Impact of Imaging on Time Intervals
Many studies suggest that additional diagnostic evaluation,
including a preoperative BMRI, could be a variable that delayed
the average time from initial consultation to surgery (Bleicher
et al., 2009). However, a BMRI done prior to the initial consultation
could result in a similar time delay reflected in the interval
from diagnosis to initial consultation. The only way to avoid
a BMRI-related delay would be not to recommend a BMRI as
a preoperative diagnostic study. According to the consensus
guidelines of the American College of Radiology ([ACR], 2013),
the current indications for recommendation of a diagnostic
BMRI is “to evaluate the extent of disease in invasive carcinoma
and ductal carcinoma in situ to determine the presence of multifocality
and multicentricity” (p. 2). In addition, this diagnostic
evaluation has been found to detect occult disease in the breast
containing the index malignancy in about 15% of patients, with
a range of 12%–27%, which potentially can alter surgical management
(ACR, 2013). According to Houssami et al. (2008), the
amount of patients affected by BMRI for surgical management
ranged from 8%–33%, but no consensus exists that using BMRI
to detect additional malignant foci within the affected breast
improved patient outcomes.
Instead of not including BMRI in preoperative diagnostic
evaluations, institutions should allocate resources to support
the availability of BMRI and make scheduling more efficient
and flexible. The breast imaging department at the site in the