Changes in Breast Cancer Reports after Pathology Second Opinion
Vicente Marco Molina, Teresa Muntal, Javier Cortes, Begona Gonzalez, Isabel Rubio, Felip Garcia Hernandez. Hospital Quiron Barcelona, Barcelona, Spain
Background: Breast cancer pathology reports contain valuable information about the histological diagnosis, prognostic factors and predictive indicators of therapeutic response. A second opinion may be requested by medical oncologists and surgeons, when a patient is referred from another institution for treatment. We report the experience with pathology second opinion in selected patients referred to the Breast Oncology Unit.
Design: 205 cases referred to the Breast Oncology Unit were selected for second opinion after clinical evaluation, between 2002 and 2012. The cases reviewed included 102 core needle biopsies, 88 surgical specimens from the breast and 18 lymphadenopathies, 14 from the axillary region. Pathology second opinion was based on review of hematoxylin-eosin preparations, recuts of submitted paraffin blocks and written outside pathology reports. Immunohistochemical studies for hormone receptors, HER2, myoepithelial cells, and other markers were performed in selected cases. A case was classified as major change in second opinion when the findings had the potential for significant change in treatment or prognosis. Otherwise, it was considered to represent minor change or concordant.
Results: In 51 cases (24.9%) the pathology review showed changes. Thirty-five (17%) patients were classified as major changes and 16 (7.8%) as minor changes. In seven patients more than one major change was identified. The major discrepancies identified were related to the histological classification (13 cases), the presence or absence of invasion in ductal carcinoma (17 cases), the results of hormone receptors (5 cases), and HER2 (7 cases). Major changes in histological classification included 2 cases diagnosed as ductal carcinoma and reclassified as benign, 3 cases with diagnosis of breast cancer reclassified as metastatic lung cancer, 3 cases with diagnosis of breast cancer in the axilla reclassified as primary cutaneous adnexal carcinomas (2) and metastatic melanoma (1). In 5 cases the histological type of the primary breast tumor was changed.
Conclusions: Second opinion in breast pathology may uncover significant discrepancies that impact in patient management and prognosis. Major discrepancies are most frequently related to the assessment of the presence or absence of invasion in ductal carcinoma, the results of predictive makers of therapeutic response, and the differential diagnosis of breast cancer and non-mammary tumors in the breast, the axilla, and at distant sites.
Wednesday, March 6, 2013 1:00 PM
Poster Session VI # 32, Wednesday Afternoon