Second Opinion in Breast Pathology: Policy and Perception
Second Opinion in Breast Pathology: Policy and Perception
Aims To assess the laboratory policies, pathologists' clinical practice and perceptions about the value of second opinions for breast pathology cases among pathologists practising in the USA.
Methods Cross-sectional data were collected from 252 pathologists who interpret breast specimens in eight states using a web-based survey. Descriptive statistics were used to characterise findings.
Results Most participants had >10 years of experience interpreting breast specimens (64%), were not affiliated with academic centres (73%) and were not considered experts by their peers (79%). Laboratory policies mandating second opinions varied by diagnosis: invasive cancer 65%; ductal carcinoma in situ (DCIS) 56%; atypical ductal hyperplasia 36% and other benign cases 33%. 81% obtained second opinions in the absence of policies. Participants believed they improve diagnostic accuracy (96%) and protect from malpractice suits (83%), and were easy to obtain, did not take too much time and did not make them look less adequate. The most common (60%) approach to resolving differences between the first and second opinion is to ask for a third opinion, followed by reaching a consensus.
Conclusions Laboratory-based second opinion policies vary for breast pathology but are most common for invasive cancer and DCIS cases. Pathologists have favourable attitudes towards second opinions, adhere to policies and obtain them even when policies are absent. Those without a formal policy may benefit from supportive clinical practices and systems that help obtain second opinions.
Obtaining second opinions is an established part of pathology practice, and many healthcare institutions have implemented policies requiring them. Second opinions may improve diagnostic accuracy and the quality of patient care, as well as provide opportunities to educate physicians. For example, double reading of screening mammography by radiologists in the USA was common before the widespread use of computer-aided detection (CAD), and this practice is still used in Europe. In breast pathology, many hospitals mandate a second review of pathology slides from outside laboratories before surgical interventions, or for all cancer diagnoses before treatment planning. While policies and practices are more established for malignant diagnoses, second opinions may also be important for high-risk non-malignant lesions, which have greater diagnostic disagreement than malignant lesions, to assure that cancer is not misdiagnosed and assess patient risk to guide surveillance and risk reduction strategies.
Little is known about current policies and practices regarding second opinions in breast pathology. To address this gap, we undertook a survey study of pathologists who interpret breast specimens in eight US states to determine details about second opinion policies, when and how second opinions are used in clinical practice, as well as pathologists' perspectives about their value.
Abstract and Introduction
Abstract
Aims To assess the laboratory policies, pathologists' clinical practice and perceptions about the value of second opinions for breast pathology cases among pathologists practising in the USA.
Methods Cross-sectional data were collected from 252 pathologists who interpret breast specimens in eight states using a web-based survey. Descriptive statistics were used to characterise findings.
Results Most participants had >10 years of experience interpreting breast specimens (64%), were not affiliated with academic centres (73%) and were not considered experts by their peers (79%). Laboratory policies mandating second opinions varied by diagnosis: invasive cancer 65%; ductal carcinoma in situ (DCIS) 56%; atypical ductal hyperplasia 36% and other benign cases 33%. 81% obtained second opinions in the absence of policies. Participants believed they improve diagnostic accuracy (96%) and protect from malpractice suits (83%), and were easy to obtain, did not take too much time and did not make them look less adequate. The most common (60%) approach to resolving differences between the first and second opinion is to ask for a third opinion, followed by reaching a consensus.
Conclusions Laboratory-based second opinion policies vary for breast pathology but are most common for invasive cancer and DCIS cases. Pathologists have favourable attitudes towards second opinions, adhere to policies and obtain them even when policies are absent. Those without a formal policy may benefit from supportive clinical practices and systems that help obtain second opinions.
Introduction
Obtaining second opinions is an established part of pathology practice, and many healthcare institutions have implemented policies requiring them. Second opinions may improve diagnostic accuracy and the quality of patient care, as well as provide opportunities to educate physicians. For example, double reading of screening mammography by radiologists in the USA was common before the widespread use of computer-aided detection (CAD), and this practice is still used in Europe. In breast pathology, many hospitals mandate a second review of pathology slides from outside laboratories before surgical interventions, or for all cancer diagnoses before treatment planning. While policies and practices are more established for malignant diagnoses, second opinions may also be important for high-risk non-malignant lesions, which have greater diagnostic disagreement than malignant lesions, to assure that cancer is not misdiagnosed and assess patient risk to guide surveillance and risk reduction strategies.
Little is known about current policies and practices regarding second opinions in breast pathology. To address this gap, we undertook a survey study of pathologists who interpret breast specimens in eight US states to determine details about second opinion policies, when and how second opinions are used in clinical practice, as well as pathologists' perspectives about their value.