Diagnostic interval for non-screening patients undergoing mammography during the COVID-19 pandemic

Abstract

Objective: During the COVID-19 pandemic, there was a temporary cessation of mammography screening. However, in some facilities, diagnostic breast imaging services continued for patients with a high clinical suspicion of breast cancer. The objective of this study was to evaluate changes in the diagnostic interval (DI) of non-screening patients presenting for diagnostic mammography during the first wave of the COVID-19 pandemic.

Methods: Retrospective chart review was performed on patients presenting for non-screening diagnostic mammography from April 1 to June 30, 2020 (pandemic group) and April 1 to June 30, 2019 (pre-pandemic group). Age, reason for referral, number and type of imaging studies/biopsies necessary for a final diagnosis were recorded. Diagnostic interval (DI) was defined as the number of days from the date of the diagnostic mammogram to the date of the final diagnosis.

Results: Compared to the pre-pandemic group (n = 64), the pandemic group (n = 77) showed a reduction in DI of the entire cohort (pandemic: 1 day; pre-pandemic: 15 days, p < 0.0001) for patients not requiring tissue sampling (pandemic: 1 day; pre-pandemic: 11 days, .p < 0.0001) and those requiring tissue sampling with benign pathology (pandemic 9 days; pre-pandemic, 33 days, p = 0.0002). A higher percentage of patients in the pandemic group had their assessment completed during the initial visit (pandemic: 50.6%; pre-pandemic: 23.4%, p = 0.0009).

Conclusion: During the first wave of the COVID-19 pandemic, the DI for patients with non-screening-related diagnostic mammography was significantly shorter, with a higher percentage of patients completing their assessments on the initial visit, compared to one year prior.

Key points: • Despite reductions in manpower and clinical services, during pandemic times, it is possible to maintain a diagnostic breast imaging service for women at high clinical suspicion for breast cancer. • During pandemic times, breast imaging departments should consider restructuring to a Rapid Diagnostic Unit model with a navigation team that follows patients through the assessment process to a final diagnosis. • Departmental restructuring and patient navigation during pandemic times could either maintain or shorten the diagnostic interval for patients presenting for diagnostic mammography.

Keywords: Breast; COVID-19; Diagnostic interval; Mammogram.

Fig. 1

Fifty-four-year-old woman presented with palpable regions in both breasts. All imaging tests and biopsies were completed on a single visit. Left breast: a left breast mediolateral oblique projection from the initial mammogram shows architectural distortion in the upper aspect of that breast (arrows). b Spot tomosynthesis view of the upper-left breast shows persistence of the architectural distortion (arrows). c On left breast ultrasound, the architectural distortion corresponds to a 1.9-cm solid mass (arrows). Right breast: d right breast craniocaudal projection from the initial mammogram shows a spiculated mass (arrows) associated with pleomorphic calcifications (arrowheads) in the medial right breast. e On right breast ultrasound, this corresponds to a 2.9-cm solid mass (arrows). Bilateral ultrasound core biopsies showed bilateral invasive ductal carcinomas. The pathology report was available 4 days later at which time the patient was contacted by a breast surgeon to discuss a treatment plan. The surgery was performed 10 days after the pathology results were available

Fig. 2

Box plots showing the diagnostic interval (DI) in days during the 2020 pandemic and the 2019 pre-pandemic times. There is a statistically significant difference in the DI between 2020 and 2019 (p < 0.0001). A final diagnosis was made for most of the patients (percentile 90^th; red line) in 21 days during the pandemic as compared to 63 days in the pre-pandemic times

Fig. 3

Box plots showing the diagnostic interval (DI) in days during the 2020 pandemic and the 2019 pre-pandemic times among patients who did and did not undergo breast biopsy. Statistically significant differences were found in DI in both groups (biopsy group p = 0.0028, no biopsy group p < 0.0001). In the pandemic group, a final diagnosis was made for most of the patients (90^th percentile; red line) requiring biopsy in 28 days and not requiring biopsy in 8 days, as compared with 91 days and 55 days, respectively, in the pre-pandemic group

Fig. 4

Box plots showing the diagnostic interval (DI) in days during the 2020 pandemic and the 2019 pre-pandemic times among patients who had benign and malignant biopsy pathology results. A statistically significant difference was found in DI among patients with a benign diagnosis (p = 0.0001). No statistically significant difference was found in the group of patients with a malignant diagnosis (p = 0.9177). In the pandemic group, a final diagnosis was made for most of the patients (90^th percentile; red line) with a benign result in 28 days and a malignant result in 37 days, as compared with 126 days and 37 days, respectively, in the pre-pandemic group