title: Inter-Institutional Pathology Consultation: The Importance of Breast Pathology Subspecialization in a Setting of Tertiary Cancer Center.
abstract: Inter-institutional pathology consultation (IPC) has shown to be significant in patient care. The purpose of the study was to evaluate the impact of IPC for breast biopsies in our institution. A total of 502 consecutive consult cases of breast core needle biopsies were reviewed. The original pathology reports from the referring institutions and our reports were compared for all cases. All cases were reviewed by specialized breast pathologists. Discordance was divided into minor and major based on the impact on patient care. We reviewed the subsequent excisional biopsy for all discordant cases. Discordance was seen in 104 (20.7%) cases; 40 (8%) had a major discordance and 64 (13%) had a minor discordance. Subsequent surgical excision was available for 25 (62.5%) cases with major discordance and for 13 (20.3%) with minor discordance. Our interpretation changed management in 15 (3%) patients, while 25 (5%) had a potential of management change. The cases with major discordance could be subcategorized into five groups, malignant 5 (12.5%), premalignant 16 (40%), biomarkers 10 (25%), fibroepithelial lesions 6 (15%), and others 3 (7.5%). Our findings support the value of IPC review in decreasing the likelihood of diagnostic errors that may lead to significant impact on patient care. It is necessary that outside pathology material in the referral settings been reviewed by a specialized breast pathologist.
authors: Department of Pathology, Roswell Park Cancer Institute, Buffalo, New York.
authors: Yousef
authors: Y
authors: Soofi
authors: Department of Pathology, Roswell Park Cancer Institute, Buffalo, New York.
authors: Thaer
authors: T
authors: Khoury
mesh_terms: D000328:Adult; D001706:Biopsy / Q000379:methods*; D001943:Breast Neoplasms / Q000145:classification* / Q000175:diagnosis / Q000473:pathology*; D002173:Cancer Care Facilities / Q000458:organization & administration*; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D016522:Oncology Service, Hospital / Q000458:organization & administration; D010338:Pathology, Clinical; D010340:Pathology, Surgical / Q000379:methods; D012017:Referral and Consultation
keywords: breast biopsy; discordant rate; inter-institutional consultation; quality assurance