额外的资源，但二次诊断及外部检查解读的做法仍应继续。
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