title: Understanding diagnostic variability in breast pathology: lessons learned from an expert consensus review panel.
abstract: OBJECTIVE
  To gain a better understanding of the reasons for diagnostic variability, with the aim of reducing the phenomenon.
  
  
  RESULTS
  In preparation for a study on the interpretation of breast specimens (B-PATH), a panel of three experienced breast pathologists reviewed 336 cases to develop consensus reference diagnoses. After independent assessment, cases coded as diagnostically discordant were discussed at consensus meetings. By the use of qualitative data analysis techniques, transcripts of 16 h of consensus meetings for a subset of 201 cases were analysed. Diagnostic variability could be attributed to three overall root causes: (i) pathologist-related; (ii) diagnostic coding/study methodology-related; and (iii) specimen-related. Most pathologist-related root causes were attributable to professional differences in pathologists' opinions about whether the diagnostic criteria for a specific diagnosis were met, most frequently in cases of atypia. Diagnostic coding/study methodology-related root causes were primarily miscategorizations of descriptive text diagnoses, which led to the development of a standardized electronic diagnostic form (BPATH-Dx). Specimen-related root causes included artefacts, limited diagnostic material, and poor slide quality. After re-review and discussion, a consensus diagnosis could be assigned in all cases.
  
  
  CONCLUSIONS
  Diagnostic variability is related to multiple factors, but consensus conferences, standardized electronic reporting formats and comments on suboptimal specimen quality can be used to reduce diagnostic variability.
authors: Department of Pathology, University of Washington Medical Center, Seattle, WA, USA.
authors: Kimberly H
authors: KH
authors: Allison
authors: Lisa M
authors: LM
authors: Reisch
authors: Patricia A
authors: PA
authors: Carney
authors: Donald L
authors: DL
authors: Weaver
authors: Stuart J
authors: SJ
authors: Schnitt
authors: Frances P
authors: FP
authors: O'Malley
authors: Berta M
authors: BM
authors: Geller
authors: Joann G
authors: JG
authors: Elmore
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D015975:Consensus Development Conferences, NIH as Topic; D005260:Female; D006801:Humans; D015588:Observer Variation; D010340:Pathology, Surgical / Q000592:standards*; D014481:United States
keywords: atypical ductal hyperplasia; borderline breast lesions; breast pathology; diagnostic disagreement; diagnostic variability; pathologist agreement