Obtaining second opinions of breast pathology decreases but does not eliminate false diagnoses

Previous studies have shown that there is an element of variability in the interpretation of biopsies obtained from breast specimens by pathologists. Obviously, a false diagnosis of cancer as well as a missed diagnosis of cancer is very concerning because of the harm to patients that such a misdiagnosis can bring. A full diagnosis of cancer will lead to unneeded treatment, while a missed diagnosis of cancer will delay timely treatment. Past studies have shown that obtaining a second opinion leads to a significant change in the diagnosis on more than 10% of breast biopsy specimens. A new study published in the British medical Journal in August 2016 attempts to systematically compared different strategies for obtaining second opinions as an approach to reducing errors in diagnosis.

The take-home points from this study are that obtaining second opinions can improve diagnostic accuracy of interpreting breast biopsy pathology specimens. When the authors used the strategy in which all breast biopsy cases received second opinions, the misdiagnosis rates fell from 25% to 18%. The lowest chance of obtaining a misdiagnosis was when both the original and second opinion were obtained from breast pathologists that work in high-volume settings. Additionally the highest rate of misdiagnosis occurred for the diagnosis of atypical hyperplasia, where 52% misdiagnosis rate was seen. This rate remained above 34% regardless of the strategy employed in obtaining second opinions. Hence, breast atypia remains challenging, were second opinions do improve but do not completely eliminate diagnostic variability.

Daniel J Farrugia MD PhD Administrator
Director, Centegra Comprehensive Breast Program
Daniel Farrugia MD PhD is a fellowship-trained breast surgeon in the northern suburbs of Chicago. He is Director of the Centegra Comprehensive Breast Program. His research in breast cancer has been published in top international journals, and has been cited over a thousand times in the medical literature.
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