In our retrospective study,
systematic imaging review of breast malignant or suspicious lesions before surgery led to the diagnosis of 38 additional BIRADS 6 lesions (with 10 atypical lesions (14,5% of all breast biopsies) and 28 carcinomas (40,6%)) corresponding to 16,1% (38/236) of all malignant breast lesions and 11 additional metastatic lymph nodes.
Surgical procedure was modified in 45 patients (24,2%).
This underlines the importance of breast specialist radiologists in management of cancer.
Several European studies such as Posso et al.
or Waldmann et al.
(1,2) outlined the benefits of double reading process which is now accepted as a reference in most countries.
In France,
the review process is not accepted by all radiologists and can have a negative impact on the relationship between specialists and non specialists.
As shown in this study,
almost 25% of our patients had surgery modification because of additional breast lesion or metastatic lymph node,
or size underestimation,
corresponding to 72% of patients who underwent biopsy or USFNA (45/62).
These results might be influenced by selection bias due to the retrospective nature of our study and must be confirmed by prospective studies.
Similar results were found by Khayat et al.
(6) in 2011 in a French scientific communication,
where 10% of their patients had breast surgery modifications corresponding to 77% of patients with additional biopsy.
Despite review,
38 patients underwent repeat surgery mainly because of insufficient margins removal and metastatic LN not detected by imaging.
Wilke et al.
(3) showed that repeat surgery rate in USA was 23,6% for additional lumpectomy or mastectomy and Dabbas et al.
(4) had breast re-excision in 12,1% cases: those results are concordant with ours.
Review is a time-consuming process that require optimal organisation between gynaecologists,
radiologists and histopathologists,
especially when surgery has to be performed quickly to avoid any delay,
and generates additional cost because of additional imaging and biopsies.
It is also a stressing-out procedure for patients who undergo anxiety of new examination and explorations that often leads to benign diagnosis.
For instance,
in our study it led to sample 23 false positive lesions at imaging (33,8% of biopsies) in 16 patients (8,6%).
There were also 10 atypical lesions (14,5%) and several low grade lesions that could be considered as overdiagnosis.
To conclude,
systematic imaging review of breast cancer by specialist radiologist before surgery is helpful to detect additional breast or axillary lesion and then to adjust care management for the patients but also generates anxiety and overdiagnosis that is still diffcult to evaluate.