Magnetic resonance imaging (MRI) can help diagnose breast cancer, but it is costly. Leadership at the University of Washington in Bellingham developed a protocol to improve the timeliness of care, moving the time of MRI prior to surgeon evaluation, and found that it led to enhanced patient care, eliminated delays in treatment, avoided unnecessary tests, shifted appropriate care to primary-care providers, and provided all necessary data prior to initial surgical consultation. They presented the findings at the .
The change in protocol followed the development of guidelines for MRI ordering for newly diagnosed patients with breast cancer. Per the organization’s leadership, the following indicators warranted an MRI: dense breast tissue, invasive lobular breast cancer, age younger than 50 years, and vague imaging of primary lesions. When appropriate, a radiologist included a statement with the core needle biopsy report indicating that a patient was identified as a candidate who would benefit from a breast MRI ordered soon after the positive biopsy. The primary care provider received the message and ordered the breast MRI prior to conference or surgical consultation.
The researchers assessed outcomes in 60 consecutive patients from two time periods: half before and half after institution of the new MRI protocol.
Prior to implementing the policy, patients who needed a breast MRI would obtain the imaging an average of 12 days after a multidisciplinary breast conference (MDC). Comparatively, breast MRI was obtained three days prior to MDC after implementation.
Preintervention, 43% of necessary breast MRIs were ordered prior to surgical consultation; the number jumped to 100% postintervention. Primary care providers rarely ordered breast MRIs preintervention, but postintervention, they ordered 80% of all breast MRIs. The guidelines also reduced the number of primary care providers ordering unnecessary tests from 21% preintervention to 10% postintervention.