Variability in pathologists' interpretations of individual breast biopsy slides: A population perspective

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

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30 Scopus citations

Abstract

Background: The effect of physician diagnostic variability on accuracy at a population level depends on the prevalence of diagnoses. Objective: To estimate how diagnostic variability affects accuracy from the perspective of a U.S. woman aged 50 to 59 years having a breast biopsy. Design: Applied probability using Bayes theorem. Setting: B-Path (Breast Pathology) Study comparing pathologists' interpretations of a single biopsy slide versus a reference consensus interpretation from 3 experts. Participants: 115 practicing pathologists (6900 total interpretations from 240 distinct cases). Measurements: A single representative slide from each of the 240 cases was used to estimate the proportion of biopsies with a diagnosis that would be verified if the same slide were interpreted by a reference group of 3 expert pathologists. Probabilities of confirmation (predictive values) were estimated using B-Path Study results and prevalence of biopsy diagnoses for women aged 50 to 59 years in the Breast Cancer Surveillance Consortium. Results: Overall, if 1 representative slide were used per case, 92.3% (95% CI, 91.4% to 93.1%) of breast biopsy diagnoses would be verified by reference consensus diagnoses, with 4.6% (CI, 3.9% to 5.3%) overinterpreted and 3.2% (CI, 2.7% to 3.6%) underinterpreted. Verification of invasive breast cancer and benign without atypia diagnoses is highly probable; estimated predictive values were 97.7% (CI, 96.5% to 98.7%) and 97.1% (CI, 96.7% to 97.4%), respectively. Verification is less probable for atypia (53.6% overinterpreted and 8.6% underinterpreted) and ductal carcinoma in situ (DCIS) (18.5% overinterpreted and 11.8% underinterpreted). Limitations: Estimates are based on a testing situation with 1 slide used per case and without access to second opinions. Population-adjusted estimates may differ for women from other age groups, unscreened women, or women in different practice settings. Conclusion: This analysis, based on interpretation of a single breast biopsy slide per case, predicts a low likelihood that a diagnosis of atypia or DCIS would be verified by a reference consensus diagnosis. This diagnostic gray zone should be considered in clinical management decisions in patients with these diagnoses.

Original languageEnglish (US)
Pages (from-to)649-655
Number of pages7
JournalAnnals of internal medicine
Volume164
Issue number10
DOIs
StatePublished - May 17 2016

ASJC Scopus subject areas

  • Internal Medicine

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    Elmore, J. G., Nelson, H. D., Pepe, M. S., Longton, G. M., Tosteson, A. N. A., Geller, B., Onega, T., Carney, P. A., Jackson, S. L., Allison, K. H., & Weaver, D. L. (2016). Variability in pathologists' interpretations of individual breast biopsy slides: A population perspective. Annals of internal medicine, 164(10), 649-655. https://doi.org/10.7326/M15-0964