Department of Surgery, Medical University of South Carolina, Charleston, SC, USA.
Department of Pathology, Medical University of South Carolina, Charleston, SC, USA.
Ann Surg Oncol. 2018 Oct;25(10):2953-2957. doi: 10.1245/s10434-018-6599-y. Epub 2018 Jul 3.
This study aimed to investigate the changes in diagnosis after a second opinion for breast cancer patients from a multi-disciplinary tumor board (MTB) review at an National Cancer Institute (NCI)-designated cancer center.
A retrospective study analyzed patients with a breast cancer diagnosed at an outside institution who presented for a second opinion from August 2015 to March 2016 at the Medical University of South Carolina (MUSC). Radiology, pathology, and genetic testing reports from outside institutions were compared with reports generated after an MTB review and subsequent workup at MUSC. The second-opinion cases were categorized based on whether diagnostic variations were present or not.
The review included 70 patients seeking second opinions, and 33 (47.1%) of these patients had additional radiologic images. A total of 30 additional biopsies were performed for 25 patients, with new cancers identified in 16 patients. Overall, 16 (22.8%) of the 70 of patients had additional cancers diagnosed. For 14 (20%) of the 70 patients, a second opinion led to a change in pathology interpretation. Genetic testing was performed for 11 patients (15.7%) who met the National Comprehensive Cancer Network (NCCN) guidelines for genetic testing, but none showed a mutation other than a variant of unknown significance. After a complete workup, 30 (42.8%) of the 70 patients had a change in diagnosis as a result of the MTB review.
A review by an MTB at an NCI-designated cancer center changed the diagnosis for 43% of the patients who presented for a second opinion for breast cancer. The study findings support the conclusion that referral for a second opinion is beneficial and has a diagnostic impact for many patients.
本研究旨在调查多学科肿瘤委员会（MTB）审查后，来自国家癌症研究所（NCI）指定癌症中心的乳腺癌患者第二次诊断意见的变化。
一项回顾性研究分析了 2015 年 8 月至 2016 年 3 月在南卡罗来纳医科大学（MUSC）就诊的来自外部机构诊断为乳腺癌的患者的第二次意见。外部机构的放射学、病理学和基因检测报告与 MTB 审查后和 MUSC 后续检查生成的报告进行了比较。根据是否存在诊断差异，将第二次意见病例进行了分类。
该审查包括 70 名寻求第二次意见的患者，其中 33 名（47.1%）患者有额外的影像学图像。总共对 25 名患者进行了 30 次额外的活检，发现 16 名患者有新的癌症。总体而言，70 名患者中有 16 名（22.8%）被诊断出患有额外的癌症。对于 70 名患者中的 14 名（20%），第二次意见导致了病理学解释的改变。对符合国家综合癌症网络（NCCN）基因检测指南的 11 名患者（15.7%）进行了基因检测，但均未发现除意义不明的变异以外的突变。经过全面检查，70 名患者中有 30 名（42.8%）因 MTB 审查而改变了诊断。
NCI 指定癌症中心的 MTB 审查改变了 43%的乳腺癌患者第二次诊断意见。研究结果支持这样的结论，即许多患者从寻求第二次意见中受益并具有诊断意义。
