Reducing the Number of Unnecessary Percutaneous Biopsies: The Role of Second Opinion by Expert Breast Center Radiologists

Background/aim: The research objectives of this study were the estimation of the number of misdiagnosed breast lesions by non-expert-center-breast-radiologists (NEBR) and the investigation of the discordant rate (DR) calculated between initial and second opinion. Moreover, this study evaluated the impact of second opinion and the factors associated with DR. Materials and methods: A total of 399 patients were sent to our Tertiary Breast Cancer (BC) Center to perform fine needle aspiration/core needle biopsy (FNAC/CNB) after external examination. Lesions were reclassified according to Breast Imaging-Reporting and Data System (BI-RADS). External examinations were classified as breast-expert, not-breast-expert and physicians as expert-center-breast-radiologists (EBR), NEBR, and non-radiologists (NR). Personal/family history of breast cancer (BC), breast-density and presence of prior imaging were collected. Results: DR was 74.3%. After second opinion, FNAC/CNB was proposed in 25.7% of cases and 2 additional cancers were detected. About 59.5% of unnecessary FNAC/CNB were avoided. Dense breast, no prior imaging examination and BC family-history were associated with higher DR (p-value<0.001); personal BC-history was associated in NEBR evaluations (p-value=0.0383). Conclusion: Second opinion review of outside examinations at expert BC Center may decrease unneeded biopsy, reducing health-care costs.