Moffitt Cancer Center, Tampa, Florida.
Moffitt Cancer Center, Tampa, Florida.
J Am Coll Radiol. 2019 Jul;16(7):922-927. doi: 10.1016/j.jacr.2019.01.006. Epub 2019 Mar 2.
The aim of our study is to determine MRI review discrepancy frequency and the subsequent impact on patient management for patients pursuing breast imaging second opinions.
A retrospective chart review was conducted on 1,000 consecutive patients with second opinion radiology interpretations performed by subspecialty-trained breast radiologists at a dedicated cancer center July 1 through December 31, 2016. Of these, 205 included review of outside breast MRI. Outside imaging reports were compared with second opinion reports to categorize breast MRI review discrepancies. These included relevant BI-RADS category changes or identification of additional extent of disease >4 cm. The discrepancy frequency, relevant alterations in patient management, and incremental cancer detection were measured. Statistical analyses were performed using Fisher's exact test.
Discrepant second opinion breast MRI review was seen in 36 of 205 patients (18%). Additional cancer was detected through image-guided biopsy in 3 of these 36 patients and through excision in 2 (5 of 205, 2%). Additionally, five biopsies yielded high-risk pathologic results without upstage on excision. Findings suspicious for additional extent of disease >4 cm were noted in five patients (2%) treated with mastectomies. Finally, five patients had BI-RADS category downgrades. Ultimately, completion of second opinion MRI review recommendations resulted in altered management in 10% of patients (20 of 205). The absence of prior imaging studies for comparison was associated with increased discrepancy frequency (P = .005).
Second opinion breast MRI review by subspecialized breast imaging radiologists increases cancer detection and results in clinically relevant changes in patient management.
我们研究的目的是确定磁共振成像（MRI）复查差异的频率，以及其对寻求乳腺影像学第二意见患者的管理的后续影响。
回顾性分析了 2016 年 7 月 1 日至 12 月 31 日在一家专门的癌症中心由专业乳腺放射科医生进行的第二意见放射学解读的 1000 例连续患者的病历。其中 205 例包括对外部乳腺 MRI 的审查。将外部影像报告与第二意见报告进行比较，以对乳腺 MRI 复查差异进行分类。这些差异包括相关的 BI-RADS 类别变化或发现>4cm 的疾病范围的增加。测量差异频率、对患者管理的相关改变以及增量癌症检测。使用 Fisher 精确检验进行统计分析。
在 205 例患者中有 36 例（18%）出现不一致的第二意见乳腺 MRI 复查。在这 36 例患者中，通过影像引导活检在 3 例中检测到额外的癌症，在 2 例中通过切除检测到 2 例（205 例中的 5 例，2%）。此外，5 例活检在切除时未进行分期但获得了高危病理结果。在 5 例（2%）接受乳房切除术的患者中，发现了疑似>4cm 疾病范围的病变。最终，有 5 例患者的 BI-RADS 类别降级。最终，完成第二意见 MRI 复查建议导致 10%（205 例中的 20 例）的患者管理发生改变。由于缺乏先前的影像研究进行比较，差异频率增加（P =.005）。
由专业乳腺影像放射科医生进行的乳腺 MRI 第二意见复查可提高癌症检测率，并导致患者管理方面的临床相关变化。
