Second opinion interpretation of outside facility breast imaging studies: work effort, value, liability, and reimbursement considerations

Objective The probability of malignancy in women who are diagnosed with a Breast Imaging Reporting and Data System (BI-RADS) 4A score is low. Application of a second opinion ultrasound (SOUS), which is low in cost and minimally invasive, may lower the biopsy rate for patients who fall into this category. This study aimed to apply SOUS to patients with a BI-RADS score of 4A and predict the pathological results of a biopsy. Methods One hundred seventy-eight patients were analyzed. Univariate and multivariate analyses were performed to screen for predictive factors that are associated with malignancy. Categorical alteration of downgraded, unchanged, or upgraded was made after SOUS results. Changes in category were compared with biopsies to determine their predictive value of benignancy or malignancy. Results Independent factors associated with malignancy were age (>50 years), tumor size (≥20 mm), margin (not circumscribed), orientation (not parallel), and peripheral location, and an upgraded categorical alteration from SOUS. Downgraded categorical alterations were associated with benignancy. Conclusions In BI-RADS 4A cases, a biopsy is recommended when independent factors are associated with malignancy. A downgraded result from an SOUS examination is a protective factor, supporting the likelihood of benignancy in these patients.

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Current practices of plastic surgeons at King Abdulaziz University Hospital in requesting breast imaging studies prior to non-oncological breast surgeries

Saudi Journal of Biological Sciences ◽

10.1016/j.sjbs.2021.03.018 ◽

2021 ◽

Author(s):

Lama H. Meriky ◽

Laila K. Ashkar

Keyword(s):

Breast Imaging ◽

University Hospital ◽

Imaging Studies ◽

King Abdulaziz University ◽

Current Practices

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Reduction Mammoplasty

10.1093/med/9780190270261.003.0061 ◽

2018 ◽

Author(s):

Laura J. Horvath

Keyword(s):

Breast Imaging ◽

Reduction Mammoplasty ◽

Screening Mammography ◽

Breast Size ◽

Fat Necrosis ◽

Imaging Studies ◽

Breast Parenchyma ◽

Imaging Protocols ◽

History Of ◽

Management Recommendations

Reduction mammoplasty is a surgical procedure performed to decrease breast size. Breast parenchyma and skin are resected, and the nipple is repositioned to a more superior location on the smaller breast mound. The goals of the procedure are to alleviate a variety of physical and psychological complaints. Because women with a history of reduction surgery are commonly seen for screening mammography and other breast imaging studies, it is important to be aware of the normal post-operative appearance. This chapter, appearing in the section on intervention and surgical change, reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnoses, and management recommendations for reduction mammoplasty. Topics discussed include clinical indications, surgical technique, and benign post-operative changes, including scars, oil cysts, fat necrosis, and calcifications.

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Breast Imaging Second Opinion Consultation: A Single Institution’s Process of Improvement and Reform

Journal of Breast Imaging ◽

10.1093/jbi/wbaa022 ◽

2020 ◽

Vol 2 (3) ◽

pp. 232-239

Author(s):

Luke Freiburg ◽

Sonya Bhole ◽

Elona Liko Hazizi ◽

Sarah M Friedewald

Keyword(s):

Quality Improvement ◽

Breast Imaging ◽

Tertiary Care ◽

Turnaround Time ◽

Second Opinion ◽

Final Report ◽

Process Data ◽

Improvement Project ◽

Report Turnaround Time ◽

Before And After

Abstract Objective To review a single institution’s second opinion breast imaging process, data tracking, and metrics before and after implementing quality improvement changes and the effect on report turnaround time. Methods This Institutional Review Board approved retrospective quality improvement project was performed at a tertiary-care academic medical center and included patients 18 years or older who submitted their outside facility imaging for reinterpretation (any combination of mammography, breast ultrasonography, and/or magnetic resonance imaging performed within the last six months) with finalized second opinion reports between June 1, 2016, and July 17, 2017. Significant intradepartmental changes were implemented March 2017 with the goal to improve second opinion report turnaround time. Key metrics from 399 studies were analyzed before and after implemented changes. Two-sided Fisher’s exact test was used to assess the significance of results. Results After department interventions, the percentage of outside reports available at the time of surgical consultation improved from 82% (213/259) to 91% (127/140), an 11% improvement (P < 0.05). The average number of days from initial second opinion consultation to the availability of final report improved from 10.2 days to 9 days, a 12% improvement. Prior to the changes, the number of days it took a radiologist to complete a report varied from 1 to 4 days, but afterwards was consistently 1 day or less. Conclusion Implementation of second opinion intradepartmental changes demonstrated a significant improvement in report turnaround time and the number of finalized reports available at the time of surgical consultation. An efficient second opinion process is crucial to a breast imaging center, as it ultimately expedites patient surgical and oncological care.

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