Accuracy of Breast Pathology and the Impact of Double Reading

病理学家的评估被认为是决定癌症是否存在以及是否报告非典型上皮的“金标准”。然而，病理学家之间的广泛差异已被记录，在超过50%的病例中，不典型导管增生（ADH）的诊断存在分歧，专家指定为导管原位癌（DCIS）的病例的错误分类率为17%。我们建议评估变异的程度，其来源及其对接受乳腺活检的妇女的影响。我们的研究还将评估可能的技术，以提高准确性，如双重阅读。为了实现我们的研究目标，我们将开发四个诊断测试集，根据国际专家小组的定义，加权以包括高比例的ADH和DCIS病例。超过100名美国病理学家将在两个阶段独立审查测试集，间隔6个月。我们的具体目标是： 1.评估病理学家对乳腺病理学标本解释的准确性，并量化观察者内和观察者间变异的程度和可能来源。 2.评估两名病理学家独立的双重阅读是否可以提高乳腺病理标本判读的准确性。 3.量化美国人群中病理学家对乳腺标本的解释对短期患者护理和相关资源利用的影响。我们假设以下特征与较低的准确性相关：a）患者特征（年龄< 50岁，致密乳腺，广泛的背景增殖性变化，ADH和DCIS解释）;和B）病理学家特征（例如，临床经验少）。总之，我们将评估乳腺病理解释的准确性，强调ADH和DCIS的分类，以前的研究揭示了诊断错误的程度。这个大型多中心研究的社区病理学家解决了一个主题，有越来越多的临床重要性.拟议的工作是创新的，因为我们将超越简单地量化存在的错误。我们将研究与不准确诊断相关的患者和医生特征。然后，我们将评估使用双重阅读改善医疗保健提供的方法。最后，我们将使用一种系统的方法，从我们的数据预测不准确诊断的临床意义。

A pathologist's assessment is considered the "gold standard" for deciding whether cancer is present or absent and whether atypical epithelium is reported. However, extensive variation between pathologists has been documented, with disagreement in diagnosis of atypical ductal hyperplasia (ADH) in more than 50% of cases and a misclassification rate for cases designated by experts as ductal carcinoma in situ (DCIS) of 17%. We propose to evaluate the extent of variability, its sources and its impact on women undergoing breast biopsy. Our research will also evaluate possible techniques to improve accuracy, such as double reading. To accomplish our study aims we will develop four diagnostic test sets, weighted to include a high percentage of cases with ADH and DCIS, as defined by a panel of international experts. More than 100 U.S. pathologists will independently review the test sets during two phases, separated by 6 months. Our specific aims are: 1. To assess the accuracy of pathologists in the interpretation of breast pathology specimens and quantify the extent and possible sources of intra- and inter-observer variability. 2. To assess whether independent double reading by two pathologists can improve the accuracy of interpretation of breast pathology specimens. 3. To quantify the implications of variability among pathologists' interpretations of breast specimens on short-term patient care and associated resource utilization within the U.S. population. We hypothesize that the following characteristics are associated with lower accuracy: a) Patient characteristics (age < 50 years, dense breast, extensive background proliferative change, ADH and DCIS interpretation): and b) Pathologist characteristics (e.g., less clinical experience). In summary, we will evaluate the accuracy of breast pathology interpretation, emphasizing the classification of ADH and DCIS, where previous studies reveal a concerning degree of diagnostic errors. This large multi- center study of community pathologists addresses a topic that has growing clinical importance. The proposed work is innovative in that we will go beyond simply quantifying the existence of errors. We will study patient and physician characteristics associated with inaccurate diagnoses. We will then evaluate methods for improving health care delivery using double reading. Finally, we will use a systematic method to make projections from our data to clinical implications of inaccurate diagnoses.