Breast Biopsy Study Points to Need for a New "Gold Standard" — Physician’s First Watch

Medical News |
March 22, 2016

Breast Biopsy Study Points to Need for a New "Gold Standard"

By Joe Elia

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

Breast biopsy findings, the gold standard for diagnosis, can vary widely among pathologists, especially with atypia and ductal carcinoma in situ (DCIS), according to an Annals of Internal Medicine study.

The B-Path Study sent single slides from 240 biopsies of U.S. women aged 50–59 to over 100 pathologists. Their findings were compared with the consensus diagnosis of a panel of three experts.

Individual pathologists' findings for invasive cancer and benign tissue without atypia were more than 97% concordant with the expert panel. However, DCIS findings were 70% concordant, and findings of atypia were only 40% concordant; in both of those cases the error was typically in the direction of a more serious finding.

The authors call for efforts to reduce diagnostic variability, and editorialists observe that "accuracy remains limited by the current (hopefully short-lived) inability of medical science to distinguish innocuous cancer cases from dangerous ones."

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