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4720. Enhancing Response to Neoadjuvant Chemotherapy Breast MRI Reporting: A Radiologist-Clinician Quality Improvement Collaboration
Authors * Denotes Presenting Author
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Sheida Ebrahimi;
University of California, San Diego Health
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Mojdeh Mirmomen;
University of California, San Diego Health
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Rebecca Rakow-Penner;
University of California, San Diego Health
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Vivian Lim;
University of California, San Diego Health
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Mohammad Eghtedari;
University of California, San Diego Health
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Sara Grossi;
University of California, San Diego Health
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Haydee Ojeda-Fournier *;
University of California, San Diego Health
Objective:
Contrast-enhanced breast MRI is the most sensitive study evaluating response to neoadjuvant chemotherapy (NAC) for patients with breast cancer. We noted inconsistent breast MRI reporting of NAC. The primary objective of this quality improvement (QI) project was to assess breast MRI reporting for NAC response, identify areas for improvement, and seek to understand referring clinicians' satisfaction with the current reports and gather their insights on report adequacy.
Materials and Methods:
As part of a QI project, we conducted a retrospective review of 30 breast MRI reports documenting the response to NAC. Five radiologists with 1-33 years of experience generated these reports. The reports were analyzed for the presence of key elements, and the frequencies of their inclusion were calculated. Specific attention was given to the inclusion of details such as indication, background parenchymal enhancement (BPE), fibroglandular tissue (FGT), the timing of NAC, type of malignancy, change in BPE, the pattern of response, the extent of disease (unifocal, multifocal, or multicentric), type of response (complete, partial, progression, stable), and changes in tumor size. To gather clinicians' perspectives, a survey was administered to referring clinicians (surgeons, oncologists, radiation oncologists, and advanced care practitioners), asking about their satisfaction with the current reports and whether they found them suitable for tumor assessment.
Results:
All 30 reports included the indication, BPE, and FGT. Only 9% indicated the timing (early, mid, or late) of NAC. No report mentioned changes in BPE. 4% mentioned the type of response in the findings section. In comparison, 77% included the type of response in the impression. 25% of reports included the extent of the disease. 83% included changes in tumor size. 71% included associated T2 signal intensity changes. 4% mentioned the change in kinetics in the target lesion. In the impression, no report included the pattern of response (concentric or nonconcentric), 95% included the maximum extent of disease, and baseline size was included in only 40% of reports. Clinician feedback indicated a moderate satisfaction level, with 67% being satisfied and 33% very satisfied. 75% agreed that current reports were adequate for tumor assessment, with 8% strongly agreeing and 17% remaining neutral. Furthermore, 50% of clinicians desired to include the response pattern, and 100% emphasized the importance of incorporating the extent of disease in the reports.
Conclusion:
This single-institution QI project suggests that there is an opportunity to improve the reporting of responses to NAC. Enhancing collaboration between radiologists and referring clinicians ensures accurate and comprehensive breast MRI reporting that leads to improved patient care. As part of this QI initiative, a structured report will be instituted, and a re-assessment of report content and the clinician's satisfaction with reporting will be undertaken.
