Obtaining a second diagnostic opinion can have a high impact for patients with breast cancer, according to a study published in the Annals of Surgical Oncology.
The authors of the study set out to evaluate the effect of using a multidisciplinary tumor board (MTB) to provide a second diagnostic opinion for patients with breast cancer. Multidisciplinary tumor boards are beginning to represent cancer center standard of care, but data on their efficacy in changing diagnostic and treatment outcomes for patients are not fully developed.
This retrospective, observational study included available radiologic imaging, pathology slides, and genetic test results for 70 patients with breast cancer diagnosed at outside clinics; these were compared with reports resulting from second opinions by an MTB at the Medical University of South Carolina that were sought by these 70 patients between August 2015 and March 2016.
An MTB second opinion changed the diagnosis in 43% of cases (30 patients). For these patients seeking second opinions, 47.1% (33 patients) underwent new imaging, 35.7% (25 patients) underwent new biopsies, with new interpretations of pathology for 20% (14 patients). Additional imaging and biopsies led to most diagnostic changes. New biopsies led to 16 additional breast cancer diagnoses, with 5 being new lymph node metastases.
Genetic testing was performed on 15.7% (11) of the patients for whom it had not been offered before with 2 of these patients showing genetic variants of unknown significance, which led to no changes in their treatment.
Because many diagnostic changes were owed to radiologic imaging and biopsy, the authors suggested that second opinions in breast cancer utilize radiologists on MTBs who are breast fellowship-trained.
Garcia D, Spruill LS, Irshad A, Wood J, Kepecs D, Klauber-DeMore N. 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.