Study doesn’t paint an accurate picture of breast biopsy pathologic interpretation

April 8, 2015 Providence Guest Blogger

Providence Cancer Survivorship Blog Guest Blogger

By Kathi Adamson, M.D.

If recent media coverage questioning the accuracy of pathology diagnoses on breast biopsies has you worried, you’re not alone!

recent study published in The Journal of the American Medical Association (JAMA) investigated diagnostic agreement for breast biopsies between individual pathologists and “consensus-derived reference diagnoses” rendered by a panel of three pathologists. In other words, do different pathologists deliver the same diagnosis after independently reviewing biopsied breast tissue?

Study design doesn’t reflect real-world practice

While variable rates of diagnostic disagreement were identified, it’s important to realize that the strict study design and methodology aren’t applicable to the daily practice of pathology.

Fortunately, in real-life practice, pathologists aren’t restricted by the number of slides available for review, and typically evaluate multiple slides/tissue levels for each breast biopsy sample. In addition, practicing pathologists are able to obtain a consultative opinion from another pathologist in order to make a diagnosis – which wasn’t permitted in the study cited in JAMA.

Consulting with other pathologists is standard

Consultative opinions – opinions from our fellow pathologists – are a key component of pathology practice, and are especially important in the evaluation of breast biopsies. Therefore, while the study findings are certainly alarming, they don’t accurately reflect the routine practice of pathology. 

CellNetix Pathology and Laboratories is the largest private pathology practice in Washington, and provides pathology services to multiple hospitals across the state. The extensive size and nature of our practice allows us to have a wide range of subspecialty pathologists, including a number with special expertise in breast pathology. Our infrastructure and transportation system allows a CellNetix pathologist to obtain a consultative opinion from a fellow pathologist (aka, “intradepartmental consultation”) on breast specimens in a timely manner, regardless of geographic location.

Multiple reviews reduce over-diagnosis and treatment

Because CellNetix supports, promotes and encourages intradepartmental consultations, nearly half of all breast specimens are reviewed by at least two separate pathologists. Furthermore, in order to minimize the possibility of over-diagnosis – and subsequent over-treatment – intradepartmental consultations are standard of care for all CellNetix breast biopsy specimens that might prompt future surgical intervention. 

You can consult with your pathologist, too

At the end of the day, the most important thing to any pathologist is you – the patient. We want you to feel comfortable and confident in your pathologists and the diagnoses you receive. So, we encourage all patients to review a copy of their pathology report and look for the “Intradepartmental Consult” section (see “Frequently asked questions” below).

If you’d like second opinion about your CellNetix pathology report, we’re happy to arrange an intradepartmental consultation with one of our breast specialists, at no extra cost. CellNetix Pathology and Laboratories recognizes that wellbeing is more than just a physical state, and we strive to minimize any anxiety our patients may have about their pathology results!

If you’re in a region not served by CellNetix, talk to your cancer care team to find out how to get in touch with the pathologists who worked on your case.

Frequently asked questions (FAQ)

How can I get a copy of my pathology report?

You can get a copy of your pathology report from your physician. Another option is to call your pathologist’s office (CellNetix Pathologists and Laboratories’ toll free number: 866-236-8296). 

Can CellNetix review my pathology slides if the case was evaluated by a different hospital/pathology group?

Yes. While there is a small cost incurred with this type of review, we frequently review pathology cases from outside institutions.

Can I send my CellNetix pathology case to another hospital/pathology group for a second opinion?

Yes. Again, a small cost is incurred with this type of review, but we are happy to facilitate such an “extra-departmental review.”

Is a pathologist available to speak with me about my CellNetix pathology report?

Yes! Please call our toll free number (866-236-8296) for additional information. Alternatively, you can call the pathologist who read your case directly. The phone number is listed below his/her name at the bottom of the report. 

Can I review my pathology slides with a CellNetix pathologist?

Absolutely! Please call our toll free number (866-236-8296) for additional information. 

Additional resources

Learn more about the role of pathology in cancer diagnosis and care in these blog posts:

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