New care approach cuts breast biopsy referrals by over 50%
A new care approach is helping one health system to cut biopsy referrals by 50%.
Rising imaging volumes have led to an uptick in the unearthing of unexpected breast lesions. Without concrete guidelines on follow-up for these findings, some have seen a corresponding rise in biopsies and other potentially unnecessary healthcare services, experts detailed Friday in the journal of Clinical Radiology.
However, radiologists in the northwest England city of Liverpool have helped design a new care pathway to address this issue. The approach has specialized breast radiologists review initial results and decide whether further investigation is warranted, helping to reduce costs and pressure on overtaxed breast clinics.
“Advantages to patients include saving unnecessary anxiety and trips to the hospital, thereby reducing travel costs and environmental impact,” lead author Dr. Rida Fatima, with the Liverpool University Hospitals NHS Foundation Trust, and colleagues wrote Sept. 5. “Furthermore, the pathway enabled rapid assessment of incidental breast lesions that were subsequently found to be malignant in nature.”
Under the new care pathway, the radiologist who found the incidental breast lesion adds an extra alert code (“JBREAS”) to their report. This automatically sorts the scan into another folder, where a specialized breast radiologist reviews the results along with any previous images. This reviewer would then add an addendum either recommending further investigation or assuring the referrer that no further action is needed. In the former scenario, an alert code (“CMALERT”) is added, noting the report contains urgent or unexpected findings that require a trip to the breast clinic.
Fatima and colleagues analyzed reports with the special code, logged between 2015 and 2024. During this timeframe, 736 studies had a JBREAS alert added to their primary reports. Most were CT exams, with MRI and nuclear medicine studies such as PET/CT also included. About 96% (or 710) had an addendum added by a breast radiologist, and of those only 48% (or 344) had further investigation recommended. For those in which a breast radiologist recommended follow-up, about 85% (or 294) had the CMALERT code added to ensure a referrer was informed of the recommendation.
Researchers also highlighted the care pathway’s promptness, with the time taken for a breast radiologist to review a flagged scan averaging about 4 days (or a median of 2). Meanwhile, the time between the primary report and a patient attending a breast clinic averaged about 26 days (or a median of 17). The latter delay may have stemmed from the high demand for an already busy breast clinic, the authors noted. Liverpool University Hospitals saw a steady increase in the number of flagged scans between 2015 and 2024, but the extra workload was outweighed by the substantial reduction in biopsies.
“While there are challenges to address, particularly regarding the oversight of some cases [resulting in the 96% figure], the benefits far outweigh the drawbacks,” Fatima et al. concluded. “Continued refinement of this system, along with targeted investigation into patient misses and longer appointment wait times, will further strengthen its reliability and efficacy.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.