Ingrid Hein

May 10, 2017

NEW ORLEANS — Radiology subspecialists can detect breast cancers missed on initial screenings in people not diagnosed with breast cancer, a new study shows.

"In an ideal world, subspecialty-trained people would read subspecialty studies," said lead investigator Lauren Chang Sen, MD, assistant professor of diagnostic radiology at the University of Texas M.D. Anderson Cancer Center in Houston.

"The more you do something, the better you are at it," she told Medscape Medical News.

The study was conducted to see if there are benefits to a subspecialty second-opinion interpretation for patients without a diagnosis of breast cancer, and "we found there are," Dr Chang Sen reported here at the American Roentgen Ray Society 2017 Annual Meeting.

"However, getting a second opinion from a subspecialist is not easy to achieve in all the community practices throughout the United States," she added.

For their study, Dr Chang Sen and her colleagues retrospectively reviewed 2400 studies submitted from outside facilities for a second opinion from January 2010 to June 2014.

Malignancy Discovered

Of the 2400 patients, 271 were found to have a malignancy, for a rate of 11.3%. After 189 patients (7.9%) underwent additional biopsies, 24 cases of cancer were identified.

Eight of these cases were excluded from the analysis because additional clinical information confirmed the cancer or there was mention of percutaneous or surgical biopsy in the outside report. One case of metastatic ovarian cancer was also excluded.

In the final analysis, the second interpretation by radiology subspecialists detected an additional 15 true breast cancers — 10 invasive carcinomas and five ductal carcinomas in situ.

This translates into a positive predictive value of 7.9% for biopsy recommended and biopsy performed.

Of the 15 additional cases, 13 had been referred from community centers not accredited by the American College of Radiology as Breast Imaging Centers of Excellence. All 15 patients underwent repeat breast imaging at M.D. Anderson.

Dr Chang Sen stressed that the intention of the study was not to show that M.D. Anderson is better than other centers, but to point out that subspecialization has a role in patient care.

We wanted to show that expertise is an element in the equation.

"We wanted to show that expertise is an element in the equation, and to increase awareness that subspecialization contributes to the improvement of patient diagnostic accuracy," she explained.

"Our hope is that this can be delivered in a cost-efficient and efficacious manner," she added.

Previous studies have shown that second-opinion interpretations of breast imaging studies from outside facilities have resulted in changes in the management of cases; however, no studies have focused solely on patients without a concurrent breast cancer diagnosis, Dr Chang Sen reported.

"It's an important distinction," she explained, because the value of subspecialty imaging studies to someone who already has a diagnosis of breast cancer is already recognized. "That's what makes our study unique."

Despite these results, "someone who lives really far from a subspecialist shouldn't feel they have to go to a subspecialist to have their results interpreted," she told Medscape Medical News.

"There's a very important place for general radiology providing care for this country," said Deborah Jeffries, MD, from the University of Michigan Health System in Ann Arbor. "Our residents are well trained."

"We wouldn't want this to be a deterrent," she added. "We don't want women to stop having mammograms because they live in an area that's not served by subspecialists, because they're still going to get a much-needed screening test."

Dr Jeffries said she started her practice before 1994, when the Mammography Quality Standards Act (MQSA) was put into place.

"That made a huge impact," she said. "People now have to prove that they are continually doing quality work with MQSA."

Dr Chang Sen and Dr Jeffries have disclosed no relevant financial relationships.

American Roentgen Ray Society (ARRS) 2017 Annual Meeting: Abstract 3260. Presented May 5, 2017.

Follow Medscape Radiology on Twitter @MedscapeRads and Ingrid Hein @ingridhein

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