Abstract P5-02-02: Improving efficiency of breast MRI utilization by coordinating primary care, breast imaging and surgeons
Authors: Kaufman CS , Behrndt VS , Hall W , Moses K , Wolgamot GM , Crabo L , Backer L , Carpenter K , Smits S 
Published: May 2019

Introduction: Breast MRI in the workup of a new breast cancer diagnosis is both a valuable and costly imaging study. The decision to obtain a breast MRI is often made by the surgeon who is referred the newly diagnosed breast cancer patient. That is followed by a delay in their management due to scheduling the MRI. Our breast center program leadership developed a protocol to move the time of MRI prior to the surgeon's evaluation while avoiding unnecessary breast MRIs ordered by some well-intentioned primary care providers. Coordinating a breast MRI protocol can optimize timely performance of breast MRI, guiding primary care to become the ordering clinician while avoiding unnecessary breast MRIs.

Methods: Recognizing a delay in the journey of newly diagnosed breast cancer patients that have their breast MRI ordered only after the multidisciplinary conference or surgical consultation, we developed a protocol to improve timeliness of care. Guidelines were identified by our breast program leadership when a newly diagnosed breast cancer patient would warrant a breast MRI. Agreed upon indicators included dense breast tissue, invasive lobular breast cancer, patients typically under 50 years old, and vague imaging of primary lesions. When these findings were identified, the radiologist included a statement with the core needle biopsy report. It stated that our breast program leadership identified this patient as benefiting from a breast MRI ordered soon after the positive biopsy. This avoided the issue of self-referral since our breast leadership created the guidelines. The message went to the primary care provider who now ordered the breast MRI prior to conference or surgical consultation. We examined sixty consecutive patients from two time periods, half before and half after institution of the MRI protocol.

Results: Prior to this policy, patients who needed breast MRI would obtain the study on average 12 days after our multidisciplinary breast conference (MDC), while after institution of the policy breast MRI was obtained 3 days PRIOR to conference. Before only 43% of necessary breast MRIs were ordered prior to surgical consultation while after the protocol 100% of breast MRIs were ordered PRIOR to surgical consultation. Before the protocol rarely did primary care order breast MRIs. After the protocol primary care providers ordered 80% of all breast MRIs. While ordering more breast MRIs, primary care ordered less unnecessary studies. After the protocol was instituted, inappropriate studies as determined by the MDC decreased from 21% deemed unnecessary to only 10%.

Conclusions: Institution of a breast MRI ordering guideline by the breast program leadership with participation of primary care had the benefits of obtaining the breast MRI before the multidisciplinary conference and/or surgical consultation while avoiding unnecessary breast MRI orders. Institution of a breast MRI protocol enhances patient care, eliminates delays in treatment, avoids unnecessary tests, shifts appropriate care to primary care providers and allows initial surgical consultation to have all the data necessary to make definitive decisions. This quality improvement effort via program leadership improved comprehensive care.

Citation Format: Kaufman CS, Behrndt VS, Hall W, Moses K, Wolgamot GM, Crabo L, Backer L, Carpenter K, Smits S. Improving efficiency of breast MRI utilization by coordinating primary care, breast imaging and surgeons [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-02-02.