Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy.
Anatomic Pathology, Department of Experimental Medicine, Policlinico Tor Vergata (PTV) University, Rome, Italy.
Anticancer Res. 2020 Feb;40(2):939-950. doi: 10.21873/anticanres.14027.
BACKGROUND/AIM: The research objectives of this study were the estimation of the number of misdiagnosed breast lesions by non-expert-center-breast-radiologists (NEBR) and the investigation of the discordant rate (DR) calculated between initial and second opinion. Moreover, this study evaluated the impact of second opinion and the factors associated with DR.
A total of 399 patients were sent to our Tertiary Breast Cancer (BC) Center to perform fine needle aspiration/core needle biopsy (FNAC/CNB) after external examination. Lesions were reclassified according to Breast Imaging-Reporting and Data System (BI-RADS). External examinations were classified as breast-expert, not-breast-expert and physicians as expert-center-breast-radiologists (EBR), NEBR, and non-radiologists (NR). Personal/family history of breast cancer (BC), breast-density and presence of prior imaging were collected.
DR was 74.3%. After second opinion, FNAC/CNB was proposed in 25.7% of cases and 2 additional cancers were detected. About 59.5% of unnecessary FNAC/CNB were avoided. Dense breast, no prior imaging examination and BC family-history were associated with higher DR (p-value<0.001); personal BC-history was associated in NEBR evaluations (p-value=0.0383).
Second opinion review of outside examinations at expert BC Center may decrease unneeded biopsy, reducing health-care costs.
背景/目的:本研究的目的是估计非专家中心乳腺放射科医生(NEBR)误诊的乳腺病变数量,并调查初始和第二意见之间的差异率(DR)。此外,本研究还评估了第二意见的影响以及与 DR 相关的因素。
共 399 例患者经外部检查后被送往我们的三级乳腺癌(BC)中心进行细针抽吸/核心针活检(FNAC/CNB)。病变根据乳腺成像报告和数据系统(BI-RADS)进行重新分类。外部检查分为乳腺专家、非乳腺专家和专家中心乳腺放射科医生(EBR)、NEBR 和非放射科医生(NR)。收集个人/家族乳腺癌(BC)病史、乳腺密度和既往影像学检查情况。
DR 为 74.3%。在进行第二意见后,25.7%的病例建议进行 FNAC/CNB,发现了 2 例额外的癌症。约 59.5%的不必要 FNAC/CNB 被避免。致密乳腺、无既往影像学检查和 BC 家族史与更高的 DR 相关(p 值<0.001);NEBR 评估中与个人 BC 病史相关(p 值=0.0383)。
在专家 BC 中心对外部检查进行第二意见审查可能会减少不必要的活检,从而降低医疗保健成本。