TY - JOUR
T1 - Understanding diagnostic variability in breast pathology
T2 - Lessons learned from an expert consensus review panel
AU - Allison, Kimberly H.
AU - Reisch, Lisa M.
AU - Carney, Patricia A.
AU - Weaver, Donald L.
AU - Schnitt, Stuart J.
AU - O'Malley, Frances P.
AU - Geller, Berta M.
AU - Elmore, Joann G.
PY - 2014/8
Y1 - 2014/8
N2 - 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.
AB - 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.
KW - Atypical ductal hyperplasia
KW - Borderline breast lesions
KW - Breast pathology
KW - Diagnostic disagreement
KW - Diagnostic variability
KW - Pathologist agreement
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U2 - 10.1111/his.12387
DO - 10.1111/his.12387
M3 - Article
C2 - 24511905
AN - SCOPUS:84904399310
SN - 0309-0167
VL - 65
SP - 240
EP - 251
JO - Histopathology
JF - Histopathology
IS - 2
ER -