Breast Pathology Second Review Identifies Clinically Significant Discrepancies in 10% of Cases
Laila Khazai, Lavinia P Middleton, Nazli Goktepe, Benjamin T Liu, Aysegul A Sahin. MD Anderson Cancer Center, Houston, TX
Background: It has been common practice at our tertiary care referral center to review the pathology materials of referred patients. To assess the relevance of this process in this era of cost containment, we compared the original pathology reports with the second-review reports issued at our institution. Our secondary objective was to assess compliance with College of American Pathologists (CAP) recommendations regarding inclusion of scientifically validated data elements (SVDE) in pathology reports.
Design: We performed a retrospective study of all 1970 consecutive breast pathology referrals cases during the calendar year 2010. The variables studied were histologic classification, tumor grade, necrosis, size, margin status, lymphatic/vascular invasion, dermal involvement, and immunohistochemical (IHC) profile (ER, PR and Her-2). Each variable was rated as agree, disagree, missing information or not applicable.
Results: A significant discrepancy, defined as a disagreement that affected patient care, was found in 200 cases (10%). In 336 cases (17%) some CAP-required information was missing. The most common areas of discrepancy were clinically significant histologic categorization (67 cases; 33%) and biomarker reporting (50 cases; 25%). In the histologic category, diagnoses were up-graded in 33 cases (20 in-situ lesions, 3 carcinomas misinterpreted as benign, and 2 missed lymph node metastases resulting in a change in tumor stage). The most problematic diagnostic categories included intraductal lesions, lobular carcinoma, metaplastic carcinomas and phyllodes tumors. Most disagreements in the IHC-profile category were interpretive. In addition, in 20% of discrepant cases, findings were confirmed by repeat IHC analysis performed at our institution. Fluorescent In-Situ Hybridization (FISH) studies performed at our institution supported the changes in interpretation in 2 of 4 cases.
Conclusions: Our results confirm the value and utility of obtaining a second opinion in a referral center setting in order to provide optimal patient care, and highlight the challenging nature of certain diagnostic categories in breast pathology and the need to obtain second opinions in such cases. Our results also support the use of second review to ensure inclusion of CAP-required SVDEs in pathology reports.
Tuesday, March 20, 2012 1:00 PM
Poster Session IV # 9, Tuesday Afternoon