Changes in breast cancer therapy because of pathology second opinions.
BACKGROUND
Examination of pathology slides is a routine part of a breast cancer second opinion. The purpose of this study was to determine how often the pathologic second opinion (1) altered the diagnosis and (2) resulted in a change in the surgical procedure.


METHODS
Patients presenting between 1997 and 2001 for a second opinion after a biopsy diagnosis of breast cancer (invasive or noninvasive) were included in this study.


RESULTS
There were 340 patients presenting for second opinions regarding 346 breast cancers. Sixty-eight pathologic second opinions (20%) did not result in any change in pathology or prognostic factors, whereas in the remaining 80%, some change occurred. Major changes that altered surgical therapy occurred in 7.8% of cases, and pathology review provided additional prognostic information in 40%. Changes were more common in in situ carcinoma than invasive carcinoma (P =.004), but biopsy type (core vs. excisional biopsy) was not a significant predictor of change in pathologic information.


CONCLUSIONS
This study confirms the benefit of a pathology second opinion to improve preoperative estimates of prognosis and to determine the appropriate surgical procedure. Missing information on grade and histological subtype was responsible for a large number of cases, suggesting a need for widespread application of standardization and quality improvement in pathology reporting.
Staradub
Valerie L
VL
Department of Surgery, Northwestern University School of Medicine, Chicago, Illinois, USA. vstaradu@nmff.org
Messenger
Kathleen A
KA
Hao
Nanjiang
N
Wiley
Elizabeth L
EL
Morrow
Monica
M
D001706:Biopsy; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D002277:Carcinoma / Q000473:pathology* / Q000601:surgery; D002278:Carcinoma in Situ / Q000473:pathology* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology* / Q000601:surgery; D002641:Chicago; D003951:Diagnostic Errors; D006801:Humans; D009367:Neoplasm Staging; D011379:Prognosis; D012017:Referral and Consultation