Preventing unnecessary referrals for incidental breast lesions detected on cross-sectional imaging: a retrospective study of the local referral pathway

AIM

Increased use of cross-sectional imaging has resulted in greater detection of incidental breast lesions. There are no guidelines for how these findings should be followed up. Prior to the implementation of our pathway, local practice was for general radiologists to refer incidental breast findings either to a symptomatic breast clinic or to breast Multi disciplinary team meeting (MDT). This referral pathway allows general radiologists to refer patients with incidental breast findings to a breast radiologist (by adding a JBREAS code in the report) who can then review the imaging. The breast radiologist can then decide whether symptomatic clinic referral is appropriate and communicate this via an addendum to the original report. The aim of this study was to review scans with a JBREAS code between 2015 and 2024 to assess whether the system is effective in avoiding unnecessary referrals.

MATERIALS AND METHODS

retrospective review of scans with JBREAS code between 27/11/2015 and 22/06/2024 was conducted. An analysis of patient data using Computerised Radiology Information System (CRIS) and Integrated Clinical Environment (ICE) for patient and scan details and histology results was performed.

RESULTS

Out of a total of 736 scans, 344 patients were recommended for breast clinic referral. Seventy-three of those referred to clinic had malignant histology.

CONCLUSION

The data show that our pathway reduced referrals by over 50%. This significantly reduced the burden on oversubscribed breast clinics. Advantages to patients include saving unnecessary anxiety and trips to the hospital, thereby reducing travel costs and environmental impact. Furthermore, the pathway enabled rapid assessment of incidental breast lesions that were subsequently found to be malignant in nature (10% of total JBREAS referrals).