Characteristics associated with requests by pathologists for second opinions on breast biopsies

Berta M. Geller, Heidi Nelson, Donald L. Weaver, Paul D. Frederick, Kimberly H. Allison, Tracy Onega, Patricia (Patty) Carney, Anna N.A. Tosteson, Joann G. Elmore

Research output: Contribution to journalArticle

Abstract

Aims Second opinions in pathology improve patient safety by reducing diagnostic errors, leading to more appropriate clinical treatment decisions. Little objective data are available regarding the factors triggering a request for second opinion despite second opinion consultations being part of the diagnostic system of pathology. Therefore we sought to assess breast biopsy cases and interpreting pathologists characteristics associated with second opinion requests. Methods Collected pathologist surveys and their interpretations of 60 test set cases were used to explore the relationships between case characteristics, pathologist characteristics and case perceptions, and requests for second opinions. Data were evaluated by logistic regression and generalised estimating equations. Results 115 pathologists provided 6900 assessments; pathologists requested second opinions on 70% (4827/ 6900) of their assessments 36% (1731/4827) of these would not have been required by policy. All associations between case characteristics and requesting second opinions were statistically significant, including diagnostic category, breast density, biopsy type, and number of diagnoses noted per case. Exclusive of institutional policies, pathologists wanted second opinions most frequently for atypia (66%) and least frequently for invasive cancer (20%). Second opinion rates were higher when the pathologist had lower assessment confidence, in cases with higher perceived difficulty, and cases with borderline diagnoses. Conclusions Pathologists request second opinions for challenging cases, particularly those with atypia, high breast density, core needle biopsies, or many co-existing diagnoses. Further studies should evaluate whether the case characteristics identified in this study could be used as clinical criteria to prompt system-level strategies for mandating second opinions.

Original languageEnglish (US)
JournalJournal of Clinical Pathology
DOIs
StateAccepted/In press - May 2 2017

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Breast
Referral and Consultation
Biopsy
Pathologists
Organizational Policy
Pathology
Large-Core Needle Biopsy
Patient Safety
Diagnostic Errors
Logistic Models

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Characteristics associated with requests by pathologists for second opinions on breast biopsies. / Geller, Berta M.; Nelson, Heidi; Weaver, Donald L.; Frederick, Paul D.; Allison, Kimberly H.; Onega, Tracy; Carney, Patricia (Patty); Tosteson, Anna N.A.; Elmore, Joann G.

In: Journal of Clinical Pathology, 02.05.2017.

Research output: Contribution to journalArticle

Geller, Berta M. ; Nelson, Heidi ; Weaver, Donald L. ; Frederick, Paul D. ; Allison, Kimberly H. ; Onega, Tracy ; Carney, Patricia (Patty) ; Tosteson, Anna N.A. ; Elmore, Joann G. / Characteristics associated with requests by pathologists for second opinions on breast biopsies. In: Journal of Clinical Pathology. 2017.
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abstract = "Aims Second opinions in pathology improve patient safety by reducing diagnostic errors, leading to more appropriate clinical treatment decisions. Little objective data are available regarding the factors triggering a request for second opinion despite second opinion consultations being part of the diagnostic system of pathology. Therefore we sought to assess breast biopsy cases and interpreting pathologists characteristics associated with second opinion requests. Methods Collected pathologist surveys and their interpretations of 60 test set cases were used to explore the relationships between case characteristics, pathologist characteristics and case perceptions, and requests for second opinions. Data were evaluated by logistic regression and generalised estimating equations. Results 115 pathologists provided 6900 assessments; pathologists requested second opinions on 70{\%} (4827/ 6900) of their assessments 36{\%} (1731/4827) of these would not have been required by policy. All associations between case characteristics and requesting second opinions were statistically significant, including diagnostic category, breast density, biopsy type, and number of diagnoses noted per case. Exclusive of institutional policies, pathologists wanted second opinions most frequently for atypia (66{\%}) and least frequently for invasive cancer (20{\%}). Second opinion rates were higher when the pathologist had lower assessment confidence, in cases with higher perceived difficulty, and cases with borderline diagnoses. Conclusions Pathologists request second opinions for challenging cases, particularly those with atypia, high breast density, core needle biopsies, or many co-existing diagnoses. Further studies should evaluate whether the case characteristics identified in this study could be used as clinical criteria to prompt system-level strategies for mandating second opinions.",
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AU - Nelson, Heidi

AU - Weaver, Donald L.

AU - Frederick, Paul D.

AU - Allison, Kimberly H.

AU - Onega, Tracy

AU - Carney, Patricia (Patty)

AU - Tosteson, Anna N.A.

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