Understanding diagnostic variability in breast pathology: lessons learned from an expert consensus review panel
Corresponding Author
Kimberly H Allison
Department of Pathology, University of Washington Medical Center, Seattle, WA, USA
Address for correspondence: K H Allison, MD, Department of Pathology, Stanford University Medical Center, 300 Pasteur Drive, Lane L235, Stanford, CA 94305, USA. e-mail: [email protected]Search for more papers by this authorLisa M Reisch
Department of Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA
Search for more papers by this authorPatricia A Carney
Departments of Family Medicine and Public Health & Preventive Medicine, Oregon Health & Science University, Portland, OR, USA
Search for more papers by this authorDonald L Weaver
Department of Pathology, University of Vermont College of Medicine and Vermont Cancer Center, Burlington, VT, USA
Search for more papers by this authorStuart J Schnitt
Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA
Search for more papers by this authorFrances P O'Malley
Department of Laboratory Medicine, Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
Search for more papers by this authorBerta M Geller
Department of Family Medicine, Health Promotion Research, University of Vermont, Burlington, VT, USA
Search for more papers by this authorJoann G Elmore
Department of Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA
Search for more papers by this authorCorresponding Author
Kimberly H Allison
Department of Pathology, University of Washington Medical Center, Seattle, WA, USA
Address for correspondence: K H Allison, MD, Department of Pathology, Stanford University Medical Center, 300 Pasteur Drive, Lane L235, Stanford, CA 94305, USA. e-mail: [email protected]Search for more papers by this authorLisa M Reisch
Department of Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA
Search for more papers by this authorPatricia A Carney
Departments of Family Medicine and Public Health & Preventive Medicine, Oregon Health & Science University, Portland, OR, USA
Search for more papers by this authorDonald L Weaver
Department of Pathology, University of Vermont College of Medicine and Vermont Cancer Center, Burlington, VT, USA
Search for more papers by this authorStuart J Schnitt
Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA
Search for more papers by this authorFrances P O'Malley
Department of Laboratory Medicine, Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
Search for more papers by this authorBerta M Geller
Department of Family Medicine, Health Promotion Research, University of Vermont, Burlington, VT, USA
Search for more papers by this authorJoann G Elmore
Department of Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA
Search for more papers by this authorAbstract
Aims
To gain a better understanding of the reasons for diagnostic variability, with the aim of reducing the phenomenon.
Methods and results
In preparation for a study on the interpretation of breast specimens (B-PATH), a panel of three experienced breast pathologists reviewed 336 cases to develop consensus reference diagnoses. After independent assessment, cases coded as diagnostically discordant were discussed at consensus meetings. By the use of qualitative data analysis techniques, transcripts of 16 h of consensus meetings for a subset of 201 cases were analysed. Diagnostic variability could be attributed to three overall root causes: (i) pathologist-related; (ii) diagnostic coding/study methodology-related; and (iii) specimen-related. Most pathologist-related root causes were attributable to professional differences in pathologists' opinions about whether the diagnostic criteria for a specific diagnosis were met, most frequently in cases of atypia. Diagnostic coding/study methodology-related root causes were primarily miscategorizations of descriptive text diagnoses, which led to the development of a standardized electronic diagnostic form (BPATH-Dx). Specimen-related root causes included artefacts, limited diagnostic material, and poor slide quality. After re-review and discussion, a consensus diagnosis could be assigned in all cases.
Conclusions
Diagnostic variability is related to multiple factors, but consensus conferences, standardized electronic reporting formats and comments on suboptimal specimen quality can be used to reduce diagnostic variability.
References
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