Abstract
Purpose: To estimate the potential near-term population impact of alternative second opinion breast biopsy pathology interpretation strategies. Methods: Decision analysis examining 12-month outcomes of breast biopsy for nine breast pathology interpretation strategies in the U.S. health system. Diagnoses of 115 practicing pathologists in the Breast Pathology Study were compared to reference-standard-consensus diagnoses with and without second opinions. Interpretation strategies were defined by whether a second opinion was sought universally or selectively (e.g., 2nd opinion if invasive). Main outcomes were the expected proportion of concordant breast biopsy diagnoses, the proportion involving over- or under-interpretation, and cost of care in U.S. dollars within one-year of biopsy. Results: Without a second opinion, 92.2% of biopsies received a concordant diagnosis. Concordance rates increased under all second opinion strategies, and the rate was highest (95.1%) and under-treatment lowest (2.6%) when all biopsies had second opinions. However, over-treatment was lowest when second opinions were sought selectively for initial diagnoses of invasive cancer, DCIS, or atypia (1.8 vs. 4.7% with no 2nd opinions). This strategy also had the lowest projected 12-month care costs ($5.907 billion vs. $6.049 billion with no 2nd opinions). Conclusions: Second opinion strategies could lower overall care costs while reducing both over- and under-treatment. The most accurate cost-saving strategy required second opinions for initial diagnoses of invasive cancer, DCIS, or atypia.
Original language | English (US) |
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Pages (from-to) | 195-203 |
Number of pages | 9 |
Journal | Breast Cancer Research and Treatment |
Volume | 167 |
Issue number | 1 |
DOIs | |
State | Published - Jan 1 2018 |
Keywords
- Breast cancer diagnosis
- Cost
- Decision analysis
- Overdiagnosis
- Pathology
- Second opinion
ASJC Scopus subject areas
- Oncology
- Cancer Research