Evaluation of 12 strategies for obtaining second opinions to improve interpretation of breast histopathology: Simulation study

Joann G. Elmore, Anna N A Tosteson, Margaret S. Pepe, Gary M. Longton, Heidi Nelson, Berta Geller, Patricia (Patty) Carney, Tracy Onega, Kimberly H. Allison, Sara L. Jackson, Donald L. Weaver

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Abstract

Objective To evaluate the potential effect of second opinions on improving the accuracy of diagnostic interpretation of breast histopathology. Design Simulation study. Setting 12 different strategies for acquiring independent second opinions. Participants Interpretations of 240 breast biopsy specimens by 115 pathologists, one slide for each case, compared with reference diagnoses derived by expert consensus. Main outcome measures Misclassification rates for individual pathologists and for 12 simulated strategies for second opinions. Simulations compared accuracy of diagnoses from single pathologists with that of diagnoses based on pairing interpretations from first and second independent pathologists, where resolution of disagreements was by an independent third pathologist. 12 strategies were evaluated in which acquisition of second opinions depended on initial diagnoses, assessment of case difficulty or borderline characteristics, pathologists' clinical volumes, or whether a second opinion was required by policy or desired by the pathologists. The 240 cases included benign without atypia (10% non-proliferative, 20% proliferative without atypia), atypia (30%), ductal carcinoma in situ (DCIS, 30%), and invasive cancer (10%). Overall misclassification rates and agreement statistics depended on the composition of the test set, which included a higher prevalence of difficult cases than in typical practice. Results Misclassification rates significantly decreased (P

Original languageEnglish (US)
Article numberi3069
JournalBMJ (Online)
Volume353
DOIs
StatePublished - 2016

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ASJC Scopus subject areas

  • Medicine(all)

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Elmore, J. G., Tosteson, A. N. A., Pepe, M. S., Longton, G. M., Nelson, H., Geller, B., Carney, P. P., Onega, T., Allison, K. H., Jackson, S. L., & Weaver, D. L. (2016). Evaluation of 12 strategies for obtaining second opinions to improve interpretation of breast histopathology: Simulation study. BMJ (Online), 353, [i3069]. https://doi.org/10.1136/bmj.i3069