Dr Klauber-Demore pointed out that their study had a higher rate of change in diagnosis than some previous studies looking at this topic, but suggested this was because MUSC is the only NCI-designated cancer center in South Carolina. In prior research, second-opinions were examined in major cities where there are multiple academic or cancer centers, and patients were more likely to have obtained their initial diagnosis at a NCI-designated or academic center.

For example, a similar study published in 2017 looking specifically at the value of second opinion reviews of breast imaging at a cancer center found a change in diagnosis rate closer to 30%.2

In this study, Donna D’Alessio, MD, a radiologist at Memorial Sloan Kettering Cancer Center, and colleagues reviewed breast imaging studies of 200 patients who had undergone MRI and ultrasound at a community facility and then submitted those images for a second opinion at a cancer center. The second-opinion review resulted in a change in interpretation in 28% of the cases, including 13% that were recommended for a major change in management.

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“A follow-up study showed that even in patients who do not yet have a diagnosis of breast cancer, we can change their diagnosis based on the interpretation of subspecialists,” Dr D’Alessio said.

The follow-up study looked at patient-initiated second opinion in women without a diagnosis of breast cancer and showed that second opinion reviews disagreed with the original interpretation of imaging in almost one-half (47%) of lesions.3 Cancer center subspecialty expert review ultimately averted 25% of originally recommended biopsies and detected cancer in about one-third of additional biopsies recommended.

“In these situations you are not just getting 1 opinion, but seeking the opinions of multiple subspecialists,” Dr D’Alessio told Cancer Therapy Advisor. “Together these studies tell us that second opinions with a subspecialist are valuable and result in significant actional change.”

References

  1. Garcia D, Spruill LS, Irshad A, et al. The value of a second opinion for breast cancer patients referred to a National Cancer Institute (NCI)-designated cancer center with a multidisciplinary breast tumor board. Ann Surg Oncol.2018;25:2953-2957.
  2. Coffey K, D’Alessio D, Keating DM, Morris EA. Second-opinion review of breast imaging at cancer center: Is it worthwhile? AJR Am J Roentgenol. 2017;208:1386-1391.
  3. Coffey K, Mango V, Keating DM, Morris EA, D’Alessio D. The impact of patient-initiated subspecialty review on patient care. J Am Coll Radoil. 2018;15:1109-1115.