ArticleBMJ (Clinical research ed.)2016
Evaluation of 12 strategies for obtaining second opinions to improve interpretation of breast histopathology: simulation study.
Article in BMJ (Clinical research ed.), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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14 citing papers in PubMed.
- Patient-driven second opinions in oncology: a review.The oncologist · 2026Review
- Are Pathologists Self-Aware of Their Diagnostic Accuracy? Metacognition and the Diagnostic Process in Pathology.Medical decision making : an international journal of the Society for Medical Decision Making · 2023Article
- Histopathological diagnosis of cutaneous melanocytic lesions: blinded and nonblinded second opinions offer similar improvement in diagnostic accuracy.Clinical and experimental dermatology · 2022Article
- Variability in grading of ductal carcinoma in situ among an international group of pathologists.The journal of pathology. Clinical research · 2021Article
- Inter-observer reproducibility of classical lobular neoplasia (B3 lesions) in preoperative breast biopsies: a study of the Swiss Working Group of breast and gynecopathologists.Journal of cancer research and clinical oncology · 2020Observational
- Article
- Assessment of Second-Opinion Strategies for Diagnoses of Cutaneous Melanocytic Lesions.JAMA network open · 2019Article
- Breast Cancer Prognostic Factors in the Digital Era: Comparison of Nottingham Grade using Whole Slide Images and Glass Slides.Journal of pathology informatics · 2019Article
- Article
- Complexities of perceived and actual performance in pathology interpretation: A comparison of cutaneous melanocytic skin and breast interpretations.Journal of cutaneous pathology · 2018Observational
- Second opinion strategies in breast pathology: a decision analysis addressing over-treatment, under-treatment, and care costs.Breast cancer research and treatment · 2018Article
- Effects of DNA Methylation on Progression to Interstitial Fibrosis and Tubular Atrophy in Renal Allograft Biopsies: A Multi-Omics Approach.American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2017Article
- Characteristics associated with requests by pathologists for second opinions on breast biopsies.Journal of clinical pathology · 2017Observational
- Diagnostic Reproducibility: What Happens When the Same Pathologist Interprets the Same Breast Biopsy Specimen at Two Points in Time?Annals of surgical oncology · 2017Article
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11 authors.
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Abstract
objectiveTo evaluate the potential effect of second opinions on improving the accuracy of diagnostic interpretation of breast histopathology.
designSimulation study.
setting12 different strategies for acquiring independent second opinions.
participantsInterpretations of 240 breast biopsy specimens by 115 pathologists, one slide for each case, compared with reference diagnoses derived by expert consensus.
main outcome measuresMisclassification rates for individual pathologists and for 12 simulated strategies for second opinions. Simulations compared accuracy of diagnoses from single pathologists with that of diagnoses based on pairing interpretations from first and second independent pathologists, where resolution of disagreements was by an independent third pathologist. 12 strategies were evaluated in which acquisition of second opinions depended on initial diagnoses, assessment of case difficulty or borderline characteristics, pathologists' clinical volumes, or whether a second opinion was required by policy or desired by the pathologists. The 240 cases included benign without atypia (10% non-proliferative, 20% proliferative without atypia), atypia (30%), ductal carcinoma in situ (DCIS, 30%), and invasive cancer (10%). Overall misclassification rates and agreement statistics depended on the composition of the test set, which included a higher prevalence of difficult cases than in typical practice.
resultsMisclassification rates significantly decreased (P<0.001) with all second opinion strategies except for the strategy limiting second opinions only to cases of invasive cancer. The overall misclassification rate decreased from 24.7% to 18.1% when all cases received second opinions (P<0.001). Obtaining both first and second opinions from pathologists with a high volume (≥10 breast biopsy specimens weekly) resulted in the lowest misclassification rate in this test set (14.3%, 95% confidence interval 10.9% to 18.0%). Obtaining second opinions only for cases with initial interpretations of atypia, DCIS, or invasive cancer decreased the over-interpretation of benign cases without atypia from 12.9% to 6.0%. Atypia cases had the highest misclassification rate after single interpretation (52.2%), remaining at more than 34% in all second opinion scenarios.
conclusionSecond opinions can statistically significantly improve diagnostic agreement for pathologists' interpretations of breast biopsy specimens; however, variability in diagnosis will not be completely eliminated, especially for breast specimens with atypia.
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