Not Reflective of Clinical Practice
Although the JAMA article (1) claims to have identified a lack of consistency in pathologists’ breast cancer diagnoses, this doesn’t reflect actual clinical practice
Kenneth Bloom |
Commenting in response to the JAMA article published in March 2015 on diagnostic concordance among pathologists interpreting breast biopsy specimens (1)…
Although the JAMA article (1) claims to have identified a lack of consistency in pathologists’ breast cancer diagnoses, this doesn’t reflect actual clinical practice, where the rate of discordance is significantly less. Pathologists are physicians and, as such, make diagnoses based on all available information, including clinical information, radiologic findings and all of the available pathology material. Communication with the submitting physician is common, as is confirmation of all malignant diagnoses by a second pathologist and a more comprehensive workup of atypical cases, including recuts, immunohistochemical stains and second opinions when necessary. This means that virtually all cases with a diagnosis of invasive cancer, DCIS or atypia are seen by more than one additional pathologist.
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