Evidence map›Paper›PMID 28879558›Full record

ArticleBreast cancer research and treatment2018

Second opinion strategies in breast pathology: a decision analysis addressing over-treatment, under-treatment, and care costs.

Anna N A Tosteson, Qian Yang, Heidi D Nelson, Gary Longton, Samir S Soneji, Margaret Pepe, Berta Geller, Patricia A Carney, Tracy Onega, Kimberly H Allison and 2 more

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Breast cancer research and treatment, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed
1.4field-weighted citation impact, top 16% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 32 citations in OpenAlex.

  1. Review
  2. Article
  3. Article
  4. 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 · 2023
    Article
  5. Article
  6. Observational
  7. Article
  8. Article
  9. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors at 6 institutions in 1 country.

Anna N A TostesonThe Dartmouth Institute for Health Policy and Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, One Medical Center Drive Level 5 WTRB, Lebanon, NH, 03756, USA. anna.n.a.tosteson@dartmouth.edu.
Qian YangThe Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA.
Heidi D NelsonDepartment of Medical Informatics and Clinical Epidemiology and Medicine, Oregon Health Sciences University, Portland, OR, USA.
Gary LongtonProgram in Biostatistics and Biomathematics, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
Samir S SonejiThe Dartmouth Institute for Health Policy and Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, One Medical Center Drive Level 5 WTRB, Lebanon, NH, 03756, USA.
Margaret PepeFred Hutchinson Cancer Research Center, Seattle, WA, USA.
Berta GellerDepartment of Family Medicine, University of Vermont, Burlington, VT, USA.
Patricia A CarneyDepartment of Family Medicine, Oregon Health Sciences University, Portland, OR, USA.
Tracy OnegaDepartment of Biomedical Data Science, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
Kimberly H AllisonDepartment of Pathology, Stanford University School of Medicine, Stanford, CA, USA.
Joann G ElmoreDepartment of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
Donald L WeaverDepartment of Pathology, UVM Cancer Center, University of Vermont, Burlington, VT, USA.
Dartmouth Institute for Health Policy and Clinical Practice · USFred Hutch Cancer Center · USOregon Health & Science University · USUniversity of Vermont · USStanford University · USUniversity of Washington · US

Funding

Accuracy of Breast Pathology and the Impact of Double ReadingR01CA140560 · NCI · UNIVERSITY OF WASHINGTON · PI ELMORE, JOANN G, WEAVER, DONALD LEE · 2009 to 2013
$3.3M
Digital Pathology_Accuracy Viewing Behavior and Image CharacterizationR01CA172343 · NCI · UNIVERSITY OF WASHINGTON · PI SHAPIRO, LINDA, WEAVER, DONALD LEE · 2013 to 2017
$3.2M
Improving Accuracy &Outcomes of Breast Cancer ScreeningK05CA104699 · NCI · UNIVERSITY OF WASHINGTON · PI ELMORE, JOANN G · 2004 to 2014
$1.2M
Breast Cancer Surveillance Consortium HHSN261201100031CNational Cancer Institute (US) K05 CA104699National Cancer Institute (US) R01 CA140560National Cancer Institute (US) R01 CA172343NCI NIH HHS HHSN261201100031CNCI NIH HHS K05 CA104699NCI NIH HHS R01 CA140560NCI NIH HHS R01 CA172343
6 · The paper itself

Abstract

purposeTo estimate the potential near-term population impact of alternative second opinion breast biopsy pathology interpretation strategies.

methodsDecision analysis examining 12-month outcomes of breast biopsy for nine breast pathology interpretation strategies in the U.S. health system. Diagnoses of 115 practicing pathologists in the Breast Pathology Study were compared to reference-standard-consensus diagnoses with and without second opinions. Interpretation strategies were defined by whether a second opinion was sought universally or selectively (e.g., 2nd opinion if invasive). Main outcomes were the expected proportion of concordant breast biopsy diagnoses, the proportion involving over- or under-interpretation, and cost of care in U.S. dollars within one-year of biopsy.

resultsWithout a second opinion, 92.2% of biopsies received a concordant diagnosis. Concordance rates increased under all second opinion strategies, and the rate was highest (95.1%) and under-treatment lowest (2.6%) when all biopsies had second opinions. However, over-treatment was lowest when second opinions were sought selectively for initial diagnoses of invasive cancer, DCIS, or atypia (1.8 vs. 4.7% with no 2nd opinions). This strategy also had the lowest projected 12-month care costs ($5.907 billion vs. $6.049 billion with no 2nd opinions).

conclusionsSecond opinion strategies could lower overall care costs while reducing both over- and under-treatment. The most accurate cost-saving strategy required second opinions for initial diagnoses of invasive cancer, DCIS, or atypia.

Indexed as

Reference StandardsBiopsyBreastBreast NeoplasmsDecision Support TechniquesDiagnostic ErrorsFemaleHumansMedical OverusePathologistsReferral and ConsultationUnited StatesBreast cancer diagnosisCostDecision analysisOverdiagnosisPathologySecond opinion

Identifiers

PMID28879558
PMCPMC6436920
OpenAlexW2752002377

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.