Abstract
Background
In the multidisciplinary care model, breast imagers frequently provide second-opinion reviews of imaging studies performed at outside institutions. However, the need for additional imaging and timeliness of obtaining these studies has yet to be established. We sought to evaluate the frequency of additional imaging orders by breast surgeons and to evaluate the impact of this supplementary imaging on timeliness of surgery.
Methods
We identified 2489 consecutive women with breast cancer who underwent first definitive surgery (FDS) at our comprehensive cancer center between 2011 and 2013. The number of breast-specific imaging studies performed for each patient between initial consultation and FDS was obtained. χ 2 tests were used to quantify the proportion of patients undergoing additional imaging by surgeon. Interval time between initial consultation and additional imaging and/or biopsy was calculated. The delay of additional imaging on time to FDS was assessed by t test.
Results
Of 2489 patients, 615 (24.7 %) had at least one additional breast-specific imaging study performed between initial consultation and FDS, with 222 patients undergoing additional biopsies (8.9 %). The proportion of patients receiving imaging tests by breast surgeon ranged from 15 to 39 % (p < 0.0001). Patients receiving additional imaging had statistically longer wait times to FDS for BCT (21.4–28.5 days, p < 0.0001).
Conclusions
Substantial variability exists in the utilization of additional breast-specific imaging and in the timeliness of obtaining these tests among breast surgeons. Further research is warranted to assess the sources and impact of this variation on patient care, cost, and outcomes.
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References
Geller BM, Nelson HD, Carney PA, et al. Second opinion in breast pathology: policy, practice, and perception. J Clin Pathol. 2014;0:1–6.
Staradub VL, Messenger KA, Hao N, Morrow, M. Changes in breast cancer therapy because of pathology second opinions. Ann Surg Oncol. 2002;9:982–7.
Chang JH, Vines E, Bertsch H, et al. The impact of a multidisciplinary breast cancer center on recommendations for patient management. Cancer. 2001;91(7):1231–7.
Newman EA, Guest AB, Helvie MA, et al. Changes in surgical management resulting from case review at a breast cancer multidisciplinary tumor board. Cancer. 2006;207(10):2346–51.
Spivey TL, Carlson K, Janssen I, Witt TR, Jokich P, Madrigrano A. Breast imaging second opinions impact surgical management. Ann Surg Oncol. 2015;22(7):2359–64. doi: 10.1245/s10434-014-4205-5.
Mallory MA, Losk K, Lin NU, et al. The influence of radiology image consultation in the surgical management of breast cancer patients. Ann Surg Oncol. 2015. doi:10.1245/s10434-015-4663-4.
Hulvat M, Sandalow N, Rademaker A, Helenowski, I, Hansen, NW. Time from diagnosis to definitive operative treatment of operable breast cancer in the era of multimodal imaging. Surgery. 2010;148(4):746–51.
Wright GP, Wong JH, Morgan JW, Roy-Chowdhury S, Kazanijian K, Lum SS. Time from diagnosis to surgical treatment of breast cancer: factors influencing delays in initiating treatment. Am Surg. 2010;76(10):1119–22.
Nessim C, Winocour J, Holloway D, Saskin R, Holloway CM. Wait times for breast cancer surgery: effect of magnetic resonance imaging and preoperative investigations on the diagnostic pathway. J Oncol Pract. 2015;11(2):e131–8.
Angarita FA, Acuna SA, Fonseca A, Crytal P, Escallon J. Impact of preoperative breast MRIs on timing of surgery and type of intervention in newly diagnosed breast cancer patients. Ann Surg Oncol. 2010;17:273–9.
Bleicher RJ, Ruth K, Sigurdson ER, et al. Preoperative delays in the US Medicare population with breast cancer. J Clin Oncol. 2012;30(36):4485–92.
Golshan M, Losk K, Kadish S, et al. Understanding process-of-care delays in surgical treatment of breast cancer at a comprehensive cancer center. Breast Cancer Res Treat. 2014;148(1):125–33.
Richards MA, Smith P, Ramirez AJ, Fentiman IS, Rubens RD. The influence on survival of delay in the presentation and treatment of symptomatic breast cancer. Br J Cancer. 1999;79(5-6):858–64.
Sue GR, Lannin DR, Killelea B, Tsangaris T, Chagpar AB. Does time to definitive treatment matter in patients with ductal carcinoma in situ? Am Surg. 2013;79(6):561–5.
Landercasper J, Linebarger JH, Ellis RL, et al. A quality review of the timeliness of breast cancer diagnosis and treatment in an integrated breast center. J Am Coll Surg. 2010;210(4):449–55.
Hislop TG, Harris SR, Jachskon J, et al. Satisfaction and anxiety for women during investigation of an abnormal screening mammogram. Breast Cancer Res Treat. 2002;76:245–54.
Del Turco MR, Pont A, Bick U, et al. Quality indicators in breast cancer care. Eur J Cancer. 2010;46:2344–56.
McCahill LE, Privette A, James T, et al. Quality measures for breast cancer surgery: initial validation of feasibility and assessment of variation among surgeons. Arch Surg. 2009;144:455–62.
Bilimoria KY, Ko CY, Tomlinson JS, et al. Wait time for cancer surgery in the United States: trends and predictors of delay. Ann Surg. 2011;253(4):779–85.
Liederbach E, Sisco M, Wang C, et al. Wait times for breast surgical operations, 2003-2011: a report from the National Cancer Data Base. Ann Surg Oncol. 2015;22(3):899–907.
Cordeiro E, Dixon M, Coburn N, Holloway CM. A patient centered approach to wait times in the surgical management of breast cancer in the province of Ontario. Ann Surg Oncol. 2015;22(8):2509–16.
Acknowledgment
This initiative was supported in part by the NIH National Institute of Health Grant R25 CA089017.
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Mehra Golshan and Katya Losk are co-first authors. They have contributed equally.
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Golshan, M., Losk, K., Mallory, M.A. et al. Variation in Additional Breast Imaging Orders and Impact on Surgical Wait Times at a Comprehensive Cancer Center. Ann Surg Oncol 22 (Suppl 3), 428–434 (2015). https://doi.org/10.1245/s10434-015-4834-3
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DOI: https://doi.org/10.1245/s10434-015-4834-3