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Changes in breast cancer therapy because of pathology second opinions

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Abstract

Background

Examination of pathology slides is a routine part of a breast cancer second opinion. The purpose of this study was to determine how often the pathologic second opinion (1) altered the diagnosis and (2) resulted in a change in the surgical procedure.

Methods

Patients presenting between 1997 and 2001 for a second opinion after a biopsy diagnosis of breast cancer (invasive or noninvasive) were included in this study.

Results

There were 340 patients presenting for second opinions regarding 346 breast cancers. Sixty-eight pathologic second opinions (20%) did not result in any change in pathology or prognostic factors, whereas in the remaining 80%, some change occurred. Major changes that altered surgical therapy occurred in 7.8% of cases, and pathology review provided additional prognostic information in 40%. Changes were more common in in situ carcinoma than invasive carcinoma (P=.004), but biopsy type (core vs. excisional biopsy) was not a significant predictor of change in pathologic information.

Conclusions

This study confirms the benefit of a pathology second opinion to improve preoperative estimates of prognosis and to determine the appropriate surgical procedure. Missing information on grade and histological subtype was responsible for a large number of cases, suggesting a need for widespread application of standardization and quality improvement in pathology reporting.

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Authors and Affiliations

  1. Lynn Sage Comprehensive Breast Program, Northwestern University School of Medicine, Galter 10-105, 201 E Huron St., 60611, Chicago, IL

    Kathleen A. Messenger BS

  2. Department of Surgery, Northwestern University School of Medicine, Galter 10-105, 201 E Huron St., 60611, Chicago, IL

    Valerie L. Staradub MD & Monica Morrow MD

  3. Pathology, Northwestern University School of Medicine, Galter 10-105, 201 E Huron St., 60611, Chicago, IL

    Elizabeth L. Wiely MD

  4. Preventive Medicine, Northwestern University School of Medicine, Galter 10-105, 201 E Huron St., 60611, Chicago, IL

    Nanjiang Hao MS

Authors
  1. Valerie L. Staradub MD
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  2. Kathleen A. Messenger BS
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  3. Nanjiang Hao MS
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  4. Elizabeth L. Wiely MD
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  5. Monica Morrow MD
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Correspondence to Valerie L. Staradub MD.

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Staradub, V.L., Messenger, K.A., Hao, N. et al. Changes in breast cancer therapy because of pathology second opinions. Annals of Surgical Oncology 9, 982–987 (2002). https://doi.org/10.1007/BF02574516

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  • DOI: https://doi.org/10.1007/BF02574516

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